Garcia C, Mayaudon H, Bordier L, Le Berre J P, Dupuy O, Bauduceau B
Service d'Endocrinologie, hôpital d'instruction des armées - Bégin, Saint Mandé.
Arch Mal Coeur Vaiss. 2007 Aug;100(8):668-72.
The aim of this study was to assess the responsibility of night-time blood pressure in the onset of nephropathy in diabetic patients.
This study included 98 diabetic patients (mean age: 54 +/- 15 years, diabetes duration: 15 +/- 10 years). An evaluation of diabetes and a 24-h ambulatory blood pressure were performed at the initial evaluation (Y0) and about five years later (Y5). At Y0, all patients had normal urinary albumin excretion (UAE) (<30 mg/24h). They were separated into two groups according to urinary albumin excretion at Y5: group (N +): UAE>30 mg/24h and group (N-): UAE<30 mg/24h. Twenty four hours ambulatory blood pressure, clinical and biological parameters recorded at Y0 were compared in both.
At Y5, there was 18 patients in group (N +) and 78 in group (N-). Patients of group (N +) were older than those of group (N-): 62.9 +/- 9.5 vs. 52.6 +/- 15.7 years, p<0.01, and their BMI was higher (28 +/- 5 vs. 25 +/- 4 kg/m2, p<0.03). Diabetes duration and Hb A1c levels did not differ from significant manner in both. At Y0, UAE was significantly higher in group (N +) than in group (N-): 13 +/- 7 vs. 8 +/- 6 mg/24h, p<0.01. At the initial evaluation, daytime systolic and diastolic blood pressures did not differ from significant manner in both. Systolic and diastolic BP night-time were higher in diabetic patients who developed microalbuminuria (SBP: 122 +/- 19 vs. 113 +/- 13 mmHg, p<0.05 and DBP: 70 +/- 6 vs. 65 +/- 10 mmHg, p<0.03). UAE collected at Y5 was correlated to night-time BP recorded at Y0 (SBP: r=0.381, p=0.001 and PAD: r=0.294, p=0.004) and night-time systolic BP explained 12.3% of the UAE variance. Progression of UAE between the two evaluations was found to be correlated to the night-time systolic BP recorded at Y0 (r=0.335, p=0.0008) and night-time systolic BP explained 11.7% of the progression variance. There was a negative correlation between UAE at A5 and the difference between daytime and night-time BP recorded during the same evaluation (r=- 0.230, p=0.024 with SBP and r=- 0.243, p=0.017 with DBP).
The results underlign the resposability of night-time blood pressure, and more especially of nighttime systolic blood pressure, for the onset of nephropathy in diabetic patients.
本研究的目的是评估夜间血压在糖尿病患者肾病发病中的作用。
本研究纳入了98例糖尿病患者（平均年龄：54±15岁，糖尿病病程：15±10年）。在初始评估（Y0）时以及大约五年后（Y5）进行了糖尿病评估和24小时动态血压监测。在Y0时，所有患者的尿白蛋白排泄量（UAE）均正常（<30mg/24小时）。根据Y5时的尿白蛋白排泄量将他们分为两组：（N +）组：UAE>30mg/24小时和（N-）组：UAE<30mg/24小时。比较了两组在Y0时记录的24小时动态血压、临床和生物学参数。
在Y5时，（N +）组有18例患者，（N-）组有78例患者。（N +）组患者比（N-）组患者年龄更大：62.9±9.5岁对52.6±15.7岁，p<0.01，且其体重指数更高（28±5对25±4kg/m²，p<0.03）。两组的糖尿病病程和糖化血红蛋白水平无显著差异。在Y0时，（N +）组的UAE显著高于（N-）组：13±7对8±6mg/24小时，p<0.01。在初始评估时，两组的日间收缩压和舒张压无显著差异。发生微量白蛋白尿的糖尿病患者夜间收缩压和舒张压更高（收缩压：122±19对113±13mmHg，p<0.05；舒张压：70±6对65±10mmHg，p<0.03）。Y5时收集的UAE与Y0时记录的夜间血压相关（收缩压：r = 0.381，p = 0.001；脉压：r = 0.294，p = 0.004），夜间收缩压解释了UAE变异的12.3%。两次评估之间UAE的进展与Y0时记录的夜间收缩压相关（r = 0.335，p = 0.0008），夜间收缩压解释了进展变异的11.7%。A5时的UAE与同一评估期间记录到日间和夜间血压差值之间存在负相关（收缩压：r = -0.230，p = 0.024；舒张压：r = -0.243，p = 0.017）。
结果强调了夜间血压，尤其是夜间收缩压，在糖尿病患者肾病发病中的作用。
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