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目的:分析比较由糖尿病(DN)肾病和非糖尿病导致的慢性肾脏病患者的动态血压变化情况,探讨糖尿病肾病患者动态血压变化的特点。方法:选择62例符合慢性肾脏病诊断标准的DN患者,均无肾脏替代治疗。观察其24 h动态血压监测结果,并与152例年龄、性别、肾功能等匹配的非糖尿病的CKD患者的动态血压结果相比较。结果:在对62例DN患者和152例非糖尿病CKD患者动态血压的分析中,我们发现:(1)DN组的24 h平均收缩压、日间平均收缩压、夜间平均收缩压均显著高于非DN组。(2)两组患者血压变异性差异无统计学意义;夜间血压下降率普遍较小,但差异无统计学意义。(3)DN组收缩压负荷均显著高于非DN组。(4)DN组非杓型节律的发生率为90.3%,非DN组为81.6%,两组血压节律类型差异无统计学意义。(5)非DN组和DN组24 h尿蛋白量与夜间收缩压均具有显著正相关。结论:中晚期DN患者收缩压控制较非糖尿病的CKD患者更差,血压非杓型节律现象比较普遍。夜间收缩压与24 h尿蛋白排泄量密切相关。
Objective: To analyze and compare the dynamic changes of ambulatory blood pressure in patients with chronic kidney disease (DN) caused by diabetic nephropathy and non-diabetic patients and to investigate the characteristics of ambulatory BP changes in diabetic nephropathy patients. Methods: Sixty-two DN patients who meet the diagnostic criteria of chronic kidney disease were selected, and no renal replacement therapy was used. The 24-h ambulatory blood pressure monitoring results were compared with ambulatory blood pressure results of 152 non-diabetic CKD patients with age, gender, and renal function. Results: In the analysis of 62 patients with DN and 152 patients with non-diabetic CKD ambulatory blood pressure, we found: (1) 24 h mean systolic blood pressure, daytime average systolic blood pressure and nighttime systolic blood pressure in DN group were significantly higher than Non-DN group. (2) There was no significant difference in blood pressure variability between the two groups. The rate of nocturnal blood pressure decline was generally small, but the difference was not statistically significant. (3) The systolic pressure load of DN group was significantly higher than that of non-DN group. (4) The incidence of non-dipper rhythm in DN group was 90.3% and that in non-DN group was 81.6%. There was no significant difference in the types of blood pressure rhythm between the two groups. (5) There was a significant positive correlation between 24-hour urinary protein and nocturnal systolic pressure in non-DN group and DN group. Conclusion: The systolic blood pressure in patients with advanced stage DN is worse than CKD patients without diabetes, and the prevalence of non-dipper rhythm is more common. Nocturnal systolic blood pressure and 24 h urinary protein excretion is closely related.