通讯作者：赵俊丽,E-mail: zhaojunli1203@126.com

【摘要】 目的 研究非透析慢性肾脏病(CKD)患者动态血压特征,探讨血压昼夜节律及血压变异性与左室肥厚的关系。方法 收集118 例CKD非透析患者,测量肾功能、血脂等生化指标,按其eGFR水平分为CKD1～2期组(n=22例),CKD3期组(n=47例),CKD4～5期组(n=49例)。另收集同期健康体检者30 例作为对照组。采用动态血压监测仪监测24h动态血压,超声心动图检测LVH 有关指标。分析CKD患者动态血压特征,探讨血压昼夜节律及血压变异性与左室肥厚的关系。结果 ①CKD各组的24 h、日间、夜间的SBP和DBP的平均值都高于对照组,差异有统计学意义(P<0.05) 。随着肾功能的下降,24h、日间和夜间SBP和夜间DBP的平均值越来越高。②与对照组相比,CKD各组24h平均收缩压标准差(24 h SSD)、白昼收缩压标准差(d SSD)、夜间收缩压标准差(n SSD) 与夜间舒张压标准差(n DSD)均明显升高,差异有统计学意义(P<0.05);随着肾功能的下降,24 h SSD、d SSD、n SSD与n DSD均明显升高,组间比较差异有统计学意义[(11.93±3.8)vs(13.98±2.9),(14.37±3.7);(12.7±4.3) vs(14.9±4.1),(15.2±4.6);(10.9±3.7)vs(11.89±4.2),(12.11±4.7);(8.9±4.1) vs (10.44±2.9),(10.76±3.16);P<0.05 ]。各组24h平均舒张压标准差(24 h DSD)、白昼舒张压标准差(d DSD)比较差异无统计学意义。③CKD患者总体非杓型血压比例为80.5%, CKD各期非杓型血压比例分别为CKD1～2期68.2％,CKD3期78.7%,CKD4～5期87.8%,均显著高于对照组20%。④与非左心室肥厚组(non-LVH 组)相比：左心室肥厚组( LVH 组)24 h、白昼、夜间SBP 与DBP 平均值升高,差异有统计学意义(P<0.01);非杓型血压发生率升高(65.4% vs 83.5%),两者比较差异有统计学意义(P<0.05);LVH 组24 h SSD、d SSD与n SSD明显高于无LVH 组,差异有统计学意义(P<0.05)。结论 随着肾功能减退,CKD 患者血压均值升高;昼夜节律改变,以非杓型血压为主;血压变异性增大。CKD患者LVH 的发生与血压升高、血压昼夜节律异常及血压变异性尤其收缩压变异性增大与密切相关。     

新诊断的老年高血压患者动态血压节律及晨峰与肾功能损害的关系

目的探讨老年高血压患者24h血压节律及晨峰与肾功能损害的关系。方法选择老年高血压患者138例,根据24h动态血压节律分为杓型节律组61例和非杓型节律组77例。另根据血压晨峰情况再分为血压晨峰组79例和非血压晨峰组59例。检测各组微量白蛋白尿(MAU),采用适用于中国人的慢性肾脏病流行病学合作研究公式评估肾小球滤过率(GFR)。结果与非杓型节律组比较,杓型节律组MAU明显降低[(22.67±10.81)mg/L vs(38.92±16.34)mg/L,P<0.01],GFR明显升高[(105.93±16.47)ml/(min·1.73 m2)vs(90.61±10.73)ml/(min·1.73m2),P<0.01]。与非血压晨峰组比较,血压晨峰组MAU明显升高,GFR明显降低(P<0.01)。非杓型血压节律及收缩压晨峰是影响MAU及GFR的独立危险因素。结论 24h动态血压节律异常及晨峰现象是影响老年高血压患者肾功能损害的独立危险因素,两者具有交互协同作用。     

老年慢性肾脏病患者24小时动态血压变化及影响因素

目的分析老年慢性肾脏病(CKD)患者24 h动态血压变化及影响因素,以评价其监测老年CKD患者价值。方法134例老年患者按病因分组,将CKD 2~5期非透析治疗的患者作为CKD组(68例),其他疾病患者作为非CKD组(66例)。收集两组临床资料及24 h动态血压监测(ABPM)结果。分析CKD和其他危险因素对动态血压的影响。结果与非CKD组患者比较,CKD组患者糖尿病、左心室肥厚和心血管病发生率增加。24 h ABPM显示,与非CKD组患者比较,CKD组患者收缩压升高,舒张压下降,脉压增大,非杓型血压发生率增加(P<0.01)。合并糖尿病、左心室肥厚和贫血与CKD患者发生非杓型血压独立相关。结论通过24 h ABPM可动态观察老年CKD患者血压特点,对临床治疗有一定意义。     

