【摘要】：目的:探討老年輕、中度原發(fā)性高血壓患者自主神經(jīng)功能與早期腎損害的關(guān)系。方法:選取2014-01-2016-09在民航總醫(yī)院心內(nèi)科門診就診的老年輕、中度原發(fā)性高血壓患者223例。測定尿微量白蛋白(UAE)和尿肌酐(Cr),根據(jù)早期腎損害指標ACR(ACR=尿UAE/尿Cr×0.113)分為兩組:ACR正常組109例,ACR升高組114例。所有患者均進行同步動態(tài)心電圖及動態(tài)血壓監(jiān)測,記錄心率變異性(HRV)及血壓變異性(BPV)指標,比較兩組患者HRV和BPV的差異。分別采用Pearson相關(guān)分析法與多元Logistic回歸分析法,分析HRV和BPV指標與早期腎損害的相關(guān)性。結(jié)果:HRV指標:ACR升高組患者相鄰RR間期大于50ms所占總心動次數(shù)的百分比(PNN50)、所有心搏RR間期均值的標準差(SDNN)和每5 min心搏RR間期均值的標準差(SDANN)均明顯低于ACR正常組(均P0.05);BPV指標:ACR升高組24h收縮壓標準差(24hSSD)、白天收縮壓標準差(dSSD)和夜間收縮壓標準差(nSSD)均明顯高于ACR正常組(均P0.05)。多元Logistic回歸分析結(jié)果顯示:24h平均脈壓(24hPP)、24hSSD、SDNN和SDANN與ACR均呈顯著相關(guān)(均P0.05)。結(jié)論:老年輕、中度原發(fā)性高血壓患者部分HRV指標和部分BPV指標與ACR獨立相關(guān),提示交感神經(jīng)興奮與老年輕、中度原發(fā)性高血壓患者早期腎損害密切相關(guān)。
[Abstract]:Objective: to investigate the relationship between autonomic nerve function and early renal damage in elderly and young patients with moderate essential hypertension. Methods: 223 elderly and moderate essential hypertension patients were selected from the outpatient department of cardiology of civil aviation general hospital in 201401 / 2016. methods: 223 elderly and moderate essential hypertension patients were selected from the outpatient department of cardiology of civil aviation general hospital. Urinary microalbumin (UAE) and urinary creatine (Cr), were divided into two groups according to the early renal damage index ACR (ACR= urine UAE/ urine Cr 脳 0.113): normal ACR group (n = 109) and ACR elevated group (n = 114). Synchronous dynamic electrocardiogram (ECG) and ambulatory blood pressure monitoring were performed in all patients. Heart rate variability (HRV) and blood pressure variability (BPV) were recorded, and the differences of HRV and BPV between the two groups were compared. Pearson correlation analysis and multiple Logistic regression analysis were used to analyze the correlation between HRV and BPV indexes and early renal damage. Results: HRV index: the adjacent RR interval in the ACR group was greater than the percentage of 50ms in the total number of cardiac beats (PNN50). The standard deviation (SDNN) of the mean RR interval of all cardiac beats and the standard deviation (SDANN) of the mean RR interval of every 5 min beats were significantly lower than those of the normal ACR group (P 0.05). BPV index: 24 h systolic blood pressure standard deviation (24hSSD), daytime systolic blood pressure standard deviation (dSSD) and nocturnal systolic blood pressure standard deviation (nSSD) in ACR elevated group were significantly higher than those in ACR normal group (P 0.05). Multiple Logistic regression analysis showed that 24 h mean pulse pressure (24hPP), 24 h SSDs, SDNN and SDANN were significantly correlated with ACR (P 0.05). Conclusion: some HRV indexes and some BPV indexes are independently correlated with ACR in elderly, young and moderate essential hypertension patients, suggesting that sympathetic nerve excitation is closely related to early renal damage in young and moderate essential hypertension patients.
【作者單位】： 北京大學民航總醫(yī)院心內(nèi)科;北京大學民航總醫(yī)院檢驗科;
【分類號】：R544.1;R692

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