中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (08): 474-477.doi: 10.3969/j.issn.1671-4091.2015.08.008

• 临床研究 • 上一篇    下一篇

维持性血液透析患者清晨高血压与心脑血管事件的关系

唐雪莲1.2,万静芳1,林利容1,卢晓梅1.2,霍本刚1,何娅妮1,李开龙1   

  1. 400042 重庆，1第三军医大学大坪医院野战外科研究所肾内科
    400042 重庆，2第三军医大学在读研究生
  • 收稿日期:2015-04-29 修回日期:2015-05-16 出版日期:2015-08-12 发布日期:2015-08-12
  • 通讯作者: 何娅妮，李开龙 heynmail@yahoo.com或likailong1966@163.com E-mail:tangxuelian141@163.com
  • 基金资助:

    本课题为国家十二五支撑计划项目(No．2011BAI10B08)

Correlation between morning hypertension and cardiovascular and cerebrovascular events in maintenance hemodialysis patients

  • Received:2015-04-29 Revised:2015-05-16 Online:2015-08-12 Published:2015-08-12

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摘要： 【摘要】目的探讨维持性血液透析(MHD)患者清晨高血压(MH)与心脑血管事件的关系。方法选取174 例MHD 伴高血压患者采用动态血压监测仪记录44h 血压，根据清晨血压分为清晨高血压组(MH 组,104 例)和非清晨高血压组(NMH 组,70 例)，其中MH 组分3 型：持续型、非持续型、激增型。记录发生的心脑血管事件，随访2 年，比较2 组患者一般资料、心脑血管事件发生率及死亡率。结果与NMH 组相比，MH组透析间期体质量增加值、睡眠障碍发生率、清晨收缩压、心脑血管事件发生率(67.3%比40%)和死亡率(13.5%比2.9% )明显升高(P＜0.05)，单室尿素清除指数(spKt/V)值显著低于NMH 组(t=10.743,P＜0.01)；亚组中持续型患者心脑血管事件发生率(75.4%)高于激增型(66.7%)和非持续型(40%)(c2=8.815,P＜0.05)，3 亚组间心脑血管事件死亡率无显著差异(c2=0.798,P＞0.05)；MH 组患者清晨收缩压值与心脑血管事件发生率呈正相关(r=0.700,P＜0.01)。结论MHD 伴高血压患者MH 与心脑血管事件发生率密切相关，可能是心脑血管事件的独立危险因素。

关键词: 维持性血液透析, 清晨高血压, 心脑血管事件

Abstract: 【Abstract】Objective To investigate the correlation between morning hypertension (MH) and cardiovascular and cerebrovascular events in maintenance hemodialysis (MHD) patients. Methods Ambulatory blood pressure monitoring was done in 174 MHD patients with hypertension. They were classified as MH group (n= 104) and non-MH group (n=70) based on the morning blood pressure. MH group was further classified into 3 types: sustained type, non-sustained type, and surge type. They were followed up for 2 years, and cardiovascular and cerebrovascular events were recorded. General information, mortality and the incidence of cardiovascular and cerebrovascular events were compared between the two groups. Results Compared to non-MH group, weight gain in dialysis interval, the incidence of sleep disorders, morning systolic blood pressure (MSBP), the incidence of cardiovascular and cerebrovascular events (67.3% vs. 40%) and mortality (13.5% vs. 2.9%) were significantly increased (P＜0.05) but spKt/V was significantly decreased (t =10.743, P＜0.01) in MH group. The incidence of cardiovascular and cerebrovascular events was significantly higher in sustained type (75.4%) than in surge type (66.7%) and non-sustained type (40%) (c2= 8.815, P＜0.05), but the mortality was indifferent among the 3 types in MH group (c2=0.798, P＞0.05). The value of MSBP was positively correlated with the incidence of cardiovascular and cerebrovascular events in MH group (r=0.700, P＜0.01). Conclusion MH closely correlates with the incidence of cardiovascular and cerebrovascular events in MHD patients with hypertension. MH may be an independent risk factor of cardiovascular and cerebrovaseuar events.

Key words: maintenance hemodialysis, morning hypertension, cardiovascular and cerebrovaseuar events