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目的 :探讨血压增高、血压昼夜节律异常和自主神经病变对糖尿病肾病的影响。方法 :同步监测 35例糖尿病肾病患者、35例糖尿病正常白蛋白尿患者和 35例正常对照组的动态血压和动态心电图。结果 :糖尿病肾病组 2 4小时血压较正常白蛋白尿组和对照组明显增高 ,昼夜平均动脉压差值百分率下降 (p <0 0 0 1) ;糖尿病正常白蛋白尿组虽然 2 4小时平均血压与对照组无明显差异 ,但却已存在夜间血压升高 ,昼夜平均动脉压差值百分率下降 (p <0 0 5～ 0 0 0 1) ;糖尿病肾病组HRV指标较糖尿病正常白蛋白尿组和对照组显著减小 (P <0 0 1～ 0 0 0 1) ;糖尿病正常白蛋白尿组HRV各项指标也较对照组减小 (P <0 0 1)。结论 :糖尿病肾病的发生、发展与血压升高、血压昼夜节律异常和糖尿病自主神经病变有关。
Objective: To investigate the effects of increased blood pressure, abnormal circadian rhythm of blood pressure and autonomic neuropathy on diabetic nephropathy. Methods: The ambulatory blood pressure and ambulatory electrocardiogram were simultaneously monitored in 35 patients with diabetic nephropathy, 35 patients with diabetic normal albuminuria and 35 normal controls. Results: The 24-hour blood pressure in diabetic nephropathy group was significantly higher than that in normal albuminuria group and the control group, and the difference in mean arterial pressure difference between day and night was decreased (p <0.01). Although the normal 24-hour mean blood pressure There was no significant difference between the control group and the control group, but there was an increase of nocturnal blood pressure and a decrease of the difference of mean arterial pressure difference between day and night (p <0.05-0.001). HRV index of diabetic nephropathy group was significantly higher than that of normal albuminuria group The control group was significantly reduced (P <0.01-0.01). The indexes of HRV in diabetic patients with normal albuminuria also decreased compared with those in the control group (P <0.01). Conclusion: The occurrence and development of diabetic nephropathy are related to the elevation of blood pressure, abnormal circadian rhythm of blood pressure and autonomic neuropathy of diabetes.