早期慢性肾病患者动态血压变化与左心室肥厚的关系

目的：分析早期慢性肾脏病（CKD1期）患者24h动态血压变化与左心室肥厚（LVH）的关系。方法：以25例正常人作为对照组（N组）,71例肾功能稳定的CKD1期患者作为疾病组（D组）。收集肾功能、血脂、24h动态血压监测（ABPM）等临床资料;采用超声心动图检测早期CKD患者LVH有关指标,分析ABPM指标与LVH的关系。结果：（1）与N组相比,D组夜间收缩压,昼、夜及24h平均舒张压均升高（P均〈0.05）;夜间收缩压下降率（nDRS）及舒张压下降率（nDRD）均明显下降（P均〈0.05）;舒张末期左室内径（LVDd）及左心室质量指数（LVMI）均升高（P均〈0.05）。（2）D组高血压及非杓型血压发生率分别达47.9%、62.0%。（3）与杓型血压组（Dip组）相比,非杓型血压组（non-Dip组）LVMI值及LVH发生率均显著增高（P均〈0.05）。（4）与非高血压组（non-LVH组）相比,高血压组（LVH组）nDRS和nDRD均明显下降,血红蛋白（Hb）显著降低（P均〈0.05）。（5）相关性分析显示LVMI值与nDRS、nDRD和Hb均呈负相关（P均〈0.01）,昼间平均收缩压（dSBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）和24h平均舒张压（mSBP）均呈正相关（P均〈0.05）。多因素逐步回归分析显示：nDRS、Hb、nDRD和血肌酐（Scr）进入回归方程：y=123.429-2.290x1-0.47x2-0.768x3＋0.178x4（y=LVMI;123.429=常数,t=8.41,P=0.000;x1=nDRS,t=-5.43,P=0.000;x2=Hb,t=-4.77,P=0.000;x3=NDRD,t=-3.47,P=0.001;x4=Scr,t=2.08,P=0.041）。结论：早期CKD患者即已出现血压升高及血压节律改变;LVH发生与早期CKD患者夜间高血压及非杓型血压关系更为密切;贫血和肾功能减退本身也与早期CKD患者LVH发生有关。

Relationship between 24 h Ambulatory Blood Pressure Change and Left Ventricular Hypertrophy in Patients with Early Chronic Kidney Disease

Objective：To study the relationship between 24 h ambulatory blood pressure change and left ventricular hypertrophy in patients with early chronic kidney disease（CKD 1）.Methods：The 24 h ambulatory blood pressure monitoring （ABPM） was done in 71 CKD stage 1 patients and 25 controls （the N group） of stable renal function.Echocardiography was used for measuring LVH relevant data,and left ventricular mass index（LVMI） was calculated.Clinical data such as creatinine clearance rate（Ccr）,hemoglobin（Hb）,body mass index（BMI） and blood lipids were collected,too.Then,the relationship of LVH with ABPM parameters and other clinical data were analyzed retrospectively.Results：（1）Compared with the N group,the D group had higher levels of the nocturnal systolic blood pressure （nSBP）,average diastolic blood pressure in daytime,night and 24-hour,the left ventricular end diastolic diameter （LVDd） and left ventricular mass index （LVMI） （all P0.05）,but lower levels of the decline rate of nocturnal systolic blood pressure （nDRS） and the nocturnal diastolic blood pressure （nDRD） （both P0.05）;（2）The incidence of non-dipper blood pressure in the D group was 47.9%,and that of hypertension was 62.0%;（3）Compared with the Dip group,the non-Dip group had higher levels of LVMI value and incidence of LVH （both P0.05）;（4）Compared with the non-LVH group,the LVH group had lower levels of nDRS,nDRD and hemoglobin（Hb） （all P0.05）;（5）LVMI had significant positive correlations with dSBP,nSBP,nDBP and mSBP （r=0.277,0.618,0.293,0.384,0.844,0.669,respectively;all P0.05）,and significant negative correlations with nDRS,nDRD and Hb （r=-0.844,-0.669,-0.561,respectively;all P0.01）.Multi-factor stepwise regression analysis showed that nDRS,Hb,nDRD and Scr entered the regression equation（y=123.429-2.290x1-0.47x2-0.768x3＋0.178x4,y=LVMI;123.429=constant,t=8.41,P=0.000;x1=nDRS,t=-5.43,P=0.000;x2=Hb,t=-4.77,P=0.000;x3=nDRD,t=-3.47,P=0.001;x4=nDRD,t=2.08,P=0.041）.Conclusion：Hypertension and the rhythm change of blood pressure existed in patients with early CKD.LVH had more closely relationship with nocturnal hypertension level and non-dipper blood pressure in patients with early CKD.Besides,both anemia and decline of renal function are also associated with LVH.