老年高血压患者动态血压负荷和脉搏波传导速度的相关性研究

目的探讨老年高血压患者24 h动态血压负荷与颈桡动脉脉搏波传导速度(crPWV)的相关性。方法选取60～79岁的老年原发性高血压患者187例,对所有入选对象进行24 h动态血压监测,根据获取的24 h动态血压监测参数分为杓型组90例与非杓型组97例,选择同期体检人群82例为正常对照组。所有受试者行24 h动态血压监测,应用脉搏波速度测定仪测定crPWV,并进行分析。结果杓型组及非杓型组24 h、昼间及夜间收缩压、舒张压负荷均显著高于正常对照组(P<0.01)。非杓型组夜间血压负荷较杓型组升高(P<0.05)。杓型组及非杓型组crPWV均较正常对照组升高(P<0.05)。控制性别、年龄因素后,老年高血压患者24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是crPWV影响的主要因素。结论老年高血压患者动态血压负荷升高,大动脉顺应性降低,其中24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是影响大动脉顺应性的主要危险因素。     

高血压病患者血压节律异常与脉搏波传导速度、脑钠肽及左室质量的相关性研究

目的探讨高血压病患者动态血压节律异常与脉搏波传导速度(PWV)、脑钠肽(BNP)及左室质量之间的相关性。方法根据24h动态血压结果100例高血压病患者分为杓型高血压组与非杓型高血压组,分别进行了PWV、BNP及超声心动图测定。结果杓型高血压组与非杓型高血压组的PWV、BNP及左室质量指数(LVMI)均显著高于对照组,差异有统计学意义(P0.01);其中非杓型高血压组显著高于杓型高血压组,差异有统计学意义(P0.01)。BNP浓度与LVMI呈正相关(r=0.61,P0.01)。结论高血压患者血压昼夜节律异常者往往伴有外周血管及心脏靶器官损害,PWV值及脑钠肽水平与高血压病患者血压节律的异常之间有明显的相关性。     

晨峰高血压患者血压的昼夜节律变化

目的分析具有晨峰现象的老年高血压患者的血压昼夜节律性变化特点。方法对90例血压正常对照者及113例原发性高血压患者分别行24 h动态血压监测,按照晨峰数值≥35 mm Hg将高血压患者分为晨峰组与非晨峰组,根据夜间血压下降率特点分为杓型(夜间血压下降率≥10%,但20%)与非杓型,非杓型进一步划分为浅杓型(夜间血压下降率10%)、超杓型(夜间血压下降率≥20%)、反杓型(夜间不下降,即0%)。结果 1高血压组昼夜节律异常(非杓型)者比例(62.8%)较对照组(23.3%)明显升高(P0.05)。2晨峰高血压组内具有浅杓型(30.3%)、超杓型(25%)、反杓型(14.5%)特征的患者比例与对照组(10.0%、8.9%、4.4%)相比均明显升高(P0.05)。3昼夜节律异常(非杓型)者比例在晨峰高血压组内(69.7%)与非晨峰高血压组(48.6%)之间相比升高(P0.05)。4晨峰高血压组内具有浅杓型特征的患者比例(30.3%)与非晨峰组(10.8%)相比明显升高(P0.05)。晨峰高血压组内具有超杓型(25%)、反杓型(14.5%)特征的患者比例较非晨峰组(24.3%、13.5%)高,但两者无差异(P0.05)。结论晨峰高血压患者昼夜节律异常主要表现为浅杓型的特点。     

高龄原发性高血压患者动态血压节律异常与靶器官损害关系的研究

目的探讨高龄原发性高血压患者动态血压特点及其与靶器官受损程度的关系。方法对80例年龄≥80岁的高血压患者进行24 h动态血压监测,根据夜间血压下降率分为杓型组38例和非杓型组42例,比较2组惠者收缩压、舒张压、血压负荷值及靶器官受损的情况。结果与杓型组比较,非杓型组24 h、昼间和夜间收缩压均明显升高(P<0.05),非杓型组和杓型组24 h收缩压负荷值分别为(72.0±11.0)%vs(32.0±8.0)%,P<0.01。非杓型组服用降压药的种类数、冠心病、缺血性脑卒中、肾功能不全及外周动脉疾病的比例显著高于杓型组(P<0.05)。结论高龄非杓型高血压患者的平均收缩压、收缩压负荷及靶器官损害发生率明显高于杓型患者,这类高血压患者更需合理控制血压。     

