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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P<0.05);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P<0.05)。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P<0.05)。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。
Objective: To investigate the relationship between autonomic nervous function and early renal damage in elderly patients with mild to moderate essential hypertension. Methods: Totally 223 elderly patients with mild to moderate essential hypertension were enrolled in the Department of Cardiology of Civil Aviation General Hospital from January 2014 to June 2016. Urinary microalbuminuria (UAE) and urinary creatinine (Cr) were measured and divided into two groups according to ACR (urine UAE / urinary Cr × 0.113): 109 cases of normal ACR group and 114 cases of elevated ACR group. All patients underwent synchronous Holter monitoring and ambulatory blood pressure monitoring. Heart rate variability (HRV) and blood pressure variability (BPV) were recorded. The differences of HRV and BPV between the two groups were compared. Pearson correlation analysis and multivariate Logistic regression analysis were used to analyze the correlation between HRV and BPV indexes and early renal damage. Results: HRV index: The percentage of total heartbeats (PNN50), the mean RR (RR) mean standard deviation (SDNN), and heart rate RR interval Mean standard deviation (SDANN) were significantly lower than ACR normal group (all P <0.05); BPV indexes: 24h standard deviation of systolic blood pressure (24hSSD), daytime systolic blood pressure standard deviation (dSSD) and nighttime systolic blood pressure Differences (nSSD) were significantly higher than the ACR normal group (all P <0.05). Multivariate logistic regression analysis showed that mean 24h pulse pressure (24hPP), 24hSSD, SDNN and SDANN were significantly correlated with ACR (all P <0.05). CONCLUSIONS: Some HRV indexes and some BPV indexes in elderly patients with mild to moderate essential hypertension are independently correlated with ACR, suggesting that sympathetic activation is closely related to early renal damage in elderly patients with mild to moderate essential hypertension.