慢性肾功能衰竭患者24h动态血压监测的临床意义

目的探讨慢性肾功能衰竭非透析患者24h动态血压昼夜节律特点及其与心脏结构功能的关系。方法研究对象为本院肾内科和心内科住院患者，其中慢性肾衰合并高血压非透析患者（A组）80例，肾功能正常的原发性高血压患者（B组）60例，采用动态血压计测定各组患者动态血压（ABPM），收集24h平均收缩压（24h-SBP）、24h平均舒张压（24h-DBP）、24h平均动脉压（24h-MAP）、白昼平均收缩压（D-SBP）、白昼平均舒张压（D-DBP）、夜间平均收缩脉（N-SBP）和夜间平均舒张压（N-DBP）以及昼夜节律。采用超声心动图测定左心室舒张末内径（LVDd）、左心事收缩术内径（LVDs）、左心室后壁厚度（INPWT）、室间隔厚度（IVST）。结果肾功能衰竭组患者非杓型比例（72.7％）高于对照组（28.3％），肾功能衰竭组患者非杓型高血压组夜间收缩压（142．34±18．04）mmHg、夜间舒张压（84．34±16．22）mmHg均高于杓型高血脉组（P〈0．05），而昼间血压差异无统计学意义。肾衰竭组患者LVDd（44．57±3．26）、IVST（10．72±1．62）和LVPWT（11．38±1．57）值高于对照组（P〈0.05）。结论慢性肾功能衰竭患者普遍存在高血压和血压节律改变，慢性。肾衰合并高血压患者较。肾功能正常的原发性高血压患者非杓型比例增加，慢性。肾衰合并高咖压患者非勺型节律和夜间收缩压升高与其心脏结构和功能改变密切相关。

Clinical signiflcance of monitoring 24 h ambulatory blood pressure in patients with chronic renal failure

Objective To analyze patterns of diurnal blood pressure change in non-dialytie patients with chronic renal failure （CRF）. Methods Eighty patients with CRF and hypertension were studied （group A）, and another 60 patients with essential hypertension hut normal renal tunction were used as control （group B）. 24-h mean systolic （24h-SBP）, 24-h mean diastolic （24h-DBP）, 24-h mean arterial （24h-MAP）, daytime mean systolic （D-SBP）, daytime mean diastolic （D-DBP）, nighttime mean systolie（N-SBP）,and nighttime mean diastolic （N-DBP） blood pressure aud circadian blood pressure rhythms were measured by ABPM. The left ventricular end-diastolic diameter （LVDd）, left ventricular end-systolic diameter （LVDs）, left ventricular posterior wall thickness （LVPWT）, and interventricular septal thickness （IVST） were measured hy echocardiography. Other correlated parameters were also measured. Results The incidence of non-dipper hypertension was significantly increased in CRF patients （ 72.7% ） compared with control group （ 28.3% ）. The levels of N-SBP （ 142.34±18.04 ） and N-DBP （ 84.34±16.22 ）in CRF patients increased significantly in non-clipper hypertension gruup compared with the dipper hypertension group （P〈0.05）. LVDd （ 44.57±3.26 ）, IVST （ 10.72±1.62 ） and LVPWT（ 11.38±1.57 ）significantly increased in CRF patients compared with control group （P〈0.05 ）. Conclusions The incidence of hypertension and non-dipper hypertension was very high in CRF patients. Nocturnal hypertensinn of CRF patients was significantly correlated with cardiac structure and function.