临床荟萃

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血压正常的慢性肾脏病患者的夜间血压研究

  

  1. 上海静安区中心医院(复旦大学附属华山医院静安分院),a.肾内科; b.老年科,上海  200040
  • 出版日期:2017-03-05 发布日期:2017-03-06
  • 通讯作者: 通信作者:李松杨, Email: shlisongyang@163.com
  • 基金资助:
    上海市卫生局科研课题研究(92009247);上海市静安区卫生系统医学学科建设特色专科项目资金支持(JWXK201205)

Study of nocturnal hypertension in patients with chronic kidney disease by normal blood pressure

  1. a.Department of Nephrology;  b.Department of Geriatrics, Jing’an District Central Hospital
    of Shanghai, Huashan Hospital,Fudan University, Shanghai 200040,China
  • Online:2017-03-05 Published:2017-03-06
  • Contact: Corresponding author: Li Songyang,Email: shlisongyang@163.com

摘要: 目的了解诊室血压正常的慢性肾脏患者(CKD)夜间血压状况,夜间高血压的发生率。方法选择诊室血压正常的CKD患者236例,男69例,女167例,年龄平均(55.8±15.1)岁。根据肾小球滤过率(GFR)将患者分为CKD 1期(119例),GFR≥90  ml/(min·1.73 m2),CKD 2期(73例),GFR 60~89 ml/(min·1.73 m2),CKD 3~5期(44例),GFR 分别为30~59 ml/(min·1.73 m2),15~29 ml/(min·1.73 m2),<15 ml/(min·1.73 m2),正常对照组(50例)。采用美国Spacelab无创便携式动态血压监测仪进行24小时血压监测。结果发现夜间动态血压均值升高79例,达33.5%(79/236例),对照组无夜间高血压发生。夜间高血压以舒张压升高为主,其次为夜间收缩压及舒张压同时升高,46例患者仅夜间出现高血压。随着CKD分期的提高,CKD患者夜间收缩压也相应升高,但仅CKD3~5期组与CKD1期组差异有统计学意义(P<0.05),但3组夜间舒张压差异无统计学意义。同样,夜间高血压的发生率也随着CKD分期的提高而升高,3组分别为31.1%,35.6%,36.4%。结论血压正常的CKD患者夜间高血压发生率高,在CKD患者中应当提倡动态血压监测,以发现夜间高血压及其他异常情况,为临床诊断,治疗提供可靠依据。

关键词: 肾炎, 血压, 高血压

Abstract: ObjectiveTo investigate the conditions of night blood pressure in patients with chronic kidney disease (CKD) by normal blood pressure and the incidence of nocturnal hypertension. MethodsA total of 236 CKD patients with normal blood pressure were selected, 69 cases male, 167 cases female, the average age (55.8±15.1)  years old. The patients were divided into CKD1 grade (1 194 cases), GFR≥90 ml/(min·1.73 m2),CKD2 grade (73 cases), GFR 6089 ml/(min·1.73 m2),CKD 35 grade (44 cases), GFR 3059 ml/(min·1.73 m2),1529  ml/(min·1.73 m2),<15  ml/(min·1.73 m2),respectively,according to the glomerular filtration rate. Fifty healthy subjects were enrolled as control group.  24 h ambulatory blood pressure was monitored in these patients by Spacelab noninvasive ambulatory blood pressure instrument made in the United States. ResultsNocturnal ambulatory blood pressure(mean)  increased in 79 cases, 33.5%(79/236 cases). But in control group,there was  no nocturnal hypertension. Mainly night time diastolic blood pressure increased,others were either systolic or diastolic blood pressure increased. Fortysix patients had hypertension only in the night. The night time systolic blood pressure of CKD patients were also corresponding increased by the increased CKD stage, but only the CKD35 phase group and CKD1 group showed significant differences(P<0.05). The night time diastolic blood pressure were no significant differences in three groups. The incidence of nocturnal hypertension in three groups were also corresponding increased by the increased CKD stage,31.1%,35.6%,36.4%,respectively. ConclusionThe incidence of nocturnal hypertension was higher in CKD patients with normal blood pressure, so ambulatory blood pressure monitoring should be performed in CKD patients, in order to find  the  nocturnal  hypertension  and other abnormal situations as well as  the evidence for clinical diagnosis and treatment.

Key words: nephritis, blood pressure, hypertension