慢性肾脏病患者24小时动态血压的特点分析

目的采用24h动态血压监测的方法，分析慢性肾脏病（CKD）不同分期患者24h动态血压特点。方法将152例CKD患者分为5组：CKD1期组（A组）15例；CKD2期组（B组）29例；CKD3期组（C组）42例；CKD4期（D组）组34例；CKD5期组（E组）32例。所有患者均无糖尿病、非肾脏替代治疗。采用携带式的动态血压检测仪测定各组患者动态血压参数和昼夜节律。结果①随着肾功能下降，24h、日间和夜间平均收缩压越来越高；②CKD患者总体非杓型血压比例为81．6o,4，肾功能下降组（CKD2～5期）非杓型血压比例显著高于肾功能正常组（CKD1期）；③夜间收缩压与24h尿蛋白定量呈正相关（r=0．427，P〈0．01），与。肾小球滤过率（GFR）呈负相关（r=-0．352，P〈0．05）。结论CKD患者的血压非杓型节律现象比较普遍，并随着肾功能下降，其发生率逐渐升高；夜间收缩压与尿蛋白排泄、肾功能有相关性。

Analysis of 24-h ambulatory blood pressure monitoring in patients with chronic kidney disease

Objective Ambulatory blood pressure monitoring （ABPM） was done to describe the characters of blood pressure in patients with chronic kidney disease （CKD） at different stages of renal function. Methods A total of 152 CKD patients at stages 1 to 5 were enrolled in the study, without diabetes or renal replacement therapy. The parameters of blood pressure and circadian rhythm were measured by ABPM. Results Analysis of ABPM data from the 152 CKD patients indicated： （1） With the decline of renal function, average 24 h, daytime and nighttime systolic blood pressure （SBP） became higher in CKD patients; （2） The prevalence of abnormal circadian BP rhythm was quite high （81.6%） in CKD patients, especially in patients with advanced CKD; （3） Nighttime SBP was positively correlated with 24-h urinary protein （r= 0. 427, P〈0. 01）, and negatively with GFR （r = - 0. 352, P〈0. 05）. Conclusions The prevalence of non-dipping rhythm is quite high in CKD patients and increases with the deterioration of renal function. Nighttime SBP was correlated with 24-h urinary protein and GFR.