动态血压均值及脉压在评估原发性高血压早期肾损害中的临床研究

目的探讨动态血压均值及动态脉压与微量蛋白尿的关系,以期为动态血压监测(ABPM)应用于早期诊断和评价高血压性肾损害提供科学依据。方法将原发性高血压患者125例按动态脉压(24 h PP)≤40 mm Hg(1mm Hg=0.133 kPa)、41～55 mm Hg、56～70 mm Hg、>70 mm Hg分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组,测量24 h 平均收缩压(24h SBP)、24 h 平均舒张压(24 h DBP)、24 h PP、尿微量白蛋白(mA1b)及尿 N-乙酰-β-D-氨基葡萄糖苷酶(NAG),比较各组的尿 mA1b、NAG 检测值及其阳性率,进行24 h SBP、24 h DBP、24 h PP 与尿 mA1b、NAG 的相关回归分析。结果 (1)Ⅰ组与Ⅱ组之间,尿 mA1b、NAG 及微量蛋白尿阳性率差异无统计学意义(P>0.05),Ⅱ组、Ⅲ组与Ⅳ组随24 h PP 的增高,尿 mA1b、NAG 及微量蛋白尿阳性率均依次明显增高,各组间差异有统计学意义(P<0.05);(2)24 h PP、24 h SBP 与尿 mA1b、NAG 呈正相关(r=0.79、0.78、0.78、0.76,P<0.05),24 h DBP 与mA1b、NAG 呈负相关(r=0.64、-0.65,P<0.05);建立多元回归方程得出高血压早期肾损害时对应的24 hSBP、24 h DBP 及24 h PP 值分别为150 mm Hg、91 mm Hg、58 mm Hg。结论动态血压均值及动态脉压可为原发性高血压患者早期肾损害的检测评价指标,24 h SBP 高于150 mm Hg、24 h PP 高于58 mm Hg,24 h DBP 过度下降的患者为高血压性肾损害高危患者。

Evaluation of 24-hour mean blood pressure and pulse pressure on early renal impairment in essential hypertension patients

Objective To investigate the relationship between 24-hour mean blood pressure and pulse pressure and microproteinuria for the evaluation of early renal impairment in essential hypertension patients.Methods A total of 125 essential hypertension patients were divided into four groups on the basis of the 24-hour mean pulse pressure (24 h PP):group Ⅰ(≤40 mm Hg),group Ⅱ(41～55 mm Hg),group Ⅲ(56～70 mm Hg),groupⅣ(>70 mm Hg).24-hour mean systolic blood pressure(24 h SBP),24-hour mean diastolic blood pressure(24 h DBP)and 24 h PP was calculated based on ABPM,urine microalbumin(mAlb)and n-acetyl-β-d-glucosaminidase(NAG)were analyzed.Urine mAlb,NAG and microproteinuria were compared among the above-mentioned groups.Correlations between 24 h SBP,24 h DBP,24 h PP and urine mAlb,NAG were analyzed.Results (1)Urine mAlb,NAG and microalbuminuria were not significantly different between group Ⅰ and group Ⅱ(P>0.05).In group Ⅱ,Ⅲ and Ⅳ,urine mAlb,NAG and microalbuminuria increased with the increase of 24 h PP(P<0.05).(2)Urine mAlb and NAG were positively correlated with 24 h PP(r=0.79 and 0.78 respectively,both P<0.05)and 24 h SBP(r= 0.78 and 0.76 respectively,both P<0.05)and negatively correlated with 24 h DBP(r=-0.64 and -0.65 respectively,both P<0.05).Early renal impairment could occurs when 24 h SBP was 150 mm Hg,24 h DBP was 91 mm Hg and 24 h PP was 58 mm Hg by multiple regression analysis.Conclusions 24 h SBP,24 h DBP and 24 h PP can indicate hypertensive renal impairment.24 h SBP>150 mm Hg,24 h PP>58 mm Hg are significantly decreased 24 h DBP in hypertensive patients are considered as high risk for renal impairment.