目的探讨原发性高血压患者血压昼夜节律与早期肾损害的关系。方法纳入原发性高血压患者225例进行24h动态血压监测,计算夜间血压下降率、24h动态脉压(24hPP)及动态脉压指数(PPI,PPI=24hPP/24h收缩压)。根据昼夜血压变异性将研究对象分为夜间血压下降率≥10%(n=76)和夜间血压下降率<10%(n=149)两组,其中夜间血压下降率≥20%为超杓型组(n=6),夜间血压下降率10%~20%为杓型组(n=70),夜间血压下降率0~10%为非杓型组(n=88),夜间血压下降率<0为反杓型组(n=61)。以Cockcroft-Gault及简化肾脏病膳食改良试验(MDRD)公式计算估算的肾小球滤过率(eGFR),测定空腹血糖、血尿素氮、血肌酐、胱抑素C、血脂、血尿酸及尿微量白蛋白(MA)水平。分析血压昼夜节律与早期肾损害的关系。结果夜间血压下降率<10%组eGFR水平较夜间血压下降率≥10%组降低[MDRD公式计算:(80.6±21.8)比(97.3±24.2)mL/(min·1.73 m2),P<0.01;Cockcroft-Gault公式计算:70.4(53.6~89.9)比91.2(76.0~113.1)mL/(min·1.73 m2),P<0.01],而尿MA水平[15.6(11.0~43.3)比11.8(10.8~22.3)mg/L,P<0.05]以及胱抑素C水平[1.0(0.8~1.3)比0.9(0.7~1.1),P<0.05]增加。分层分析结果显示,杓型组和非杓型组患者的eGFR水平高于反杓型组,而尿MA水平低于反杓型组(P<0.05);杓型组患者的eGFR水平高于非杓型组(P<0.05)。夜间血压下降率<10%组的24hPP、PPI较夜间血压下降率≥10%组增高[56(47~63)比50(44~58)mm Hg,0.42±0.07比0.39±0.06;均P<0.05]。多因素线性回归分析结果显示血尿素氮、胱抑素C及PPI是eGFR(MDRD)的影响因素,胱抑素C、白天平均舒张压、24h平均舒张压、血尿酸及血尿素氮是eGFR(Cockcroft-Gault)的影响因素。结论与杓型高血压患者比较,非杓型和反杓型高血压患者早期肾损害的指标均异常升高,提示血压昼夜节律减弱或消失与早期肾损害密切相关。 Objective To investigate the relationship between circadian rhythm of blood pressure and early renal damage in patients with essential hypertension. Methods Twenty-five patients with essential hypertension were enrolled in this study. Blood pressure was monitored 24h and nocturnal blood pressure was decreased, 24h ambulatory pulse pressure (24hPP) and dynamic pulse pressure index (PPI, PPI = 24hPP / 24h systolic pressure) were calculated. According to the diurnal variability of blood pressure, subjects were divided into nocturnal blood pressure reduction rate ≥10% (n = 76) and nocturnal blood pressure reduction rate <10% (n = 149), of which nocturnal blood pressure reduction rate ≥20% (N = 6). The rate of nocturnal blood pressure decrease was 10% ~ 20% for the dipper group (n = 70) and the nocturnal pressure drop rate was 0 ~ 10% for the non dipper group (n = 88) 0 for the anti-dipper group (n = 61). The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault and simplified kidney disease diet modification test (MDRD) formulas, and fasting blood glucose, blood urea nitrogen, serum creatinine, cystatin C, lipids, serum uric acid and urine Microalbumin (MA) levels. Analysis of the relationship between circadian rhythm of blood pressure and early renal damage. Results The level of eGFR was lower than nocturnal normotensive (≥10%) in the group with nocturnal decrease of blood pressure <10% (calculated by MDRD formula: (80.6 ± 21.8) vs (97.3 ± 24.2) mL / (min · 1.73 m2) The Cockcroft-Gault formula calculated 70.4 (53.6-89.9) versus 91.2 (76.0-113.1) mL / (min.1.73 m2), P <0.01, whereas urinary MA levels [15.6 (11.0-43.3) vs. 11.8 (10.8-22.3 ) mg / L, P <0.05] and the level of cystatin C [1.0 (0.8-1.3) vs 0.9 (0.7-1.1), P <0.05]. Stratified analysis showed that eGFR levels in dipper group and non-dipper group were higher than that in anti-dipper group and urinary MA levels were lower than that of anti-dipper group (P <0.05); eGFR level in dipper group was higher than that of anti-dipper group Non-dipper group (P <0.05). The nighttime blood pressure reduction rate of <10% group was significantly higher than that of nighttime blood pressure reduction rate> 10% (56-47) (P <0.05) 0.05]. The results of multivariate linear regression analysis showed that blood urea nitrogen, cystatin C and PPI were the influential factors of eGFR (MDRD). Cystatin C, mean daytime diastolic blood pressure, mean diastolic blood pressure 24h, blood uric acid and blood urea nitrogen were eGFR Cockcroft-Gault). Conclusion Compared with patients with dipper hypertension, the indicators of early renal damage in both non-dipper and anti-dipper hypertensive patients are abnormally elevated, suggesting that the decrease or disappearance of circadian rhythm of blood pressure is closely related to early renal damage.