维生素D与慢性肾脏病患者夜间血压的相关性分析

doi:10.16138/j.1673-6087.2021.04.005

摘要/Abstract

摘要：

目的：观察慢性肾脏病患者维生素D水平是否与夜间血压变化相关。方法：纳入2019年6月至2020年2月在我院住院的慢性肾脏病患者120例,其中男性62例,女性58例。平均年龄（55.22±14.33）岁。根据维生素D的水平不同将患者分为3组：≤20 mg/L为维生素D缺乏组;21~29 mg/L为维生素D不足组;≥30 mg/L为维生素D充足组。比较3组患者的人口学特征和临床资料及血压相关指标,同时对维生素D浓度与各变量间的相关性进行分析。结果：维生素D缺乏组（n=40）和不足组（n=45）24 h收缩压、24 h舒张压、夜间收缩压、夜间舒张压均高于维生素D充足组（n=35）,而夜间血压下降率低于维生素D充足组（均P<0.05）。维生素D水平与钙（r=-0.259, P=0.026）、24 h收缩压（r=-0.657, P=0.036）、夜间舒张压（r=-0.203, P=0.000）、夜间收缩压（r=-0.198, P=0.000）呈负相关,与夜间收缩压下降率呈正相关（r=0.291, P=0.000）。多元Logistic回归分析结果显示,维生素D缺乏或不足是慢性肾脏病患者夜间高血压的危险因素（P=0.037）。随着血清维生素D水平的降低,夜间高血压下降率减少。结论：慢性肾脏病患者维生素D水平与24 h收缩压、24 h舒张压、夜间收缩压、夜间舒张压呈负相关,与夜间血压下降率呈正相关。

关键词: 慢性肾脏病, 维生素D, 动态血压

Abstract:

Objective To observe whether vitamin D level is related to changes of blood pressure in the patients with chronic kidney disease. Methods A total of 120 patients (62 male and 58 female) with chronic kidney disease [age, 18-80(55.22±14.33) years] were enrolled. The patients were divided into 3 groups based on their vitamin D concentration, including very low vitamin D group (≤20 mg/L), low vitamin D group (21-29 mg/L) and vitamin D sufficient group (≥30 mg/L). The clinical data and blood pressure of 3 groups were compared, and the correlation between vitamin D concentration and each variable was analyzed. Results The levels of 24-h systolic blood pressure, 24-h diastolic blood pressure, daytime systolic blood pressure, daytime systolic blood pressure, nocturnal systolic blood pressure, and nocturnal diastolic blood pressure in very low vitamin D group (n=40) and low group (n=45) were higher than those in vitamin D sufficient group(n=35)（all P<0.05）, but the dropping rate of blood pressure at night in two groups were lower than the vitamin D sufficient group. It showed that vitamin D level had negative linear correlation with calcium concentration（r=-0.259, P=0.026）, 24-h systolic blood pressure（r=-0.657, P=0.036）, 24-h diastolic blood pressure, nocturnal diastolic blood pressure（r=-0.203, P=0.000）, nocturnal systolic blood pressure（r=-0.198, P=0.000）.However, vitamin D level was positively correlated with the dropping rate of blood pressure at night. Multivariate Logistic regression analysis showed that vitamin D was a risk factor for the development of nocturnal hypertension in the patients with chronic kidney disease(P=0.037). As serum vitamin D levels decreased, the dropping rate of nocturnal hypertension decreased. Conclusions In the patients with chronic kidney disease,vitamin D level was negatively correlated with 24-h systolic blood pressure, 24-h diastolic blood pressure, nocturnal systolic blood pressure, and nocturnal diastolic blood pressure, but it was positively correlated with the dropping rate of blood pressure at night.

Key words: Chronic kidney disease, Vitamin D, Ambulatory blood pressure

中图分类号:

R692

轩应利, 陈斐虹, 秦丽, 和瑞斌, 庞诗情, 袁江姿. 维生素D与慢性肾脏病患者夜间血压的相关性分析[J]. 内科理论与实践, 2021, 16(04): 246-250.

XUAN Yingli, CHEN Feihong, QIN Li, HE Ruibin, PANG Shiqing, YUAN Jiangzi. Correlation analysis of vitamin D and nocturnal blood pressure in the patients with chronic kidney disease[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 246-250.

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项目	维生素D缺乏组（n=40）	维生素D不足组（n=45）	维生素D充足组（n=35）	F	P
年龄（岁）	44.69±14.13	45.27±13.63	45.29±13.88	1.90	0.68
男性（%）	24（60）	22（49）	16（46）	1.68	0.49
BMI（kg/m²）	22.93±2.98	23.62±2.74	22.82±3.24	1.72	0.98
ACEI[n（%）]	21（52）	23（51）	19（54）	1.67	0.06
ARB[n（%）]	20（50）	24（53）	20（57）	1.73	0.09
β受体阻滞剂[n（%）]	19（47）	20（44）	15（42）	1.70	0.34
α受体阻滞剂[n（%）]	18（45）	19（42）	15（42）	1.65	0.48
CCB[n（%）]	15（37）	19（42）	20（57）	1.61	0.08
利尿剂[n（%）]	15（37）	20（44）	14（40）	1.50	0.79
肌酐（μmol/L）	100±20	95±22	93±20	1.66	0.07
糖化血红蛋白（%）	5.7±0.2	6.0±0.1	5.8±0.3	1.74	0.08
总胆固醇（mmol/L）	3.62±0.41	4.4±0.32	3.56±0.21	1.63	0.89
钙（mmol/L）	2.20±0.11	2.30±0.2	2.32±0.24	1.57	0.74
磷（mmol/L）	1.25±0.26	0.95±0.33	0.89±0.21	1.75	0.72
PTH（ng/L）	100±10	105±20	110±10	1.71	0.83

血压	维生素D缺乏组（n=40）	维生素D不足组（n=45）	维生素D充足组（n=35）	F	P
24 h收缩压	163±7.2	149±7.0¹⁾	140±7.2¹⁾²⁾	2.03	0.032
24 h舒张压	90±4.5	82±4.8¹⁾	72±7.4¹⁾²⁾	2.01	0.02
日间收缩压	153±6.9	143±6.8	145±7.9	1.66	0.053
日间舒张压	98±7.2	86±7.4	84±6.3	1.65	0.060
夜间收缩压	153±7.4	140±7.1¹⁾	138±10.4¹⁾²⁾	2.10	0.01
夜间舒张压	99±7.4	90±7.2¹⁾	80.5±5.9¹⁾²⁾	2.13	0.013
夜间收缩压下降率（%）	4.54±2.31	5.21±3.17¹⁾	10.45±2.4¹⁾²⁾	2.09	0.012
夜间舒张压下降率（%）	3.21±1.02	4.98±2.08¹⁾	10.02±2.7¹⁾²⁾	2.06	0.015