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目的探讨糖尿病肾病(DN)患者24h动态血压变化,分析其与尿白蛋白的相关性。方法按Mogensen分期将患者194例分为4组:正常白蛋白尿组(尿白蛋白≤30mg/24h,n=71),微量白蛋白尿(MAU)组(尿白蛋白30～<300mg/24h,n=47)、大量白蛋白尿组(尿白蛋白≥300mg/24h,n=31)及肾功能不全组[尿白蛋白≥300mg/24h且eGFR≤60mL/(min·1.73m2),n=43]。观察各组动态血压、血压昼夜节律、平滑指数等的变化,分析其与尿白蛋白的相关性。结果随尿白蛋白增加及肾功能下降,24h、白昼及夜间的收缩压和舒张压均逐渐升高[24h平均收缩压由正常白蛋白尿组(125.4±14.6)增至肾功能不全组(146.6±13.3)mmHg,舒张压由(66.9±8.9)增至(83.0±8.8)mmHg,P<0.05],24h收缩压标准差由(9.3±2.2)增至(11.9±4.8)mmHg(P<0.05),收缩压及舒张压平滑指数逐渐降低(4组收缩压平滑指数分别为1.82±0.3、1.75±0.3、1.64±0.2、1.56±0.2,P<0.05)。Pearson相关分析显示,24h血压变化、血压标准差与24h尿白蛋白呈正相关(P<0.01),而夜间血压下降率及平滑指数与24h尿白蛋白呈负相关(P<0.05)。结论早期DN患者存在血压昼夜节律异常,且血压变异性增大。
Objective To investigate the changes of 24h ambulatory blood pressure (DN) in patients with diabetic nephropathy (DN) and analyze its correlation with urinary albumin. Methods According to the Mogensen stage, 194 patients were divided into 4 groups: normal albuminuria (urinary albumin ≤30mg / 24h, n = 71), microalbuminuria (MAU) group (urinary albumin30 ~ <300mg / 24h , n = 47), a large amount of albuminuria group (urinary albumin≥300mg / 24h, n = 31) and renal dysfunction group [urinary albumin≥300mg / 24h and eGFR≤60mL / (min · 1.73m2) = 43]. The changes of ambulatory blood pressure, blood pressure circadian rhythm, smoothness index and so on were observed, and its correlation with urinary albumin was analyzed. Results With increasing urinary albumin and decreasing renal function, systolic and diastolic blood pressures gradually increased in 24h and daytime [mean systolic blood pressure (24h) increased from normal albuminuria group (125.4 ± 14.6) to renal dysfunction group (146.6 (P <0.05). The standard deviation of systolic blood pressure increased from (9.3 ± 2.2) to (11.9 ± 4.8) mmHg at 24 h (P <0.05) ), Systolic pressure and diastolic pressure smoothness index gradually decreased (systolic pressure smoothing index of the four groups were 1.82 ± 0.3,1.75 ± 0.3,1.64 ± 0.2,1.56 ± 0.2, P <0.05). Pearson correlation analysis showed that the change of blood pressure and the standard deviation of blood pressure were positively correlated with 24h urine albumin (P <0.01), while the nighttime blood pressure declining rate and smoothness index were negatively correlated with 24h urinary albumin (P <0.05). Conclusion Early DN patients have abnormal circadian rhythm of blood pressure and blood pressure variability.