老年人原发性高血压动态脉压水平与肾脏损害程度关系

目的探讨老年人原发性高血压患者脉压(PP)与肾脏病变程度的关系。方法选择256例老年原发性高血压患者,进行动态血压监测,根据其脉压水平分为4组(<50mmHg、50～59mmHg、60～69mmHg、>70mmHg),取晨尿用免疫散射法测定尿白蛋白(Alb)、转铁蛋白(TRF)、α1-微球蛋白(α1-MG)和免疫球蛋白G(IgG),根据其结果评价不同脉压水平患者肾脏器官的受损情况。然后对患者进行随访,进行个体化药物治疗,控制其脉压,1年后测定四组患者Alb、TRF、α1-MG和IgG,每组前后对比进行分析。结果脉压升高,各项尿微量蛋白指标均有升高,尿转铁蛋白、尿微量白蛋白水平同步增高(P<0.05),经治疗后,四组患者脉压有所下降,患者肾脏损害情况有所减轻,以尿微量白蛋白下降最为明显(P<0.05)。结论PP是肾脏早期损害的重要危险因子,控制脉压可以一定程度降低其肾脏功能的损害。

Relationship between dynamic pulse pressure level and renal injury extent in elderly patients with essential hypertension

Objective To investigate the relationship between dynamic pulse pressure（PP）and renal damage in elderly patients with essential hypertension（EH）.Methods The twenty-four hour ambulatory blood pressure（24h ABP）was monitored in 256 elderly patients with essential hypertension,The patients were divided into four groups according to the levels of ambulatory PP（50 mmHg、50-59 mmHg、60-69 mmHg、70 mmHg）,Urine albumine（Alb）,transferrin（TRF）,a1-microglobulin（a1-MG）and IgG were determined by immunonephelometric system,and one year later these indexes were determined again after therapy,and analyzed it.Results In the four groups,the levels of urine Alb and TRF increased synchronously with the PP levels（P0.05）,and the pulse pressure and related indicators was decreased after therapy.Among them,urine albumine declined obviously（P0.05）.Conclusion The renal injury is more severe in patients with higher pulse pressure,PP is the important risk factor of early renal impairment.To control pulse pressure might alleviate renal damage.