青少年 1 型糖尿病患者的动态血压参数及其与白蛋白尿的关系。
Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus.
机构信息
Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572, Poznan, Poland.
Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 60-572, Poznan, Poland.
出版信息
Pediatr Nephrol. 2024 Oct;39(10):3037-3047. doi: 10.1007/s00467-024-06416-3. Epub 2024 Jun 12.
BACKGROUND
This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1).
METHODS
The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor.
RESULTS
Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE.
CONCLUSIONS
Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.
背景
本研究旨在评估血压(BP)状况,包括动脉僵硬度参数、血流动力学指标、昼夜节律特征及其与 1 型糖尿病(DM1)青少年白蛋白尿的关系。
方法
该分析纳入了 46 名糖尿病病程为 7.38±3.48 年的患者。使用示波法设备 Mobil-O-Graph 进行动态血压监测(ABPM)。
结果
31 名青少年(67%的患者)被诊断为高血压(HT),主要是由于单纯夜间血压升高(21 例,HT 患者的 68%)。HT 组的舒张负荷(DL)显著增加。脉搏波速度(PWV,一种衡量动脉僵硬度的指标)值与外周收缩压(r=0.954)和中心收缩压(r=0.838)均呈强相关。此外,HT 组中 61%存在非杓型血压。尿白蛋白排泄率(UAE)与舒张压(尤其是夜间)、外周和中心血压、DL、心率、增强指数(AIx@75)以及夜间总血管阻力(TVR)呈正相关。舒张压非杓型者 UAE 显著增加。
结论
高血压是 1 型糖尿病青少年的常见并发症,主要由夜间舒张压升高引起。白蛋白尿主要与舒张压相关,尤其是夜间和舒张压非杓型时。UAE 与 AIx@75 和夜间 TVR 的相关性提示糖尿病青少年存在早期血管病变。