高血压患者神经内分泌昼夜活性与血压昼夜节律的关系

目的探讨杓型与非杓型高血压患者血浆去甲肾上腺素、肾素、血管紧张素Ⅱ的昼夜浓度变化与高血压昼夜节律变化的相关性及在高血压发病中的作用。方法符合高血压病诊断标准的住院高血压病人103例,使用无创性便携式24h动态血压监测仪检查,设定每日6:00-22:00为日间,22:00-次日6:00为夜间,根据其夜间平均动脉压下降10%以上或以下分为二组:杓型组和非杓型组,采静脉血用放射免疫法分别测定二组病人清晨8时与夜间11时血浆去甲肾上腺素、肾素、血管紧张素Ⅱ水平。结果杓型高血压组8AM去甲肾上腺素水平(290.12±32.54ng/L)较11PM(245.34±26.18ng/L)高(p<0.05),而非杓型组去甲肾上腺素水平8AM(326.11±36.81ng/L)较11PM(368.33±45.26ng/L)低(p<0.05),非杓型高血压病人8AM、11PM去甲肾上腺素均较杓型高血压病人8AM、11PM高,但只有11PM水平比较具有显著性差异(p<0.05)。非杓型高血压患者8AM、11PM血浆肾素、血管紧张素Ⅱ浓度较杓型高血压患者高,但比较无显著差异。结论高血压患者血压昼夜节律与其并发症的发生及预后有密切关系。非杓型高血压患者存在交感神经活性增强,夜间交感输出增多。调整服药时间,加强夜间抗交感活性可能恢复此类患者血压的昼夜节律,减少靶器官的损害。

THE RELATIONSHIP BETWEEN DAY AND NIGHT ACTIVATION OF NEUROENDOCRINE AND BLOOD PRESSURE CIRCADIAN RHYTHM OF HYPERTENSION PATIENT

Objective To explore the relationship between plasma level variation of Norepinephrine, Rennin and Angiotensin Ⅱ in the Dipper type and non - dipper type hypertension patients and the change of the hypertension circadian rhythm and the mechanism in the hypertension pathogenesis. Methods The 113 hypertension inpatients according with the diagnostic standard （71 males and 42 females with the ages between 35 and 78 years old）were taken to monitor 24 - hour BP with no - damaged portable BP monitor（ U. S. A. spacelab90217 - 1B）, the monitor course was divided into two periods including （6：00 -22： 00） for daytime, （ 22：00 -6： 00） for night, to divide the patients into dipper type and non - dipper type group according to night mean artery blood pressure dropping more than or less than 10%. Take vein blood with radioimmunoassay to determine 8AM and 11PM Plasma concentration of Norepinephrine, Rennin, Angiotensin Ⅱ of two group patients respectively. Results the 8AM Norepinephrine level of the patients who are dipper type hypertension group is higher than 11PM, but non - dipper type group Norepinephrine level of 8AM is lower than llPM. 8AM and llPM Norepinephrine level of Non- dipper type hypertension patient is higher than dipper type, but only t 1PM level has a significant difference （p 〈 0. 05 ）. The patients who are non - dipper type hypertension, whose concentration of 8AM, llPM plasma rennin, angiotensin Ⅱ is higher than dipper type, but there is no significant difference. Conclusion There are close relations between hypertension circadian rhythm and its emergence of comphcation and prognosis. The patient who is non - dipper type hypertension has enhanced sympathetic nerve activation, increasing output sympathetically at night. Adjusting medicine time and strengthening to resist sympathetic activation at night may resume circadian rhythm of this kind of patient＇ s blood pressure and reduce the harm of the target -organs.