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目的探讨高血压合并2型糖尿病患者的血压昼夜节律与早期肾损害的相关性。方法入选128例高血压合并2型糖尿病患者,行24 h动态血压监测,根据夜间血压下降率(?MBP)分为杓型(10%~20%,25例)组、非杓型(0%~10%,57例)组、超杓型(>20%,14例)组和反杓型(<0%,32例)组。根据尿微量白蛋白/尿肌酐比值(UACR)分为:非早期肾损害组(A组,UACR<30 mg/g,70例)及早期肾损害组(B组,UACR≥30 mg/g,58例),进行血生化、尿微量白蛋白、尿肌酐检测等。结果 A组与B组间四种昼夜节律的患者分布无明显差异性(P>0.05);反杓型组的UACR数值均高于超杓型组及杓型组[(67.38±32.12)mg/g>(40.56±20.56)mg/g>(32.09±20.03)mg/g](P<0.05);UACR与日间平均收缩压(DSBP)、夜间平均收缩压(NSBP)、糖化血红蛋白及低密度脂蛋白呈正相关(β值分别为0.18、0.22、0.36、0.19,均P<0.05);反杓型组、非杓型组及超杓型组的24 h平均收缩压(24 h SBP)和DSBP均高于杓型组(P<0.05)。结论高血压合并2型糖尿病患者的昼夜节律异常可加重早期肾损害,其中反杓型患者的早期肾损害程度更重,另外,在治疗上降压降糖的同时也应该注意血脂的管理。
Objective To investigate the relationship between circadian rhythm of blood pressure and early renal damage in hypertensive patients with type 2 diabetes. Methods 128 patients with type 2 diabetes mellitus and type 2 diabetes mellitus were enrolled in this study. Ambulatory blood pressure monitoring was performed at 24 hours. According to the nighttime blood pressure reduction rate (? MBP), the patients were divided into dipper (10% -20%, 25% ~ 10%, 57 cases), over-dipper (> 20%, 14 cases) and anti-dipper (<0%, 32 cases). According to the urinary albumin / urinary creatinine ratio (UACR), the patients were divided into non-early renal damage group (A group, UACR <30 mg / g, 70 cases) and early renal damage group (B group, UACR≥30 mg / 58 cases), blood biochemistry, urine microalbuminuria, urine creatinine detection. Results There was no significant difference in the circadian rhythm among the four groups (P> 0.05). The UACR values of the anti-dipper group were significantly higher than those of the super dipper group and the dipper group [(67.38 ± 32.12) mg / g> (40.56 ± 20.56) mg / g> (32.09 ± 20.03) mg / g] (P <0.05). UACR correlated with daytime average systolic blood pressure (DSBP), nighttime average systolic blood pressure (P <0.05). The mean systolic blood pressure (24 h SBP) and DSBP of anti-dipper group, non-dipper group and super dipper group at 24 h Were higher than the dipper group (P <0.05). Conclusion Abnormal circadian rhythm of patients with type 2 diabetes mellitus can aggravate early renal damage. Among them, the patients with anti-dipper type have more severe renal damage. In addition, they should pay attention to the management of blood lipid while lowering blood pressure and lowering blood sugar.