老年冠心病患者的动态血压变化与心率变异性的关系

目的观察老年冠心病患者的动态血压变化与心率变异性的关系,探讨老年冠心病患者血压变异性的影响因素。方法对179例老年冠心病患者同时行24h动态血压监测和24h动态心电图检查,将患者按照收缩压昼夜节律变化情况分为杓型组30例、非杓型组84例和反杓型组65例,记录冠状动脉造影结果、24h血压变异性参数、心率变异性参数及其他临床变量的基线值。比较各组冠状动脉病变Gensini评分和心率变异性各参数。结果非杓型组和反杓型组的log Gensini评分均高于杓型组(P<0.05);非杓型组和反杓型组的24h内正常R-R间期的标准差、24h内连续每5min平均R-R间期的标准差均低于杓型组(P<0.05);24h血压变异性各参数与心率变异性各参数无明显相关性。结论血压昼夜节律异常的老年冠心病患者比血压昼夜节律正常者冠状动脉病变程度更重;血压昼夜节律与心率变异性相关,随血压昼夜节律减弱,心率变异性降低,而24h动态血压监测所测血压变异性与心率变异性无明显相关性。     

老年脑梗死患者血压昼夜节律异常影响因素

目的探讨老年脑梗死患者血压昼夜节律异常的影响因素。方法选取老年脑梗死患者220例,均行24 h动态血压监测,依据血压监测结果将患者分为血压昼夜节律异常组和血压昼夜节律正常组,统计记录所有患者性别、年龄、有无吸烟史、有无饮酒史、有无糖尿病史、有无持续性房颤、血液黏度及体重指数水平;并采集患者清晨空腹肘静脉血3 ml,采用全自动生化分析仪测定三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、同型半胱氨酸、尿酸水平。分析上述资料在老年脑梗死患者血压昼夜节律异常中的影响作用。结果220例老年脑梗死患者血压昼夜节律正常78例,占35.45%;血压昼夜节律异常142例,占64.55%,其中超杓形59例(26.82%),非杓形34例(15.45%),反杓形49例(22.27%),脑梗死血压昼夜节律异常主要以超杓形、反杓形为主。脑梗死血压昼夜节律正常组在性别、年龄、饮酒、吸烟等方面与脑梗死血压昼夜节律异常患者相比,差异无统计学意义(P>0.05);脑梗死血压昼夜节律正常组在糖尿病、持续性房颤、血液黏度、体重指数等方面与脑梗死血压昼夜节律异常患者相比,差异有统计学意义(P<0.05);脑梗死血压昼夜节律正常组三酰甘油、总胆固醇、高密度脂蛋白、尿酸水平与脑梗死血压昼夜节律异常患者相比,差异无统计学意义(P>0.05);脑梗死血压昼夜节律正常组低密度脂蛋白、同型半胱氨酸水平与脑梗死血压昼夜节律异常组相比,差异有统计学意义(P<0.05);经Logistic多因素分析,糖尿病、持续性房颤、体重指数>24 kg/m^2、高水平同型半胱氨酸是导致脑梗死患者血压昼夜节律异常的危险因素(OR>0,P<0.05)。结论脑梗死发生后患者多伴有血压昼夜节律异常,以超杓形、反杓形常见,诱发血压昼夜节律异常因素较多,其中糖尿病、持续性房颤、高水平同型半胱氨酸、体重指数>24 kg/m^2是导致血压昼夜节律异常的危险因素,对合并上述因素的患者应积极干预,改善病情。     

