目的 研究单纯原发性高血压及原发性高血压合并2型糖尿病对患者血压昼夜节律及早期肾功能的影响.方法 选取高血压病患者150例,按是否合并2型糖尿病,分为对照组和2型糖尿病组,每组75例.治疗后通过比较两组血压、血压变异性(采用血压标准差表示)及NGAL和KIM-1水平,以有急性肾功能损伤(acute kidney iniury,AKI)为因变量,进行Logistic回归分析.结果 2型糖尿病组首诊3月后24 h收缩压和舒张压、夜间收缩压和舒张压、白昼收缩压、非杓型节律的比例、24 h收缩压标准差、24 h收缩压和舒张压变异系数、KIM-1浓度及AKI比例高于对照组(P<0.05),夜间收缩压和夜间舒张压下降百分率较对照组降低(P<0.05).Logistic回归分析显示,夜间舒张压下降率是AKI保护因素(OR=0.834),糖尿病是AKI的危险因素(OR=3.237).结论 糖尿病能明显增强高血压患者的血压昼夜节律的异常改变,是高血压患者发生AKI的独立危险因素,夜间舒张压下降率是AKI保护因素.%Objective To explore the effect of the essential hypertension (EH) and EH combined with type 2 diabetes mellitus (T2DM) on the circadian rhythm of blood pressure and early renal damage. Methods A total of 150 EH patients were recruited in this study and divided into the control group and the T2DM group by the standard of whether EH was combined with T2DM, and each group included 75 cases. After 3 months of treatment, the comparisons were made between the two groups in their blood pressure, blood pressure variability (indicated by standard deviation of blood pressure) and the levels of NGAL and KIM-1. Logistic regression analysis was conducted with AKI as the dependent variable. Results After 3 months of treatment, the T2DM group was significantly higher than the control group in 24h systolic blood pressure (24h SBP), 24h diastolic blood pressure (24h DBP), nighttime SBP and DBP, daytime SBP, ratio of non-dipper rhythm, standard deviation of the 24h SBP, variation coefficient of 24h SBP (SVC) and 24h DBP (DVC), the concentration of KIM-1and the incidence of AKI respectively (P<0.05), while it was significantly lower than the control group in nighttime DBP fall (DBPF) and nighttime SBP fall (SBPF) (P<0.05). The results of Logistic regression analysis showed that DBPF was a protective factor for AKI (OR=0.834) while T2DM was a risk factor for it (OR=3.237). Conclusion T2DM can significantly increase the incidence of abnormal blood pressure circadian rhythm in hypertensive patients and it is an independent risk factor for AKI. DBPF is a protective factor for AKI.
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