Mulec H, Blohmé G, Kullenberg K, Nyberg G, Björck S
Department of Nephrology, Northern Alvsborg Hospital, Trollhättan, Sweden.
Diabetologia. 1995 Feb;38(2):216-20. doi: 10.1007/BF00400097.
With the aim of studying the diurnal variation in blood pressure in relation to degree of fluid retention, 24-h ambulatory blood pressure monitoring was performed in 31 insulin-dependent diabetic patients with nephropathy. The extracellular volume was calculated from the distribution volume of 51Cr-EDTA after a single injection. The study population was arbitrarily divided into two groups, depending on their extracellular volume. Group 1 included 15 patients with a lower extracellular volume and group 2, 16 patients with a higher extracellular volume. Ambulatory blood pressure was measured with a portable monitor using an oscillometric technique. In all patients, the mean +/- SD 24-h ambulatory blood pressure was 135/79 +/- 14/7 mmHg. Day and night-time blood pressure were 136/81 +/- 14/7 and 133/75 +/- 17/8, respectively (p < 0.02). The ambulatory blood pressure was 135/80 +/- 14/7 in group 1 and 136/78 +/- 15/6 mmHg in group 2. The nocturnal change in blood pressure was significantly greater in group 1 than in group 2, -9/-9 +/- 10/5 mmHg and 1/-3 +/- 10/6 mmHg, respectively (p = 0.005/0.01). There were no other significant differences between the groups than the diurnal blood pressure pattern. There were significant correlations between day ambulatory blood pressure and night ambulatory blood pressure and 24-h ambulatory blood pressure and urinary albumin excretion. There was no correlation between ausculatatory clinic blood pressure on the one hand and albuminuria on the other. Latent fluid retention therefore may contribute to nocturnal hypertension in diabetic nephropathy.
为了研究血压的昼夜变化与液体潴留程度的关系，对31例胰岛素依赖型糖尿病肾病患者进行了24小时动态血压监测。单次注射51Cr-EDTA后，根据分布容积计算细胞外液量。根据细胞外液量，将研究人群任意分为两组。第1组包括15例细胞外液量较低的患者，第2组包括16例细胞外液量较高的患者。使用便携式监测仪通过示波技术测量动态血压。所有患者24小时动态血压的平均值±标准差为135/79±14/7 mmHg。白天和夜间血压分别为136/81±14/7和133/75±17/8（p<0.02）。第1组的动态血压为135/80±14/7，第2组为136/78±15/6 mmHg。第1组血压的夜间变化显著大于第2组，分别为-9/-9±10/5 mmHg和1/-3±10/6 mmHg（p = 0.005/0.01）。除了昼夜血压模式外，两组之间没有其他显著差异。白天动态血压与夜间动态血压、24小时动态血压与尿白蛋白排泄之间存在显著相关性。听诊诊所血压与蛋白尿之间没有相关性。因此，潜在的液体潴留可能导致糖尿病肾病患者的夜间高血压。
