Soylu Ahmet, Güleç Hakan, Alihanoğlu Yusuf Izzettin, Sönmez Osman, Ayhan Selim Suzi, Gök Hasan
Department of Cardiology, Meram Medicine Faculty of Selçuk University, Konya, Turkey.
Turk Kardiyol Dern Ars. 2009 Oct;37(7):454-60.
Both metabolic syndrome (MetS) and nondipping status (insufficient reduction in nocturnal blood pressure) have been linked with target organ damage. We evaluated the effect of nondipping status on target organ damage in subjects with MetS.
Eighty-two patients diagnosed as having MetS were divided into two groups according to the findings of 24-hour ambulatory blood pressure monitoring as dipper (n=35, 19 women, 16 men; mean age 48.4+/-6.4 years) and nondipper (n=47, 35 women, 12 men; mean age 50.4+/-4.7 years). Cardiac damage was assessed by conventional and tissue Doppler echocardiography, and renal damage by 24-hour urinary albumin excretion.
The two groups were similar with regard to age, body mass index, presence of diabetes, smoking, clinical and 24-hour, daytime and nighttime blood pressures, plasma lipid profile, distribution of and the mean total number of MetS criteria. The ratio of early (Em) to late (Am) left ventricular peak diastolic myocardial velocities (Em/Am) was significantly lower in nondippers (p=0.016). Nondippers also had higher values of left ventricular mass index, myocardial performance index, and 24-hour urinary albumin excretion, but these differences did not reach a significant level (p=0.110, p=0.099, p=0.093, respectively). Multivariate regression analysis showed increasing age and nondipping status as independent factors associated with decreased Em/Am ratio (beta=-0.25, p=0.020 and beta=-0.22, p=0.042, respectively).
In subjects with MetS, nondipping status may be associated with both cardiac and renal damage independent of other components of MetS. Since the degree of diastolic dysfunction is more marked than that of albuminuria in nondippers, it may be extrapolated that the extent of cardiac damage surpasses renal damage in these subjects.
代谢综合征（MetS）和非勺型状态（夜间血压下降不足）均与靶器官损害有关。我们评估了非勺型状态对代谢综合征患者靶器官损害的影响。
根据24小时动态血压监测结果，将82例诊断为代谢综合征的患者分为两组，勺型组（n = 35，女性19例，男性16例；平均年龄48.4±6.4岁）和非勺型组（n = 47，女性35例，男性12例；平均年龄50.4±4.7岁）。通过传统和组织多普勒超声心动图评估心脏损害，通过24小时尿白蛋白排泄评估肾脏损害。
两组在年龄、体重指数、糖尿病的存在、吸烟情况、临床及24小时、日间和夜间血压、血脂谱、代谢综合征标准的分布及平均总数方面相似。非勺型组左心室舒张早期峰值心肌速度（Em）与舒张晚期峰值心肌速度（Am）之比（Em/Am）显著降低（p = 0.016）。非勺型组的左心室质量指数、心肌性能指数和24小时尿白蛋白排泄值也较高，但这些差异未达到显著水平（分别为p = 0.110、p = 0.099、p = 0.093）。多因素回归分析显示，年龄增加和非勺型状态是与Em/Am比值降低相关的独立因素（β分别为-0.25，p = 0.020和β = -0.22，p = 0.042）。
在代谢综合征患者中，非勺型状态可能与心脏和肾脏损害均相关，且独立于代谢综合征的其他成分。由于非勺型组舒张功能障碍程度比蛋白尿更明显，可以推断这些患者中心脏损害程度超过肾脏损害程度。
