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目的探讨原发性高血压患者血清25羟基维生素D[25(OH)D]水平与血压变异性(BPV)及昼夜节律的相关性。方法检测389例未经治疗的原发性高血压患者的血清25(OH)D浓度,按血清25(OH)D水平将患者分为25(OH)D正常组(>30nmol/L,89例)、25(OH)D轻度缺乏组(16~30nmol/L,120例)、25(OH)D重度缺乏组(<16nmol/L,180例),对所有患者行24h动态血压监测,记录24h、白天、夜间平均收缩压和舒张压值,比较25(OH)D水平与BPV及昼夜节律的关系。以标准差作为BPV指标。结果高血压患者中25(OH)D正常者占22.9%,轻度缺乏者占30.8%,重度缺乏者占46.3%;女性25(OH)D水平低于男性[(15.20±8.23)比(19.47±7.02)nmol/L,P<0.05]。3组间24h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、24h收缩压标准差(24hSSD)、24h舒张压标准差(24hDSD)、白天收缩压标准差(dSSD)、白天舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)、夜间收缩压和舒张压下降率的差异有统计学意义(均P<0.05);重度缺乏组24h平均舒张压(24hDBP)、白天平均舒张压(dDBP)、夜间平均舒张压(nDBP)较25(OH)D正常组及轻度缺乏组高(均P<0.05),后两组间的差异无统计学意义(P>0.05)。Pearson相关分析显示,25(OH)D与24hSSD、24hDSD、dSSD、dDSD、nSSD、nDSD呈负相关(分别r=-0.583、-0.530、-0.520、-0.389、-0.463、-0.377),与夜间收缩压和舒张压下降率呈正相关(r=0.308、r=0.336),均P<0.01。多元线性回归分析显示,25(OH)D是24hSSD(B=-0.227)、24hDSD(B=-0.193)、dSSD(B=-0.211)、dDSD(B=-0.119)、nSSD(B=-0.193)、nDSD(B=-0.136)及夜间收缩压和舒张压下降率(B=0.273、0.329)的影响因素(均P<0.01)。结论血清25(OH)D可能是原发性高血压患者BPV及昼夜节律改变的影响因素。
Objective To investigate the relationship between serum 25-hydroxyvitamin D [25 (OH) D] and variability of blood pressure (BPV) and circadian rhythm in patients with essential hypertension. Methods Serum levels of 25 (OH) D in 389 patients with untreated essential hypertension were measured and divided into 25 (OH) D normal group (> 30nmol / L, 89cases ), 25 (OH) D mild deficiency group (16-30nmol / L, 120 cases) and 25 (OH) D severe deficiency group (<16nmol / L, 180 cases) 24h, daytime and nighttime mean systolic and diastolic blood pressure, and compared the relationship between 25 (OH) D level and BPV and circadian rhythm. Standard deviation as BPV indicator. Results 25 (OH) D was normal in 22.9% of hypertensive patients, 30.8% of mild hypertensive patients and 46.3% of severe hypertensive patients. The female 25 (OH) D level was lower than that of male [(15.20 ± 8.23) vs 19.47 ± 7.02) nmol / L, P <0.05]. The mean systolic blood pressure (24hSBP), mean systolic blood pressure (dSBP), nSBP, 24hSSD, 24hSDSD, daytime systolic blood pressure standard deviation dSSD, dDSD, nSSD, nDSD, nocturnal systolic pressure and diastolic blood pressure decreased significantly (all P <0.05) ); 24 hours mean diastolic blood pressure (24hDBP), daytime mean diastolic blood pressure (dDBP) and nighttime mean diastolic blood pressure (nDBP) in severe lacking group were higher than those in 25 (OH) D normal group and mild deficient group (all P <0.05) There was no significant difference between the two groups (P> 0.05). Pearson correlation analysis showed that 25 (OH) D was negatively correlated with 24hSSD, 24hDSD, dSSD, dDSD, nSSD and nDSD (r = -0.583, -0.530, -0.520, -0.389, -0.463, -0.377, respectively) Systolic blood pressure and diastolic blood pressure decreased positively (r = 0.308, r = 0.336), both P <0.01. Multivariate linear regression analysis showed that 25 (OH) D was significantly higher at 24hSSD (B = -0.227), 24hDSD (B = -0.193), dSSD (B = -0.211), dDSD ), NDSD (B = -0.136) and nocturnal systolic and diastolic blood pressure (B = 0.273, 0.329), respectively. Conclusions Serum 25 (OH) D may be the influencing factor of BPV and circadian rhythm in patients with essential hypertension.