摘要
目的了解诊室血压正常的慢性肾脏患者(CKD)夜间血压状况,夜间高血压的发生率。方法选择诊室血压正常的CKD患者236例,男69例,女167例,年龄平均(55.8±15.1)岁。根据肾小球滤过率(GFR)将患者分为CKD 1期(119例),GFR≥90ml/(min·1.73m^2),CKD 2期(73例),GFR 60~89ml/(min·1.73m^2),CKD 3~5期(44例),GFR分别为30~59ml/(min·1.73m^2),15~29ml/(min·1.73m^2),<15ml/(min·1.73m^2),正常对照组(50例)。采用美国Spacelab无创便携式动态血压监测仪进行24小时血压监测。结果发现夜间动态血压均值升高79例,达33.5%(79/236例),对照组无夜间高血压发生。夜间高血压以舒张压升高为主,其次为夜间收缩压及舒张压同时升高,46例患者仅夜间出现高血压。随着CKD分期的提高,CKD患者夜间收缩压也相应升高,但仅CKD3~5期组与CKD1期组差异有统计学意义(P<0.05),但3组夜间舒张压差异无统计学意义。同样,夜间高血压的发生率也随着CKD分期的提高而升高,3组分别为31.1%,35.6%,36.4%。结论血压正常的CKD患者夜间高血压发生率高,在CKD患者中应当提倡动态血压监测,以发现夜间高血压及其他异常情况,为临床诊断,治疗提供可靠依据。
Objective To investigate the conditions of night blood pressure in patients with chronic kidney disease（CKD）by normal blood pressure and the incidence of nocturnal hypertension.Methods A total of 236 CKD patients with normal blood pressure were selected,69 cases male,167 cases female,the average age（55.8±15.1）years old.The patients were divided into CKD1grade（1 194cases）,GFR≥90ml/（min·1.73m2）,CKD2grade（73cases）,GFR 60-89ml/（min·1.73m2）,CKD 3-5grade（44cases）,GFR 30-59ml/（min·1.73m2）,15-29ml/（min·1.73m2）,15 ml/（min·1.73 m2）,respectively,according to the glomerular filtration rate.Fifty healthy subjects were enrolled as control group.24 hambulatory blood pressure was monitored in these patients by Spacelab noninvasive ambulatory blood pressure instrument made in the United States.Results Nocturnal ambulatory blood pressure（mean）increased in 79 cases,33.5%（79/236cases）.But in control group,there was no nocturnal hypertension.Mainly night time diastolic blood pressure increased,others were either systolic or diastolic blood pressure increased.Forty-six patients had hypertension only in the night.The night time systolic blood pressure of CKD patients were also corresponding increased by the increased CKD stage,but only the CKD3-5phase group and CKD1 group showed significant differences（P〈0.05）.The night time diastolic blood pressure were no significant differences in three groups.The incidence of nocturnal hypertension in three groups were also corresponding increased by the increased CKD stage,31.1%,35.6%,36.4%,respectively.Conclusion The incidence of nocturnal hypertension was higher in CKD patients with normal blood pressure,so ambulatory blood pressure monitoring should be performed in CKD patients,in order to find the nocturnal hypertension and other abnormal situations as well as the evidence for clinical diagnosis and treatment.
作者
李松杨
陈松
马骏
武立群
易扬
宣怡
Li Songyang a Chen Songb Ma Juna Wu Liqungb Yi Yanga Xuan Yi(a. Department of Nephrolog b. Department of Geriatrics, Jing ＇ an District Central Hospital of Shanghai, Huashan Hospital ,Fudan University, Shanghai 200040,China)
出处
《临床荟萃》
CAS
2017年第3期224-227,232,共5页
Clinical Focus
基金
上海市卫生局科研课题研究(92009247)
上海市静安区卫生系统医学学科建设特色专科项目资金支持(JWXK201205)
关键词
肾炎
血压
高血压
nephritis
blood pressure
hypertension