血压正常高值者动态血压变化与动脉顺应性的相关性研究

目的探讨血压正常高值者24 h动态血压变化与颈桡动脉脉搏波传导速度(crPWV)、颈动脉内膜中层厚度(IMT)的相关性。方法入选受试对象286例,其中理想血压组(血压<120/80 mm Hg,1 mm Hg=0.1 33 kPa)90例,血压正常高值组196例,对所有入选对象进行24 h动态血压监测,根据监测参数将血压正常高值组又分为杓型组103例,非杓型组93例,同时进行crPWV及颈动脉IMT检测。结果非杓型组24h收缩压均值较杓型组升高[(122.00)±9.74)mm Hg vs(11 6.74±8.66)mm Hg,P<0.05]。非杓型组夜间血压各指标均较杓型组明显升高(P<0.01),非杓型组crPWV较杓型组升高[(9.53±1.14)m/s vs(8.38±0.88)m/s.P<0.05],非杓型组IMT较杓型组升高[(0.93±0.11)mm vs(0.81±0.1 2)mm,P<0.05],多元回归分析显示,夜间收缩压均值、夜间收缩压下降率、夜间舒张压均值等是crPWV的影响因素,夜间舒张压下降率、24 h收缩压均值、甘油三酯是IMT的影响因素。结论血压昼夜节律异常与crPWV及IMT密切相关,血压正常高值者已出现血管结构与弹性功能异常。     

Riser pattern is a predictor of kidney mortality among patients with chronic kidney disease

Background: Hypertension is a crucial risk factor for cardiovascular death and loss of residual kidney function. Absence of the nocturnal decline in blood pressure (BP) predicts cardiovascular events and poor prognosis. However, characteristics of hypertension in moderate-to-severe chronic kidney disease (CKD) have not been fully evaluated. We aimed to assess the circadian variation of BP and kidney survival in CKD patients. Methods: Patients who were examined by 24-h ambulatory BP monitoring (ABPM) and estimated glomerular filtration rate (eGFR), <45 ml/min/1.73 m², were enrolled in the study. The impacts of BP circadian rhythm and brain natriuretic peptide (BNP) on kidney survival were evaluated. Results: A total of 124 patients were enrolled. The average age was 64 ± 14 years, 57% were male, and 43% had diabetes. Forty-five percent of patients had a non-dipper pattern, 35% had a riser pattern, 19% had a dipper pattern, and 1% had an extreme-dipper pattern. The prevalence of diabetes and plasma BNP levels was higher and eGFR was lower in the riser-pattern group than in the non-riser-pattern group. Kidney survival rates were significantly worse in the riser-pattern group than in the non-riser-pattern group (p < 0.05). Moreover, among riser and non-riser pattern groups divided by BNP levels, the riser group with higher BNP level showed the worst kidney survival (p < 0.05). Conclusion: The riser pattern is frequently associated with several conditions at higher risk for kidney survival. Patients with a rising pattern and higher BNP levels have a worse kidney prognosis.     

Ambulatory Blood Pressure in Chronic Kidney Disease

Chronic kidney disease (CKD) affects approximately 20 million adults in the United States. Patients with CKD have an increased risk of cardiovascular (CV) disease. Ambulatory blood pressure monitoring (ABPM) provides superior BP measurements when compared to office BP measurements in normotensive, hypertensive and CKD patients. ABPM measurements are often abnormal in CKD, with CKD patients frequently showing an altered circadian rhythm with an increased rate of non-dipping and reverse dipping. The prevalence of non-dippers and reverse-dippers increases progressively as stage of CKD progresses. ABPM has been shown to be a better tool for predicting CV risk, CKD progression, end stage renal disease (ESRD) or death than office-based pressures. ABPM is also additive and adds prognostic value for predicting CKD and CV outcomes when added to estimated glomerular filtration rate (eGFR). Although ABPM is time consuming, it is worth considering, as the data demonstrates that information from ABPM can potentially impact future CV and renal outcomes in patients with CKD.     

老年维持性血液透析患者透析间期血压节律的影响因素分析

目的探讨老年维持性血液透析（MHD）患者透析间期动态血压节律的影响因素。方法选择28例老年MHD患者,均于透析间期进行24h动态血压监测,同时完善血液生化指标和心脏超声检查。根据动态血压监测中夜间收缩压下降率情况将患者分为2组：血压节律正常组和血压节律异常组。采用独立样本t检验或Fisher确切概率法比较两组患者一般情况、血液生化指标、动态血压参数、心脏结构及功能的差异;采用多因素Logistic回归分析老年MHD患者透析间期血压节律的影响因素。结果（1）血压节律异常组甲状旁腺激素水平、动态动脉硬化指数、对称性动态动脉硬化指数、左室质量指数高于血压节律正常组（P〈0．05）,差异有统计学意义。（2）多因素Logistic回归分析结果显示,甲状旁腺激素、对称性动念动脉硬化指数、左室肥大是动态血压节血律异常的独立危险因素。结论继发性甲状腺机能亢进、动脉硬化、左室肥大是老年MHD患者透析间期动态血压节律异常的独立危险因素。     

