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- 저자 : 임석환(Seok Hwan Lim) (검색결과 2 건)
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미세단백뇨를 보인 인슐린비의존성 당뇨병환자에서 혈압 및 맥박의 일중변동의 변화
김승준(Seung Jun Kim),배원엽(Won Yeop Bae),임석환(Seok Hwan Lim),이윤호(Yun Ho Lee),전인표(In Pyo Jeon),김순호(Sun Ho Kim),조상기(Sang Kee Cho),임중규(Joong Kyu Im),허진득(Jin Deuk Hur) 대한내과학회 1997 대한내과학회지 Vol.52 No.3
N/A Objectives: In diabetics the disturbance of circardian variation of blood pressure and heart rate has been supposed to be related to diabetic autonomic neuropathy and diabetic nephropathy. We performed this study to evaluate the circardian variation of blood pressure and heart rate and the difference of affecting factors between normoalbuminuric patients and microalbuminuric patients. Methods: We studied 50normotensive NIDDM patients without overt nephropathy, divided two grooups, which are normoalbuminuric patients(D1 group) and microalhuminuric patients(D2 group), according to the urinary albumine excretion rate(AER) on 24-h urine collection. We simultaneosly measured 24-hour blood pressure and heart rate by using of ambulatory 24-hour blood pressure monitoring (ABPM). Results: 1) In group Kb, 24-h systolic and diastolic blood pressure were significantly higher than in C(normal control group) and D1 2) 24-h heart rate values did not significantly differ between the groups, but night heart was significantly elevated in group D2 than C and D1. 3) The night/day ratio of SBP(systolic blood pressure) and HR(heart rate) was significantly higher in D2 than C and D1, but the night/day ratio of DBP(diastolic blood pressure) was significantly higher in D2 compaired with C only. 4) The night/day ratio of SBP correlated significantly with duration of diabetes, log of AER, HDL, HbAlc and 24-h DBP. The determinants selected in a multiple stepwise regression were duration of diabetes and HbAlc. 5) The night/day ratio of DBP was related to duration of diabetes, log of AER, 24-h DBP and night HR. The determinants selected in a multiple stepwise regression were duration of diabetes and 24-h DBP. 6) The night/day ratio of HB was related to neuropathy, 1/creatinine, HDL, night SBP, duration of diabetes and log of AER. The determinants selected in a multiple stepwise regression were neruopathy and night SBP. Conclusion: In this study, the normal circardian variation of blood pressure was disturbed in a group of micoralbuminuric patients. But it seems that AER was not a principle independent factor and circardian variation of blood pressure and heart rate were affected by different several factors identified in this study. The nocturnal heart rate was significantly elevated in microalbuminuric group, suggesting the possibility of the presence of parasympathetic neuropathy which is supposed to be related with sudden cardiac death. So it is thought that blunted circardian variation of blood pressure and heart rate can be a prognostic indicator and further prospective study is necessary.
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