Diabetes Obes Metab:糖尿病患者24小时动态血压模式的预后价值

2022-06-22 MedSci原创 MedSci原创

在糖尿病患者中,反杓状血压与较高的CKD和CAN患病率相关,并在21年的观察期中使调整后的全因死亡风险增加一倍以上。

异常的昼夜节律血压(BP)模式是糖尿病和一般人群血管事件的危险因素。夜间收缩压(SBP)非杓状下降(夜间收缩压下降<日间收缩压值的10%)在1型糖尿病和2型糖尿病患者中非常常见,并与顽固性高血压、高血压介导的靶器官损伤、内皮功能障碍和颈动脉粥样硬化相关。在一般人群中,异常的昼夜节律血压模式是心血管事件的危险因素。

近日,代谢内分泌疾病领域权威杂志Diabetes Obesity & Metabolism上发表了一篇研究文章,该研究的目的是明确它们对糖尿病患者长期预后的影响。

研究人员回顾性地分析了349例门诊糖尿病患者,他们筛查微血管并发症并随访21年。根据24小时动态血压监测(ABPM),将收缩压下降≥10%、下降<10%和夜间收缩压(SBP)与日间平均收缩压(SBP)的任何增加分别定义为收缩压下降、非收缩压下降和反向收缩压下降。

经过6251人次每年的随访(中位随访为21.0年[范围1.1-22.0年],52%为女性,平均年龄为57.1±11.9岁,81.4%为2型糖尿病和18.6%为1型糖尿病),该研究共发生136例(39%)死亡。与杓状血压者相比,非杓状血压者和反杓状血压者慢性肾脏疾病(CKD)、心脏自主神经病变(CAN)和体位性低血压的患病率逐步升高。校正传统危险因素后,反杓状血压者平均总生存率降低13.4%(2.5年),全因死亡风险增加两倍(风险比2.2[1.3-3.8])。夜间与日间收缩压比每下降1%与20年死亡率降低4%独立相关。

由此可见,在糖尿病患者中,反杓状血压与较高的CKD和CAN患病率相关,并在21年的观察期中使调整后的全因死亡风险增加一倍以上。
 
原始出处:
 
Martina Chiriacò,et al.Prognostic value of 24-hour ambulatory blood pressure patterns in diabetes: a 21-year longitudinal study.Diabetes Obesity & Metabolism.2022.https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14798

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    2023-05-18 guojianrong
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    2022-09-03 docwu2019
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createdName=guojianrong, createdTime=Thu May 18 10:07:35 CST 2023, time=2023-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761958, encodeId=f8fe1e6195825, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sat Sep 03 17:07:35 CST 2022, time=2022-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1636425, encodeId=0acc1636425c6, content=<a href='/topic/show?id=eb4810160a' target=_blank style='color:#2F92EE;'>#24小时动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1016, 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time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1509023, encodeId=18aa150902304, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1902740, encodeId=2a711902e40a4, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Sun Jan 29 19:07:35 CST 2023, time=2023-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888439, encodeId=ab8f188843979, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, 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content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475297, encodeId=4c8614e529765, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1509023, encodeId=18aa150902304, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
    2023-05-20 chengjn
  6. [GetPortalCommentsPageByObjectIdResponse(id=1902740, encodeId=2a711902e40a4, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Sun Jan 29 19:07:35 CST 2023, time=2023-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888439, encodeId=ab8f188843979, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, 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time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1509023, encodeId=18aa150902304, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
  7. 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time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1509023, encodeId=18aa150902304, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Fri Jun 24 04:07:35 CST 2022, time=2022-06-24, status=1, ipAttribution=)]
    2023-04-19 一闲
  8. 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  9. 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  10. 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