糖尿病肾病患者24h动态血压临床特点分析

目的:分析比较由糖尿病(DN)肾病和非糖尿病导致的慢性肾脏病患者的动态血压变化情况,探讨糖尿病肾病患者动态血压变化的特点。方法:选择62例符合慢性肾脏病诊断标准的DN患者,均无肾脏替代治疗。观察其24 h动态血压监测结果,并与152例年龄、性别、肾功能等匹配的非糖尿病的CKD患者的动态血压结果相比较。结果:在对62例DN患者和152例非糖尿病CKD患者动态血压的分析中,我们发现:(1)DN组的24 h平均收缩压、日间平均收缩压、夜间平均收缩压均显著高于非DN组。(2)两组患者血压变异性差异无统计学意义;夜间血压下降率普遍较小,但差异无统计学意义。(3)DN组收缩压负荷均显著高于非DN组。(4)DN组非杓型节律的发生率为90.3%,非DN组为81.6%,两组血压节律类型差异无统计学意义。(5)非DN组和DN组24 h尿蛋白量与夜间收缩压均具有显著正相关。结论:中晚期DN患者收缩压控制较非糖尿病的CKD患者更差,血压非杓型节律现象比较普遍。夜间收缩压与24 h尿蛋白排泄量密切相关。

Analysis of 24 h Ambulatory Blood Pressure Monitoring in Diabetic Nephropathy Patients

Objective:To analysis and compare the differences in the 24 h blood pressure profile between diabetic nephropathy(DN) and those with non-diabetic chronic kidney disease(CKD),and to investigate the features of 24 h ambulatory blood pressure in diabetic nephropathy.Methods:62 CKD patients with diabetic nephropathy(DN) and 152 non-diabetic CKD patients were enrolled in the study,without renal replacement therapy.The parameters of blood pressure and circadian rhythm were measured by ABPM.Serum creatinine,blood glucose,lipid profile,et al were measured.We observed the change of 24 h blood pressure in the DN and non-DN groups.Results:Analysis of ABPM data from 62 CKD patients with DN and 152 non-diabetic CKD patients indicated:(1)The average 24 h,daytime and nighttime systolic blood pressure(SBP) in the patients with DN were constantly higher than the patients with non-DN.(2)Blood pressure variability did not differ considerably,and the nighttime blood pressure decline was blunted,absent or reversed in both groups.(3)The systolic blood pressure load were constantly higher in the patients with DN than those with non-DN.(4)The prevalence of abnormal circadian BP rhythm was quite high(90.3%) in patients with DN,which did not differ considerably from the patients with non-DN(81.6%).(5)The nighttime SBP was positively correlated with 24 h urinary protein in patients with non-DN and those with DN.Conclusion:Systolic blood pressure in patients with advanced diabetic nephropathy is higher than the CKD patients with non-DN,and the prevalence of non-dipping rhythm is quite high.The nighttime SBP was correlated with 24h-urinary protein.