脑梗死合并2型糖尿病患者的动态血压特征观察

背景血压异常与糖尿病的多种并发症及其预后有密切关系,因此,国内外对血压正常的糖尿病伴脑梗死患者的昼夜节律研究是十分重要的.目的了解2型糖尿病伴脑梗死患者的动态血压变化特点,为糖尿病患者早期介入康复干预,预防脑梗死的发生提供理论依据.设计以诊断为依据的病例对照研究.地点、对象和方法采用无创性携带式动态血压监测仪对来自于解放军北京军区总医院门诊或住院伴有(40例)和不伴有脑梗死(40例)的2型糖尿病患者及健康正常对照组40例进行动态血压监测.主要观察指标伴有和不伴脑梗死的2型糖尿病患者80例及健康人40例的24h白昼和夜间平均收缩压、平均舒张压以及夜间血压下降百分率.结果伴有脑梗死的糖尿病患者的24h平均舒张压、白昼平均舒张压及夜间平均舒张压均比对照组明显升高;两组糖尿病患者夜间收缩压、夜间舒张压下降幅度均较正常对照组减小,尤以伴有脑梗死的2型糖尿病患者收缩压下降幅度[(7.0±1.6)%]最小,与其余两组[对照组(13.2±1.7)%,糖尿病组(8.8±1.1)%]比较,差异有显著性意义(t＞2.639,P＜0.01).结论伴有脑梗死的2型糖尿病患者正常血压昼夜节律消失,而且正常血压节律消失可能在糖尿病患者发生脑梗死中起重要作用.

Observation of the ambulatory characteristics of blood pressure in type 2 diabetes patients complicated with cerebral infarction

BACKGROUND: The abnormity of blood pressure is closely related with many complications and prognosis in diabetes; therefore, researches of circadian rhythms in diabetes complicated with cerebral infarction patients who have normotension, are very important.OBJECTIVE: To understand the ambulatory characteristics of blood pressure variability in type 2 diabetes patients complicated with cerebral infarction so as to provide a theoretical gist in early rehabilitation interventions and prevention of cerebral infarction.DESIGN: A case-control study on the basis of diagnosis.SETTING, PARTICIANTS and INTERVENTIONS: Type 2 diabetes patients complicated with(40 cases) or without(40 cases) cerebral infarction were selected from Outpatient or Inpatient Department of Beijing Command General Hospital as well as 40 healthy subjects(control group) to be monitored by non-traumatic portable ambulatory blood pressure monitoring apparatus.MAIN OUTCOME MEASURES: 24-hour mean systolic pressure(SP) and diastolic pressure(DP) of daytime and night as well as the descending percentage of nocturnal blood pressure were observed in 40 healthy individuals and 80 type 2 diabetes patients complicated with or without cerebral infarction.RESULTS: 24-hour mean DP, daytime mean DP as nocturnal mean DP in diabetes complicated with cerebral infarction group increased significantly compared with that of control group; the descending widths of noctumal SP and DP in two diabetes groups were decreased compared with control group, especially with the smallest descending width in type 2 diabetes complicated with cerebral infarction group[ (7.0 ± 1.6)% ], which with significances compared with the rest two groups[ntrol group: (13.2 ± 1.7)%, diabetes groups: (8.8 ± 1.1 )%,t＞ 2.639, P ＜0.01].CONCLUSION: Normal circadian rhythms in blood pressure disappear in type 2 diabetes complicated with cerebral infarction patients, and furthermore the disappearance of normal circadian rhythms in blood pressure might play an important role in the occurrence of cerebral infarction in diabetes patients.