动态血压与高血压左心室肥厚及肾功能的关系

摘要

Objective To study the relationship between 24-hour ambulatory blood pressure (ABP) and left ventricular hypertrophy (LVH) and renal function. Methods 52 hypertension patients were studied through 24-hour ABP,echocardiography,renal function and routine urine test. All the patients were divided into normal blood pressure control group and abnormal blood pressure group,normal daytime blood pressure group and abnormal daytime blood pressure group,normal nighttime blood pressure group and abnormal nighttime blood pressure group,dipper and non-dipper group,LVH and non-LVH group. Echocardiography,renal function and ABP parameters were compared in these groups. Results IVST,PWT and LVM were significantly higher in abnormal blood pressure group,abnormal daytime blood pressure group and abnormal nighttime blood pressure group than those in normal group. LVMI were significantly higher in abnormal blood pressure group and abnormal nighttime blood pressure group than those in normal group (P< 0.05). LVDd.LVM and LVMI were higher in non-dipper group versus dipper group,but the differences were not significant (P > 0.05). 24 h-SBP and nSBP were significantly higher in LVH group compared to non-LVH group (P < 0.05 ). Urinary protein was found to be positively correlated with 24h-SBP through bivariate correlation analysis (r= 0.443,P= 0.001). Conclusion Nocturnal blood pressure,especially systolic blood pressure level in hypertension patients, was closely related with target organ damages such as left ventricular hypertrophy and impairment of renal function.%目的 探讨24h动态血压与左心室肥厚及肾功能的关系.方法 对52例高血压患者进行24 h动态血压监测、超声心动图、肾功能检测,根据监测结果分为24h、白昼、夜间平均血压正常和升高组及杓型血压组、非杓型血压组,比较各组超声心动图各参数及肾功能的变化.比较左心室肥厚(LVH)组和非LVH组动态血压各参数的变化.结果 24h、白昼、夜间平均血压升高组室间隔厚度(IVST)、左室后壁厚度(PWT)、左室心肌质量(LVM)均明显高于24h、白昼、夜间平均血压正常组；24h、夜间平均血压升高组左室质量指数(LVMI)高于24h、夜间平均血压正常组,差异均有统计学意义(P＜0.05)；非杓型血压组左心室舒张末期内径(LVDd)、LVM、LVMI较杓型组略增大,但差异无统计学意义(P＞0.05)；LVH组的24h平均收缩压(24 h SBP)及夜间平均收缩压(nSBP)均明显高于非LVH组,差异有统计学意义(P＜0.05)；尿蛋白与24h平均血压的两变量相关性分析结果显示,尿蛋白与24 h SBP呈正相关(r=0.443,P=0.001).结论 高血压患者的夜间血压,尤其是收缩压水平,与左心室肥厚及肾功能损害关系密切.