慢性肾脏病非透析患者血压昼夜节律与甲状旁腺素关系的研究

摘要

Objective To observe the change of 24-hour blood pressure and to explore the relation between abnormality of circadian rhythm and parathyroid hormone in predialysis patients with chronic kidney disease (≥3 stage). Methods Ambulatory blood pressure monitoring (ABPM) was conducted in 130 predialysis patients with chronic kidney disease. Two groups were identified with their ambulatory blood pressure: non-hypertension group 28 cases (24-h average blood pressure<130/80 mmHg) and hypertension group 102 cases (24-h average blood pressure≥ 130/80 mmHg). Blood routine, creatinine, urea, serum total calcium, serum phosphate, immunoreactive parathyroid hormone (iPTH), blood albumin etc were assessed. Results In non-hypertension group, nocturnal systolic blood pressure declined,nocturnal diastolic blood pressure declined and dipper percentage[M(QR)] were 6.8(7.3)% ,7. 3 (7.5)% and 8(28.6)%. In hypertension group, nocturnal systolic blood pressure declined, nocturnal diastolic blood pressure declined and dipper percentage were 4. 2(9. 0) % ,1.7(7.1) % and 25(24.5) %. Although significant difference was found in decline in nocturnal diastolic blood pressure, it was not found in decline in nocturnal systolic blood pressure and dipper percentage between two groups. Nocturnal systolic blood pressure declined and iPTH in 63 patients with 24-h average diastolic blood pressure ≥90 mmHg were 5.4(10.5) and (168. 12 ± 113. 87) ng/L, there was negatively correlation between them ( r = -0.414, P < 0. 05). In non-hypertension group, nocturnal systolic and diastolic blood pressure decline were negatively correlated to age ( r = -0.690, r = -0.631, all P < 0. 01). In hypertension group, nocturnal diastolic blood pressure decline was negatively correlated to usage of recombinant human erythropoietin. Conclusion Nocturnal blood pressure decline was negatively correlated to iPTH,in addition,it was correlated to age and usage of erythropoietin.%目的 观察慢性肾脏病非透析患者24小时血压动态变化,探讨血压昼夜节律异常与甲状旁腺素的关系.方法 随机选择承德市中心医院肾内科非透析的慢性肾脏病患者130例.动态血压监测采用携带式动态血压检测仪进行检测及数据分析.24小时平均血压≥130/80 mmHg(1 mmHg＝0.133 kPa)为高血压组102例,＜130/80mmHg为正常血压组28例.同时检测血常规及血肌酐、尿素、血钙、血磷、甲状旁腺素、白蛋白等生化指标.结果 正常血压组夜间收缩压下降率、夜间舒张压下降率、杓型血压比例[M(QR)]分别为6.8(7.3)％、7.3(7.5)％、8(28.6)％,高血压组夜间收缩压下降率、夜间舒张压下降率、杓型血压比例分别为4.2(9.0)％、1.7(7.1)％、25(24.5)％,两组间夜间舒张压下降率差异有统计学意义(P ＜0.01),但夜间收缩压下降率和杓型血压比例在两组间的差异无统计学意义.在高血压组平均舒张压≥90 mmHg的63例患者中夜间收缩压下降率为5.4(10.5)％,血全段甲状旁腺激素为(168.12±113.87) ng/L,两者呈负相关(r=-0.414,P＜0.05).在正常血压组28例中,夜间收缩压下降率和夜间舒张压下降率均和年龄呈负相关(r =-0.690,r=-0.631,均P＜0.01).在高血压组102例中,夜间舒张压下降率和重组人红细胞生成素用量呈负相关(r＝-0.430,P＜0.05).结论 慢性肾脏病非透析患者血压节律异常与血甲状旁腺素呈负相关；还与年龄、重组人红细胞生成素用量等因素有关.