摘要：
目的 探讨在合并多种慢性疾病的状态下,血压昼夜节律与血清白蛋白及胆红素等指标的关系.方法 选择2012-2015年我院6个科室患者为研究对象.排除标准:合并危及生命的疾病,如严重的心动过缓、急性心肌梗死、主动脉夹层、各种慢性疾病终末期等.行24h动态血压监测,根据夜间血压下降10％为标准,将患者分为杓型组和非杓型组,比较两组的临床特点和生化指标.结果 ①共入选1113名患者,其中杓型组783例、非杓型组330例.两组间年龄[(62.7±14.5)岁比(68.7±13.8)岁]、冠心病(145例比97例)、脑卒中(226例比119例)、糖尿病(142例比87例)、慢性肾功能不全(30例比24例)、不稳定型心绞痛(59例比42例)比较差异有统计学意义(P＜0.05).②杓型组总蛋白[(68.3±6.2)g/L比(68.3±6.2)g/L]、白蛋白[(42.6±4.1)g/L比(41.5±4.4)g/L]、前白蛋白[(243.6±65.1)g/L比(299.4±69.2)g/L]、白球比例(1.71±0.35比1.65±0.35)均高于非杓型组(P＜0.05).杓型组直接胆红素/总胆红素比值(0.308±0.066比0.321±0.070)低于非杓型组(P＜0.05).③多因素Logistic回归提示,年龄、合并冠心病、慢性肾功能不全、血清白蛋白浓度及直胆/总胆比值是血压昼夜节律的独立相关因素.结论 血清白蛋白、直胆/总胆比值与血压的昼夜节律相关.%Objective To investigate the relationship of BP circadian rhythm with serum albumin and bilirubin in these people.Methods All patients who admitted into six departments of Taixing People's Hospital from 2012 to 2015,were included in this study.However,some of them had been excluded if they composited with certain serious diseases,such as acute myocardial infarction,aortic dissection,end-staged of liver,renal,or heart diseases,and so on.All of them underwent 24 hours ambulatory blood pressure monitoring (ABPM) as soon as they were admitted.According whether those systolic blood pressure(SBP) decreased by 10％ or more during the nighttime,those patients were divided into two groups respectively,the dippers and the non-dippers.Besides ABMP,the serum hepatic enzyme,serum albumin and bilirubin were measured and recorded before treatment,and the complications were diagnosed before discharged.Results Up to 1113 patients were enrolled in this study.783 of them were dippers,while 330 were non-dippers.Dippers were older than non-dippers [(62.7±14.5)years vs.(68.7± 13.8)years].And patients in dippers have more coronary heart disease(145 cases vs.97 cases),stroke (226 cases vs.119 cases),diabetes mellitus(142 cases vs.87 cases),chronic renal insufficiency(30 cases vs.24 cases) than those in non-dippers.Dipper patients had higher levels of serum total protein,albumin,prealbumin and ratio of albumin/globulin compared to nor-dippers [(68.3±6.2)g/L vs.(67.4±6.5)g/L,(42.6±4.1)g/L vs.(41.5±4.4)g/L,(243.6±65.1)g/L vs.(229.4±69.2)g/L,and (1.71±0.35)g/L vs.(1.65±0.35)g/L,P＜0.05 respectively].Also ratio of direct bilirubin/total bilirubin in dippers was statistically lower compared to those in nondippers(0.308±0.06 vs.0.321±0.070,P=0.006).With multivariate logistic regression analysis,several factors,including serum albumin and bilirubin were found to independently associate with the circadian rhythm.Conclusion Serum albumin and bilirubin are correlate with the circadian rhythm independently.
