肾实质性高血压患者血压变异与血管内皮功能的相关性研究及对心脏的影响

【摘要】 目的:分析血压变异与血管内皮功能的相关性,探讨血压变异对左心室结构的影响。方法:选择我院2011年12月至2012年12月收治的92例肾小球疾病患者进行前瞻性研究,其中男性47例,女性45例,年龄26~82(平均49.7)岁。按照CKD-EPI公式估算肾小球滤过率,据K/DOQI指南分组:1期36例,2期30例,3~5期26例。所有患者行24小时动态血压监测和超声心动图检查,用放射免疫法检测血浆内皮素-1含量,硝酸还原酶法检测血浆一氧化氮含量,酶联免疫吸附法检测血浆血管性假血友病因子含量。按照血压水平分为血压正常组(44例)和血压升高组(48例),分析比较不同肾功能和有无高血压组间血压变异、血管内皮功能指标和左心室质量指数的差异并分析原因。数据采用SPSS 13.0统计软件包分析。计量资料以x±s表示,多组间检验用单因素方差分析,血压变异、血管内皮功能指标和左心室质量指数间做多元线性回归分析,P<0.05认为差异有统计学意义。结果:1慢性肾脏疾病各组间患者年龄、性别构成比、吸烟者比率等一般资料无统计学差异。随着肾功能减退,CKD患者血浆内皮素-1含量增加(54.08±20.65pg/ml,74.27±25.67pg/ml,110.63±47.86pg/ml,P<0.01);一氧化氮含量减少(87.61±23.86umol/L,64.72±19.65umol/L,45.63±15.32umol/L,P<0.05);血管性假血友病因子含量增加(98.68±11.76%,105.12±13.91%,120.81±8.37%,P<0.05);血压昼夜节律消失非勺型比率增大(67.3%,70.6%,88.5%,P<0.05);左心室重塑加重:左室质量指数增大(75.06±14.29g/M2,107.10±18.46g/M2,125.56±44.40g/M2,P<0.01)。2随着肾功能减退,平均收缩压及收缩压变异增大(P<0.05);平均舒张压、舒张压变异增大(P>0.05);收缩压和舒张压夜间下降值均减少(P<0.05)。但Q检验示1期、2期组间无统计学差异。3血压正常组与血压升高组间年龄、性别构成比、吸烟者比率等一般资料无统计学差异。血压升高组血浆内皮素-1增加(67.48±20.29pg/ml vs 84.13±23.34pg/ml,P<0.05);血管性假血友病因子增加(94.59±19.21%vs100.91±18.81%,P>0.05);血浆一氧化氮减低(67.62±18.26umol/L vs 47.19±14.56umol/L,P<0.05);左室重塑明显加重(86.98±27.81g/M2 vs 117.78±44.53g/M2,P<0.01)。4血压升高组平均血压、血压变异、非勺型比率增加(P均<0.05)。5血压变异与内皮素-1呈正相关(r=0.207~0.686,P<0.05),与一氧化氮呈负相关(r=﹤0.199~﹤0.417,P<0.05),与左心室质量指数呈正相关,血压变异加重了左室重塑(r=0.303~0.636,P<0.05)。结论:随肾功能减低血管内皮损伤加重,血压昼夜节律异常增加,平均血压及血压变异增大,左心室质量指数增加。血压变异增大加重了内皮损伤及左心室重塑。更多还原

【Abstract】 Objective:To analyse the relationship between blood pressure variability and vascular endothelial function and to explore affect of blood pressure variability on left ventricular structure. Methods:92 cases with renal hypertension were chosen for a prospective study from the Nephrology in the Second Hospital of Hebei Medical University from 2011/12 to 2012/12, male 47 cases, female 45 cases, aged 26 years old to 82 years old, average 49.7 years old. According to the K/DOQI guidelines: stage1 36 cases, stage2 30 cases, stage3~5 26 cases. All patients underwent 24-hour ambulatory blood pressure monitoring and echocardio- graphy, detected the plasma endothelin-1 content by radioimmuno- assay, plasma nitric oxide levels by nitrate reductase method detects, plasma von Willebrand factor content using enzyme-linked immunosorbent assay. Meanwhile all cases were divided into two groups according to blood pressure levels: the normal blood pressure group(44 cases) and the elevated the blood pressure group(48 cases). Blood pressure variation, vascular endothelial function index and left ventricular mass index in different enal function groups and blood pressure groups were compared to clear differences and causes. Data were analyzed using the SPSS 13.0 statistical software, Measurement data were writed as x ±s. A multiple linear regression analysis was used to analysed differences between blood pressure variability, vascular endothelial function index and left ventricular mass index. And P <0.05 for the difference was statistically significant.Results: 1 Differences in age, sex ratio, smokers ratio, fasting glucose, uric acid, high-sensitivity C-reactive protein, body mass index general, serum sodium and urinary sodium between three groups were not statistically significant. With renal dysfunction, plasma endothelin-1 levels gradually increased(54.08±20.65pg/ml, 74.27±25.67pg/ml, 110.63± 47.86pg/ml, P<0.01); Nitric oxide content gradually decreased(87.61±23.86 umol/L, 64.72±19.65umol/L, 45.63±15.32umol/L, P<0.05); Von Willebrand fa- ctor content gradually increased(98.68±11.76%, 105.12±13.91%, 120.81± 8.37%, P<0.05); the non dipper blood pressure ratio of blood pressure circadian rhythm gradually increased(67.3%, 70.6%, 88.5%, P<0.05); Left ventricular remodeling increased: left ventricular mass index increased gradually(75.06±14.29g/M2, 107.10±18.46g/M2, 125.56±44.40g/M2, P<0.01).2 With renal dysfunction, average systolic blood pressure values and systolic blood pressure variability gradually increased(P<0.05); average diastolic blood pressure values and diastolic blood pressure variation gradually increased(P>0.05); But a Q test showed no significant between stage 1 group and stage 2 group.3 Differences in age, sex ratio, smokers ratio, fasting glucose, uric acid, high-sensitivity C-reactive protein, body mass index general, serum sodium and urinary sodium between the normal blood pressure group and the high blood pressure group were not statistically significant.The comparision between the elevated blood pressure group and the normal blood pressure group: content of plasma endothelin-1 in the elevated blood pressure group, 84.13± 23.34pg/ml, were higher than that in the normal blood pressure group, 67.48±20.29pg/ml(P<0.05); content of von Willebrand factor was higher than that in the normal blood pressure group(P>0.05); the content of pasma nitric oxide in the elevated blood pressure group, 47.19±14.56umol/L, was lower than that in the normal blood pressure group, 67.62±18.26umol/L(P<0.05); left ventricular remodeling increased in the elevated blood pressure group(117.78±44.53g/M2 VS 86.98±27.81g/M2 P<0.01).4 average blood pressure, blood pressure variability and the non dipper blood pressure ratio in the elevated blood pressure group were higher(P <0.05).5 There was a positive correlation between blood pressure variability and endothelin-1(r=0.207~0.686, P<0.05), and a negative correlation between blood pressure variability and nitric oxide(r=﹣0.199~﹣0.417, P<0.05), and a positive correlation between blood pressure variability and LVMI, blood pressure variability increased left ventricular remodelin(r=0.303~0.636, P <0.05).Conclusions: 1 With reduced kidney function in end stage kidney diseases, endothelial dysfunction, abnormal blood pressure circadian rhythm, the average blood pressure and blood pressure variability values all increased, which increased the likelihood of occurrence of left ventricular hypertrophy.2 The blood pressure variability increases emphasis the vascular endothelial injury and the process of left ventricular remodelling.更多还原