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目的探讨24 h动态收缩压与老年人肾小球滤过率(glomeruar filtration rate,GFR)的关联。方法 2006~2007年第一次对开滦集团公司在职及离退休职工进行健康体检,此后分别于2008~2009、2010~2011年进行第二、三次健康体检,并于第三次体检时整群随机抽取年龄≥60岁的开滦集团离退休员工2 814例进行诊室血压测量、动态血压监测等检查。符合入选标准的有2 464例,24 h动态收缩压及肾小球滤过率资料均完整者1 405例,并根据24h收缩压、日间收缩压、夜间收缩压三分位数将研究对象分别分为第一分位组、第二分位组、第三分位组。采用多因素线性回归分析24h收缩压、日间收缩压、夜间收缩压与肾小球滤过率估计值(estimated glomeruar filtration rate,eGFR)的关联。结果随着24h收缩压、日间收缩压、夜间收缩压升高,eGFR呈降低趋势,但差异无统计学意义(P>0.05)。校正年龄、性别后的偏相关分析显示:24h收缩压与eGFR呈负相关(r=-0.056,P=0.035),日间收缩压(r=-0.051,P=0.056)、夜间SBP(r=-0.052,P=0.050)与eGFR的相关性无统计学差异;诊室收缩压与eGFR呈负相关(r=-0.074,P=0.005)。多因素线性回归分析显示:校正混杂因素后,24h收缩压、日间收缩压、夜间收缩压与eGFR之间的线性关系无统计学差异(B=-0.28、-0.14、-0.34,P=0.619、0.798、0.521),而诊室收缩压与eGFR呈线性负相关(P<0.05)。结论 24h收缩压、日间收缩压、夜间收缩压与GFR无关联,而诊室收缩压与GFR呈负相关,积极密切监测血压并将血压保持在较低的稳定水平对预防和延缓肾功能下降是必要的。
Objective To investigate the relationship between dynamic systolic pressure at 24 hours and glomerular filtration rate (GFR) in the elderly. Methods The first physical examination of serving and retired workers of Kailuan Group Company from 2006 to 2007 was conducted. After that, the second and third physical examinations were carried out from 2008 to 2009 and from 2010 to 2011, respectively. During the third physical examination, A total of 2 814 retired employees of Kailuan Group, aged ≥60 years, were randomly selected for blood pressure measurement and ambulatory blood pressure monitoring. Comply with the inclusion criteria of 2 464 cases, 24 h dynamic systolic blood pressure and glomerular filtration rate data were complete 1 405 cases, and according to 24h systolic blood pressure, day systolic blood pressure, night systolic blood pressure tertile Divided into the first sub-group, the second sub-group, the third sub-group. Multivariate linear regression was used to analyze the associations of 24h systolic pressure, daytime systolic blood pressure, nocturnal systolic blood pressure, and estimated glomeruar filtration rate (eGFR). Results With the systolic blood pressure at 24h, the systolic blood pressure at daytime and the systolic blood pressure at night increased, eGFR showed a decreasing trend, but the difference was not statistically significant (P> 0.05). Partial correlation analysis showed that systolic blood pressure was negatively correlated with eGFR (r = -0.056, P = 0.035), systolic blood pressure (r = -0.051, P = 0.056) and nighttime SBP -0.052, P = 0.050). There was no significant difference between eGFR and systolic blood pressure (r = -0.074, P = 0.005). Multivariate linear regression analysis showed that there was no significant difference in systolic blood pressure, daytime systolic blood pressure, nighttime systolic blood pressure and eGFR after adjusting for confounding factors (B = -0.28, -0.14, -0.34, P = 0.619 , 0.798,0.521), while the systolic blood pressure in office was negatively correlated with eGFR (P <0.05). Conclusions 24h systolic blood pressure, daytime systolic blood pressure and nighttime systolic blood pressure have no correlation with GFR, but the systolic blood pressure in the office is negatively correlated with GFR, positive and close monitoring of blood pressure and keeping the blood pressure at a low stable level are both effective in preventing and delaying the decline of renal function necessary.