263例中老年慢性肾病患者血压昼夜节律及蛋白尿、肾功能损害关系.doc

263例中老年慢性肾病患者血压昼夜节律及蛋白尿、肾功能损害关系 　 作者：俞荣强，沈开跃，郑宇琳 【摘要】 目的 观察中老年慢性肾病(CKD)患者24h血压动态变化情况，探讨昼夜节律异常与蛋白尿、肾功能损害的关系。方法 随机选择本院内科住院及肾脏科门诊中老年CKD患者263例。全部患者均监测24h动态血压，动态血压监测(ABPM)采用携带式动态血压检测仪。根据患者24h血压动态变化情况分为血压昼夜节律正常组48例;血压昼夜节律消失组215例，其中夜间血压大于白天组93例。分组讨论各组尿微量白蛋白尿、24h尿蛋白定量及肾功能情况。结果 血压昼夜节律消失组，特别是夜间血压大于白天组的尿微量白蛋白、24h尿蛋白定量明显高于血压昼夜节律正常组，且其肾功能受损情况严重。结论 在中老年慢性肾病患者中普遍存在血压昼夜节律消失情况;血压昼夜节律的消失明显与慢性肾病患者的尿微量白蛋白、24h尿蛋白定量、肾脏受损程度相关。 【关键词】 慢性肾病;动态血压监测;昼夜节律;蛋白尿;肾功能 　　【Abstract】 Objective To observe the change of 24-hour blood pressure and explore the relation between abnormality of circadian blood pressure rhythm, albuminuria and renal injury in middle and old aged patients with chronic kidney disease. Methods Circadian blood pressure rhythm was studied by ambulatory 24-hour monitoring in 263 patients with chronic kidney disease. Ambulatory blood pressure monitoring (ABPM) was performed with a portable oscillometric recorder. According to 24h blood pressure in patients with dynamic changes in circadian rhythm of blood pressure was divided into 48 cases of normal group. Circadian rhythm of blood pressure group of 215 cases of disappeared, in which 93 cases of blood pressure at nighttime higher than during daytime. Microalbuminuria, 24h urinary protein and renal function were discussed in each group.Results The results of blood pressure circadian rhythm in the disappearance of group, especially serious at the group of blood pressure at nighttime higher than during daytime, the CKD patients with microalbuminuria, a 24-hour urinary protein was significantly higher than the normal circadian rhythm of blood pressure group, and it was seriously impaired renal function. Conclusion In middle and old aged patients with chronic kidney disease are prevalent in the disappearance of the situation of circadian rhythm of blood pressure. The disappearance of circadian rhythm of blood pressure significantly in patients with chronic kidney disease and urinary albumin, 24-hour urinary protein and the degree of kidn