慢性肾功能衰竭患者血压变化特点的临床研究

目的探讨慢性肾功能衰竭(肾衰)合并高血压的非透析患者血压昼夜节律特点,以及与肾功能、钙、磷、白蛋白、血脂、心脏结构和功能的关系。方法慢性肾衰合并高血压的非透析患者(A组)30例,男16例,女14例,血肌酐(307.93±97.13)μmol/L;肾功能正常的原发性高血压患者(B组)30例,男、女各15例,分别检测24h动态血压、血生化,计算肌酐清除率,行心脏彩超检查,记录左心房内径、左心室舒张末期内径、室间隔舒张期厚度和左室后壁舒张期厚度,计算射血分数,6个月后重复上述检查。分析血压节律改变的影响因素,昼夜血压的改变对肾功能及心脏结构和功能的影响。按夜间与日间平均动脉压比值是否大于0.9,根据血压昼夜变化曲线分为杓型组(A1和B1)与非杓型组(A2和B2)。结果A2组和B2组患者夜间血压明显升高;A组非杓型比例高于B组,其夜间高血压对肾功能及心脏结构和功能均有影响。结论慢性肾衰合并高血压患者与肾功能正常的原发性高血压患者相比,非杓型比例增加,夜间血压水平对肾功能及心脏结构和功能均有影响。

Clinical characteristics of blood pressure changes in chronic renal failure patients

Objective To describe the patterns of diurnal blood pressure change in patients with chronic renal failure(CRF). Methods Thirty patients with CRF and hypertension were studied, and 30 primary hypertension patients with normal renal function were selected as control group. Everyone received 24 hours ambulatory blood pressure monitoring and blood examination including serum creatinine (Cr), blood urea nitrogen (BUN),total circulation hemoglobin(TCH),trigeminal ganglion(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL), gave them cardiac Doppler and recorded diameter of left atrium and left ventricle, thickness of posterior wall of left ventricle during end stage of diastolic period, thickness of interventricular septum, ejection fraction(EF). Repeated the above after 6 months. Result The diurnal blood pressure could be divided into dipper and non-dipper patterns according to 24 hours ambulatory blood pressure monitoring. In the control group, there was significant difference in ages .In both groups, there were significant difference in nocturnal systolic blood pressure. Conclusion Nocturnal hypertension of CRF patients has significant influence on the progression of renal function,and has significant correlation with renal function,cardiac structure and function.