论文部分内容阅读
目的探讨中老年原发性高血压(EH)患者动态脉压相关指数即24 h平均脉压(24 h PP)、动态脉压指数(PPI)和动态动脉硬化指数(AASI)预测早期肾脏损害的意义。方法对104例中老年EH患者进行血压测量和24 h动态血压监测,观察不同24hPP、PPI、AASI、肾小球滤过率(GFR)、微量白蛋白尿(MAU)及血清胱抑素C(Cys-C)的变化;采用受试者工作特征曲线(ROC)判断24hPP、PPI和AASI在预测肾脏功能早期受损的意义;采用多元线性逐步回归分析肾脏功能早期受损相关因素。结果以24hPP≥55 mm Hg、PPI≥0.36及AASI≥0.30为切点,高血压患者的GFR水平明显低(P<0.01);24hPP、PPI和AASI的ROC下面积从大到小依次为AASI、PPI和24hPP;多元线性逐步回归结果显示年龄(P=0.009)和高血压病程(P=0.008)与GFR的变化密切相关,且随着年龄的增长和高血压病程的延长,GFR有逐渐下降的趋势;相关和多因素回归分析结果显示GFR与年龄(r=-0.367,P=0.001)、高血压病程(r=-0.371,P=0.001)、24hPP(-0.254,P=0.009)、PPI(-0.262,P=0.007)及AASI(-0.316,P=0.001)呈负相关。结论动态脉压相关指数是预测中老年EH患者早期肾脏功能受损的有用指标,年龄和高血压病程是预测EH患者早期肾功能受损的重要指标。
Objective To investigate the predictive value of dynamic pulse pressure related index (24 h PPr), dynamic pulse pressure index (PPI) and dynamic atherosclerosis index (AASI) in early middle age patients with essential hypertension (EH) significance. Methods A total of 104 middle-aged and elderly patients with EH underwent blood pressure measurement and 24-hour ambulatory blood pressure monitoring. The changes of 24hPP, PPI, AASI, glomerular filtration rate (GFR), microalbuminuria (MAU) and serum cystatin C Cys-C). The receiver operating characteristic curve (ROC) was used to determine the significance of 24hPP, PPI and AASI in predicting early renal damage. Multiple linear stepwise regression was used to analyze the correlation of early renal impairment. Results Hypotension patients had a significantly lower level of GFR (P <0.01) at 24 h PP ≥55 mm Hg, PPI ≥0.36 and AASI ≥0.30. The areas of ROC under 24hPP, PPI and AASI were AASI, PPI and 24hPP. The results of multiple linear stepwise regression showed that age (P = 0.009) and duration of hypertension (P = 0.008) were closely related to the changes of GFR. With the increase of age and duration of hypertension, GFR decreased gradually (R = -0.371, P = 0.001), 24hPP (-0.254, P = 0.009), PPI (r = -0.367, P = 0.001) -0.262, P = 0.007) and AASI (-0.316, P = 0.001). Conclusions The dynamic pulse pressure index is a useful predictor of early renal impairment in middle-aged and elderly patients with EH. Age and duration of hypertension are important predictors of early renal impairment in EH patients.