263例中老年慢性肾病患者血压昼夜节律与蛋白尿、肾功能损害关系的分析.doc

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1、263例中老年慢性肾病患者血压昼夜节律与蛋白尿、肾功能损害关系的分析作者：俞荣强，沈开跃，郑宇琳【摘要】目的观察中老年慢性肾病(CKD)患者24h血压动态变化情况，探讨昼夜节律异常与蛋白尿、肾功能损害的关系。方法随机选择本院内科住院及肾脏科门诊中老年CKD患者263例。全部患者均监测24h动态血压，动态血压监测(ABPM)采用携带式动态血压检测仪。根据患者24h血压动态变化情况分为血压昼夜节律正常组48例;血压昼夜节律消失组215例，其中夜间血压大于白天组93例。分组讨论各组尿微量白蛋白尿、24h尿蛋白定

2、量及肾功能情况。结果血压昼夜节律消失组，特别是夜间血压大于白天组的尿微量白蛋白、24h尿蛋白定量明显高于血压昼夜节律正常组，且其肾功能受损情况严重。结论在中老年慢性肾病患者中普遍存在血压昼夜节律消失情况;血压昼夜节律的消失明显与慢性肾病患者的尿微量白蛋白、24h尿蛋白定量、肾脏受损程度相关。【关键词】慢性肾病;动态血压监测;昼夜节律;蛋白尿;肾功能　　【Abstract】ObjectiveToobservethechangeof24-hourbloodpressureandexploretherelati

3、onbetweenabnormalityofcircadianbloodpressurerhythm,albuminuriaandrenalinjuryinmiddleandoldagedpatientswithchronickidneydisease.MethodsCircadianbloodpressurerhythmwasstudiedbyambulatory24-hourmonitoringin263patientswithchronickidneydisease.Ambulatorybloodp

4、ressuremonitoring(ABPM)wasperformedwithaportableoscillometricrecorder.Accordingto24hbloodpressureinpatientswithdynamicchangesincircadianrhythmofbloodpressurewasdividedinto48casesofnormalgroup.Circadianrhythmofbloodpressuregroupof215casesofdisappeared,inwh

5、ich93casesofbloodpressureatnighttimehigherthanduringdaytime.Microalbuminuria,24hurinaryproteinandrenalfunctionwerediscussedineachgroup.ResultsTheresultsofbloodpressurecircadianrhythminthedisappearanceofgroup,especiallyseriousatthegroupofbloodpressureatnig

6、httimehigherthanduringdaytime,theCKDpatientswithmicroalbuminuria,a24-hoururinaryproteinwassignificantlyhigherthanthenormalcircadianrhythmofbloodpressuregroup,anditwasseriouslyimpairedrenalfunction.ConclusionInmiddleandoldagedpatientswithchronickidneydisea

7、seareprevalentinthedisappearanceofthesituationofcircadianrhythmofbloodpressure.Thedisappearanceofcircadianrhythmofbloodpressuresignificantlyinpatientswithchronickidneydiseaseandurinaryalbumin,24-hoururinaryproteinandthedegreeofkidneydamagerelated.4　　【Keyw

8、ords】chronickidneydisease;ambulatorybloodpressure;monitoringcircadianrhythm;albuminuria;renalfunction　　动态血压监测(ABPM)近年来逐渐用于临床，它在反映人体真实血压水平、昼夜变化规律、与靶器官损害程度相关性以及评价抗高血压药物降压疗效方面均优于传统的偶测血压[1]。本研究通过观察中老年慢性肾病患者的24h动态血压监测，了解