不同阶段慢性肾脏病患者动态血压变化规律研究

摘要

目的：探讨不同阶段慢性肾脏病（CKD）患者动态血压的变化规律。方法选择2012年7-12月广西医科大学第四附属医院住院及门诊收治的 CKD 患者149例，根据肾小球滤过率（GFR）分组，GFR≥60 ml·min -1·（1.73 m2）-1为早期组（n ＝46）、15 ml·min -1·（1.73 m2）-1≤GFR ﹤60 ml·min -1·（1.73 m2）-1为中期组（n ＝54）、GFR ﹤15 ml·min -1·（1.73 m2）-1为晚期组（n ＝49）；将该院同期30例体检健康者作为对照组。分别测量各组受试者诊室血压及24 h 动态血压，记录相关指标进行比较分析。结果149例 CKD 患者中诊室血压升高58例（38.9％），24 h 动态血压升高74例（49.7％），非杓型血压91例（61.1％）。4组受试者诊室血压升高、动态血压升高及非杓型血压发生率比较：晚期组均高于中期组，中期组均高于早期组，早期组均高于对照组（P ﹤0.05）。日间平均收缩压（dSBP）、日间平均舒张压（dDBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）比较：晚期组均高于中期组，中期组均高于早期组，早期组均高于对照组（ P ﹤0.05）；夜间血压下降率比较：晚期组均低于中期组，中期组均低于早期组，早期组均低于对照组（P ﹤0.05）。结论 CKD 患者中高血压发生率较高且控制不良，不同阶段CKD 患者的血压升高程度及非杓型血压发生率随着肾功能减退逐渐升高。%Objective To explore the variation characteristics of ambulatory blood pressure(ABP)at different stages of chronic kidney disease(CKD). Methods A total of CKD 149 patients admitted to this hospital from July to December in 2012 were divided,according to glomerular filtration rate( GFR),into groups A〔 at early stage,n = 46,GFR≥60 ml· min - 1 ·(1. 73 m2 )- 1〕,B〔at medium stage,n = 54,15 ml·min - 1 ·(1. 73 m2 )- 1 ≤GFR ﹤ 60 ml·min - 1 ·(1. 73 m2 )- 1〕,C〔at terminal stage,n = 49,GFR ﹤ 15 ml·min - 1 ·(1. 73 m2 )- 1 〕. And 30 healthy subjects were enrolled as control group. Clinic blood pressure(BP),24 h ambulatory blood pressure(ABP)were measured,related indicators were ana-lyzed comparatively. Results In the 149 patients,58 had increased clinic BP(38. 9% ),74 had increased ABP(49. 7% ), 91 had non - dipper BP(61. 1% ). The incidences of increased BP,ABP,non - dipper BP were higher in group C than in group B,higher in group B than in group A,higher in group A than in group control(P ﹤ 0. 05). The mean daytime SBP and DBP,mean nighttime SBP and DBP were higher in group C than in group B,higher in group B than in group A,higher in group A than in group control(P ﹤ 0. 05). The BP decrease rate was lower in group C than in group B,lower in group B than in group A,lower in group A than in group control(P ﹤ 0. 05). Conclusion The hypertension incidence is high and poorly controlled in CKD patients. The BP level and non - dipper BP incidence increase gradually with renal dysfunction.