IgA肾病患者血压节律和血浆B型钠尿肽变化的临床价值

目的探讨IgA肾病患者血压节律与水钠负荷的关系。方法选择2008年2月-2012年1月收治的原发性IgA肾病103例,收集临床和病理资料。采用动态血压监测和血浆B型钠尿肽（BNP）测定观察患者的血压昼夜节律和夜间水钠负荷情况。结果本研究中高血压发生率为53.4%。高血压组中89.0%的患者呈非勺型血压节律,有10例（18.2%）甚至出现反勺型血压节律。正常血压组中54.2%的患者呈非勺型血压,两组比较有显著差异（P〈0.05）。高血压组的血浆BNP浓度显著高于正常血压组（P〈0.05）。高血压组90.9%的患者存在动脉内膜增厚,显著多于正常血压组（P〈0.05）。两组患者的尿蛋白量、血清肌酐（Scr）、白蛋白（Alb）、胆固醇（Chl）、肾小球滤过率（GFR）、CKD分期、HASS分级、左室收缩末期内径（LVDs）、舒张末期内径（LVDd）和射血分数（EF）均无显著差异（P〉0.05）。结论 IgA肾病在较早阶段即可出现血压昼夜节律的变化,该节律变化与血浆BNP水平相关,提示水钠负荷异常是IgA肾病发生血压昼夜节律变化的重要因素。限钠和临睡加用相应降压药可能有益于IgA肾病血压控制和血压节律的恢复。

The clinical value of blood pressure rhythm and plasma B-type natriuretic peptide in patients with IgA nephropathy

Objective To study the relation between circadian rhythm of blood pressure and loads of water sodium at night in patients with IgA nephropathy.Methods 103 cases of primary IgA nephropathy from February,2008 to January,2012 year registered in the hospital were included.Clinical and pathological data were collected.The changes of circadian rhythm of blood pressure and loads of water sodium at night were studied by the observation in patients with determination of ambulatory blood pressure monitoring and plasma B-type natriuretic peptide（BNP）.Results The incidence of hypertension was 53.4%.The incidence of nocturnal blood pressure was 89.0% in patients with hypertension.There were 10（18.2%） cases represented anti-spoon type of blood pressure.There were 54.2% of patients with nocturnal blood pressure in normal blood pressure group.There was significant difference in the two groups（P ＆gt;0.05）.Plasma BNP concentrations in hypertension group were significantly higher than in normal blood pressure group（P ＆lt; 0.05）.There were 90.9% patients with arterial intimal thickening in hypertension group.It was significantly more than normal blood pressure group（P ＆lt; 0.05）.There was no difference in amount of urinary protein and serum creatinine（Scr）,albumin（Alb）,cholesterol（Chl）,glomerular filtration rate（GFR）,CKD stages,HASS grading,left ventricular end diastolic diameter（LVDs）,end diastolic diameter（LVDd） and ejection fraction（EF）（P ＆gt; 0.05）.Conclusion Changes in the circadian rhythm of blood pressure can occur at an earlier stage of IgA nephropathy.Plasma BNP level was closely to the changes of rhythm,and so abnormal sodium load was important factor in circadian rhythms of blood pressure changes.Limiting sodium and appropriate antihypertensive drugs may be beneficial to blood pressure control and recovery of blood pressure rhythm in IgA nephropathy.