Renal scintigraphy predicts global cardiovascular risk in hypertensive subjects with normal serum creatinine levels

BACKGROUND. This cross-sectional study investigates the role of renal scintigraphy on cardiovascular (CV) risk stratification in normoalbuminuric, non-diabetic hypertensive subjects (HTs) free from CV disease and renal dysfunction. METHODS. In 200 HTs aged 55-75 years, glomerular filtration rate (GFR) was measured by technetium-99m-diethylene triamine pentacetic acid clearance during renal scintigraphy. Stage III chronic kidney disease (CKD) was defined as GFR < 60 ml/min/1.73 m(2). For comparing the impact of different methods for CKD diagnosis on CV risk stratification, CKD was also considered as GFR estimated by the Modification of Diet in Renal Disease (MDRD) equation and Cockcroft-Gault's formula. Target organ damage (TOD) was assessed by echocardiography and carotid ultrasonography. Gender-specific odds ratio (OR) with 95% confidence intervals for CKD were derived from a multiple stepwise logistic regression analysis. Global CV risk was stratified according to routine examinations, TOD and CKD. RESULTS. In 38% of cases, an unknown stage III CKD was found. Independent of age, CKD was predicted by history of hypertension (OR = 1.69, p = 0.0001), albuminuria (OR = 1.25, p = 0.0001), smoking (OR = 1.85, p = 0.028) and pulse pressure (OR = 1.21, p = 0.019) in men only. Men had an increased risk of CKD (OR = 2.62, p = 0.002) in comparison with women. Prevalence of TOD was significantly higher only in HTs having CKD diagnosed by renal scintigraphy; TOD and CKD assessment added to classic risk factors modified the CV risk stratification from low-moderate to high and very high. CONCLUSIONS. Renal scintigraphy is an important aid in risk stratification and should be performed in HTs aged >55 years. Pulse pressure was the main blood pressure component that predicted the risk of stage III CKD.     

Circadian variation of blood pressure and neurohumoral factors during the acute phase of stroke

This study was to investigate the relationship between circadian blood pressure (BP) variation and circadian variation of neurohumoral factors during the acute phase of stroke. We studied 17 patients with cerebral infarction in 16 and cerebral hemorrhage in one. We performed 24-hour ambulatory BP monitoring and examined plasma renin activity (PRA), catecholamine, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin 1 (ET1) and prothrombin fragment 1+2 (PT F1+2) and urinary catecholamine. Our result showed that the circadian variation of BP, neurohumoral and coagulation factors were diminished. There were significant relationships between BP levels and plasma BNP levels, nocturnal urinary adrenalines and ET1s. There were also significant relationships between night/day ratio of BP and plasma ET1 level. In conclusion the abnormal patterns of circadian BP rhythm were frequently observed during the acute phase of stroke. The cause of this abnormality may result from the diminished circadian rhythms of neurohumoral factors.     

血压评估参数与老年男性慢性肾脏病合并高血压病人肾功能下降的关系

目的 研究不同血压评估参数与老年男性慢性肾脏病(CKD)3～4期合并高血压病人肾功能下降的关系.方法 对2015年1月至2019年12月北京同仁医院老年医学科/干部医疗科112例CKD 3～4期合并高血压的老年男性病人的临床资料进行回顾性分析,记录病人连续2年临床检验数据及此2年间动态血压监测数据.以2年间eGFR减低...     

非透析慢性肾脏病患者肾小球滤过率的评估值与动脉硬化的相关性

目的 通过测量非透析慢性肾脏病(CKD)患者的踝臂指数(ABI)及肾小球滤过率的评估值(eGFR),分析ABI作为评估CKD患者动脉硬化程度的临床意义.方法 横断面研究诊断明确的非透析CKD(1-5期)患者118例,记录患者性别、年龄、身高、体重、吸烟状况、血压、空腹血糖、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、肾功能.通过简化的肾脏病膳食改良公式计算eGFR,多普勒血流检测仪测定ABI.结果 按eGFR水平分为CKD1期、CKD2期、CKD3期、CKD4期、CKD5期五个组,与CKD1期组比较,CKD3期组、CKD4期组、CKD5期组ABI值明显降低(P＜0.01),但CKD1期组与CKD2期组间ABI值无统计学差异(P＞0.05).在CKD 2-5期组间随着eGFR降低,ABI值也逐渐下降(P＜0.01).多元线性回归分析显示,年龄、糖尿病、高血压和eGFR为ABI的独立危险因素(P＜0.01).结论 肾功能减退是动脉硬化的独立危险因素,eGFR下降与动脉硬化病变程度密切相关,而ABI可作为评估CKD患者动脉硬化程度的重要临床指标.     

