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正常血压高值患者血压变异性与肾功能损害的关系
The relationships between blood pressure variabilityThe relationships between blood pressure variability
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DOI:
作者:
李志强 胡春燕 郑兴
LI Zhi-qiang, HU Chun-yan, ZHENG Xing
作者单位:
上海市浦东医院 上海复旦大学附属浦东医院(李志强 胡春燕) 第二军医大学附属长海医院心血管内科(郑兴)
LI Zhi-qiang, HU Chun-yan. Department of Cardiology, Shanghai Pudong Hospital, Fufan University Pudong Medical Center, Shanghai (201399 shanghai, China);ZHENG Xing. Department of Cardiology, Changhai Hospital, Second Military Medical University (200433 shanghai, China)
关键词:
正常血压高值;血压变异性;肾功能
Prehypertension; blood pressure variability; Renal function
摘要:
[摘要] 目的:观察正常血压高值患者血压变异性(BPV)变化及其与血清肌酐(Scr)的关系,探讨正常血压高值患者BPV对肾功能的影响。方法:根据《中国高血压防治指南》2010年修订版诊断标准筛选180例研究对象并分为3组:理想血压组(NT组)、正常血压高值组(PH组)和高血压组(EH组)各60例。所有研究对象行动态血压(ABP)监测,参数包括,①24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP);②24h收缩压变异系数(24hSBPV)、24h舒张压变异系数(24hDBPV)、白昼收缩压变异系数(dSBPV)、白昼舒张压变异系数(dDBPV)、夜间收缩压变异系数(nSBPV)、夜间舒张压变异系数(nDBPV)。测定Scr,比较3组间Scr和BPV参数是否存在差别,分析Scr与BPV的关系。结果:(1)在NT组、PH组和EH组,Scr分别为69.2±15.5 umol/L、76.6±14.9 umol/L和83.7±18.2 umol/L,3组间存在显著差别,在PH组高于NT组(P<0.05),EH组高于NT组和PH组(P<0.05或0.01)。(2)3组间ABP参数24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP和BPV参数24hSBPV、24hDBPV、dSBPV、dDBPV、nSBPV、nDBPV存在显著差别,PH组高于NT组(P<0.05或0.01),EH组高于NT组和PH组(P<0.05或0.01)。(3)多元线性回归分析显示:调整年龄、性别、体重指数(BMI)、血脂、血糖等因素后,在NT组,Scr与24hSBPV相关的标准偏回归系数为0.231(P值为0.049),Scr与24hSBPV关联。在PH组,Scr与24hSBPV、24hDBPV、dSBPV、nSBPV相关的标准偏回归系数分别为0.347、0.248、0.236、0.252,(P值分别为<0.001、0.042、0.028、0.039),Scr与24hSBPV、24hDBPV、dSBPV、nSBPV关联。在EH组Scr与24hSBPV、24hDBPV、dSBPV、dDBPV、nSBPV、nDBPV相关的标准偏回归系数分别为0.381、0.279、0.368、0.272、0.294、0.263 (P值分别为<0.001、0.017、<0.001、0.021、0.009、0.031),Scr与24hSBPV、24hDBPV、dSBPV、dDBPV、nSBPV、nDBPV关联。结论:PH组患者BPV和Scr出现了明显变化,Scr与BPV关联。提示正常血压高值患者BPV有明显异常,并且与肾功能损害相关。
[Abstract] Objective To investigate the change of blood pressure variability (BPV) and the relationships between serum creatinine (Scr)and BPV in prehypertensive patients, to analyse of the effect of BPV on renal function. Methods 180 patients were recruited according to the revised edition 2010 of guideline for prevention and treatment of hypertension in China and divided into three groups: 60 normotensive subjects (NT group, 39 males, 21 females, mean age [ 53.8±11.7 ] years old); 60 prehypertensive patients (PH group, 35 males, 25 females, mean age [ 57.2±12.9 ] years old) and 60 hypertensive patients (EH group, 32 males, 28 females, mean age [ 65.3±13.3 ] years old). Scr and ambulatory blood pressure (ABP) parameters that include 24h systolic blood pressure (24hSBP), 24h diastolic blood pressure (24hDBP), day time systolic blood pressure (dSBP), day time diastolic blood pressure (dDBP), night time systolic blood pressure (nSBP) and night time diastolic blood pressure (nDBP) and blood pressure variability (BPV) parameters that include 24h systolic blood pressure variability (24hSBPV), 24h diastolic blood pressure variability (24hDBPV), day time systolic blood pressure variability (dSBPV), day time diastolic blood pressure variability (dDBPV), night time systolic blood pressure variability (nSBPV) and night time diastolic blood pressure variability (nDBPV) were determined and compared in three group patients. The relationships between Scr and BPV parameters were analyzed. Result (1) In the NT group, PH group and EH group patients, the Scr concentration was respectively 69.2±15.5 umol/L, 76.6±14.9 umol/L and 83.7±18.2 umol/L, the Scr was significantly higher in the PH group compare to NT group (P < 0.05), in the EH group were significantly higher than those in the NT group and PH group (P < 0.05 or 0.01). (2) The ABP parameter 24hSBP, 24hDBP, dSBP, dDBP, nSBP, nDBP and BPV parameter 24hSBPV, 24hDBPV, dSBPV, dDBPV, nSBPV, nDBPV were significantly higher in the PH group compare to NT group (P < 0.05 or 0.01), in the EH group were significantly higher than those in the NT group and PH group (P < 0.05 or 0.01). (3)Multiple linear regression analysis showed that adjusting age, sex, body mass index (BMI), serum lipid and serum glucose, in the NT group patients, the standard partial regression coefficient of correlation between between Scr and 24hSBPV was 0.231 (P = 0.049). Scr were associated with 24hSBPV. In the PH group patients, the standard partial regression coefficient of correlation between between Scr and 24hSBPV, 24hDBPV, dSBPV and nSBPV was respectively 0.347, 0.248, 0.236 and 0.252 (P < 0.001, = 0.042, 0.028 and 0.039). Scr were associated with 24hSBPV, 24hDBPV, dSBPV and nSBPV. In the EH group patients, the standard partial regression coefficient of correlation between Scr and 24hSBPV, 24hDBPV, dSBPV, dDBPV, nSBPV and nDBPV was respectively 0.381, 0.279, 0.368, 0.272, 0.294 and 0.263 (P < 0.001, = 0.017, <0.001, = 0.021, 0.009 and 0.031). Scr were associated with 24hSBPV, 24hDBPV, dSBPV, dDBPV, nSBPV and nDBPV. Conclusion The BPV and Scr had significant changes in prehypertensive patients, Scr was significantly associated with BPV. It prompts that obvious abnormality of BPV occurred in prehypertensive patients and that renal function damage was correlated with BPV.
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