老年轻、中度高血压患者自主神经功能与早期肾损害的关系

发布时间：2019-07-27 07:45

【摘要】：目的:探讨老年轻、中度原发性高血压患者自主神经功能与早期肾损害的关系。方法:选取2014-01-2016-09在民航总医院心内科门诊就诊的老年轻、中度原发性高血压患者223例。测定尿微量白蛋白(UAE)和尿肌酐(Cr),根据早期肾损害指标ACR(ACR=尿UAE/尿Cr×0.113)分为两组:ACR正常组109例,ACR升高组114例。所有患者均进行同步动态心电图及动态血压监测,记录心率变异性(HRV)及血压变异性(BPV)指标,比较两组患者HRV和BPV的差异。分别采用Pearson相关分析法与多元Logistic回归分析法,分析HRV和BPV指标与早期肾损害的相关性。结果:HRV指标:ACR升高组患者相邻RR间期大于50ms所占总心动次数的百分比(PNN50)、所有心搏RR间期均值的标准差(SDNN)和每5 min心搏RR间期均值的标准差(SDANN)均明显低于ACR正常组(均P0.05);BPV指标:ACR升高组24h收缩压标准差(24hSSD)、白天收缩压标准差(dSSD)和夜间收缩压标准差(nSSD)均明显高于ACR正常组(均P0.05)。多元Logistic回归分析结果显示:24h平均脉压(24hPP)、24hSSD、SDNN和SDANN与ACR均呈显著相关(均P0.05)。结论:老年轻、中度原发性高血压患者部分HRV指标和部分BPV指标与ACR独立相关,提示交感神经兴奋与老年轻、中度原发性高血压患者早期肾损害密切相关。
[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.
【作者单位】：北京大学民航总医院心内科;北京大学民航总医院检验科;
【分类号】：R544.1;R692

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