CIRCADIAN VARIATION OF BLOOD PRESSURE AND NEUROHUMORAL FACTORS DURING THE ACUTE PHASE OF STROKE

This study was to investigate the relationship between circadian blood pressure (BP) variation and circadian variation of neurohumoral factors during the acute phase of stroke. We studied 17 patients with cerebral infarction in 16 and cerebral hemorrhage in one. We performed 24-hour ambulatory BP monitoring and examined plasma renin activity (PRA), catecholamine, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin 1 (ET1) and prothrombin fragment 1 + 2 (PT F1 + 2) and urinary catecholamine. Our result showed that the circadian variation of BP, neurohumoral and coagulation factors were diminished. There were significant relationships between BP levels and plasma BNP levels, nocturnal urinary adrenalines and ET1s. There were also significant relationships between night/day ratio of BP and plasma ET1 level. In conclusion the abnormal patterns of circadian BP rhythm were frequently observed during the acute phase of stroke. The cause of this abnormality may result from the diminished circadian rhythms of neurohumoral factors.     

慢性肾脏病患者游离脂肪酸与细胞因子及颈动脉病变的关系

目的 研究慢性肾脏病(CKD)患者血清游离脂肪酸(FFA)水平的变化及其与细胞因子及颈动脉病变的关系.方法 对188例CKD患者[非透析治疗130例,血液透析(HD)58例]的临床及实验室资料作回顾性研究,采用酶比色法检测FFA,应用颈动脉超声检查颈动脉病变的程度,同时检测高敏C反应蛋白(hsCRP)、血清IL-1β、IL-6和TNFα水平,分析FFA水平与此细胞因子及颈动脉病变的关系.结果 CKD患者无论透析与否,FFA水平较健康对照组显著升高[(492.63±143.59)比(302.65±142.18)μmol/L,P＜0.01],在非透析CKD患者中,随着肾功能的逐渐减退,血FFA水平也逐渐升高,各组间比较差异有统计学意义(P＜0.05或P＜0.01),且HD组FFA水平较非透析CKD 5期更高(P＜0.05).CKD患者hsCRP、IL-1β、IL-6、TNFα水平均显著高于健康对照组(P＜0.05或P＜0.01),颈动脉内膜中层厚度(IMT)及斑块形成、颈动脉硬化的患病率较健康对照组显著升高(P＜0.05或P＜0.01),HD组上述指标较非透析CKD5期均更高(P＜0.05).直线相关分析显示,血FFA水平与hsCRP、IL-1β、IL-6、TNFα、TG及IMT、斑块形成、颈动脉硬化的患病率呈正相关(P＜0.05或P＜0.01),与GFR呈负相关(P＜0.05).多因素逐步回归分析显示,FFA、hsCRP和年龄是CKD患者颈动脉病变的独立危险因素.结论 非透析CKD及HD患者血清FFA水平均显著升高,且与hsCRP等微炎性反应的指标及颈动脉病变相关,提示高游离脂肪酸血症是CKD患者并发动脉粥样硬化的危险因素之一.     

老年代谢综合征患者血压负荷值、昼夜节律与靶器官损害的关系

目的：探讨老年代谢综合征（MS）患者动态血压负荷值及血压昼夜节律与靶器官损害的关系。方法：选择204例老年MS患者进行24h动态血压监测,其中55例无靶器官损害为对照组,心脏损害组43例、脑损害组35例、肾损害组38例及多器官损害组33例,分析其24h、白昼、夜间血压负荷值,血压昼夜节律。结果：与对照组比较,心脏损害组、脑损害组、肾损害组、多器官损害组的24h、白昼、夜间血压负荷值均明显升高（P〈0．01）,夜间血压下降率明显降低（P〈0．01～〈0．001）;与心脏损害组、脑损害组、肾损害组比较,多器官损害组的24h、白昼、夜间血压负荷值明显升高（P〈0．05）,夜间血压下降率明显降低（P〈0．05～〈0．01）。结论：老年代谢综合征伴靶器官损害者的血压负荷值明显升高,血压昼夜节律明显减弱。