Study Of The Relationship Between 24-hour Ambulatory Blood Pressure Pattern And Liver And Kidney Function In Pregnant Women With Hypertensive Disorders Of Pregnancy

Objective: To investigate the correlation between 24-hour ambulatory blood pressure model and liver and kidney function in pregnant women with hypertensive disorders of pregnancy.Method: A retrospective collection of 110 patients with hypertensive disorders of pregnancy in the Department of Obstetrics,Hebei Provincial People’s Hospital from January 2018 to December 2018,excluding abortion,stillbirth,multiple pregnancies,pre-pregnancy diabetes,liver dysfunction,renal dysfunction,autoimmune diseases and pregnant women with important organ diseases,all the people underwent 24 h ambulatory blood pressure monitoring(ABPM).The 24-hour ambulatory blood pressure values were recorded and classified into a dippers group(24 persons),a nondippers group(53persons),and a reverse dippers group(33persons)according to changes in circadian rhythm.General information such as age,parity,number of pregnancies,weeks of admission,gestational weeks of delivery,height,weight,biochemical parameters,blood analysis,plasma D-dimer,24-hour urinary protein quantification and 24-hour urinary protein concentration were recorded.The basic information,blood pressure index,blood index and urine index of each group were compared.All data are input into Excel table and analyzed by IBM SPSS Statistics 21.0 software.If the measurement data are normal distribution,they are expressed in the form of mean ± standard deviation,and the comparison among the three groups is analyzed by one-way ANOVA;the non-normal distribution data are expressed in quartiles,and the comparison among the three groups is tested by rank sum test(RST),P<0.05 is the significant difference.Results: The basic information of three groups of pregnant women showed that there were no significant differences in age,pregnancy times,parity,height,weight before pregnancy,BMI before pregnancy,weight gain during pregnancy,admission weight,admission BMI and dDBP(P> 0.05),but there were significant differences in gestational weeks,dSBP,nSBP,nDBP,24 hSBP and 24hDBP(P<0.05).The gestational weeks of delivery in dipper group,non-dipper group and reverse dipper group decreased gradually.Compared with dipper group,there was significant difference between non-dipper group and reverse dipper group(P<0.05).nSBP,nDBP,24 hSBP and 24 hDBP increased gradually among dipper group,non-dipper group and reverse dipper group.Compared with dipper group,there were significant differences in dSBP,nSBP and 24 hSBP in non-dipper group(P<0.05),and nSBP,nDBP,24 hSBP and 24 hDBP in reverse dipper group(P<0.05).Compared with non-dipper group,nSBP and nDBP in reverse dipper group had significant difference(P<0.05).The blood and 24-hour urinary protein indices of three groups of pregnant women showed that there was no significant difference in eGFR,HGB and PLT among dipper group,non-dipper group and reverse dipper group(P> 0.05).There were significant differences in ALB,ALT,AST,Scr,PLT,24-hour urinary protein concentration and 24-hour urinary protein quantification among dipper group,non-dipper group and reverse dipper group(P<0.05).There was a negative correlation between dDBP,nSBP,nDBP,24 hSBP,24hDBP and ALB in 24hABMP(P<0.05).dDBP,nDBP,24 hDBP and Scr were negatively correlated(P < 0.05).24 hABPM parameters dDBP,dSBP,nDBP,nSBP,24 hSBP.There was a positive correlation between 24 hDBP and 24 h urine protein quantitation(P<0.05).The parameters of dDBP,dSBP,nDBP,nSBP,24 hSBP and 24 hDBP were positively correlated with 24 h urine protein concentration(P<0.05).Conclusion: 1.The ambulatory blood pressure monitoring of inpatients in this study showed that the detection rate of abnormal blood pressure circadian rhythm in pregnant women was 78%.2.The circadian rhythm in dipper type group,non-dipper type group and reverse dipper type group increased in order of dSBP,nSBP,nDBP,24 hSBP and 24 hDBP.dSBP,nSBP,nDBP,24 hSBP and 24 hDBP in dipper,non-dipper and reverse dipper blood pressure circadian rhythms gradually increased.3.ALB,ALT,AST and Scr in dipper,non-dipper and reverse dipper blood pressure circadian rhythms gradually decreased,while D-dimer,24-hour urinary protein quantification and 24-hour urinary protein gradually increased.Liver and kidney function is related to the circadian rhythm of blood pressure.4.ALB was negatively correlated with dDBP,nSBP,nDBP,24 hSBP and 24 hDBP,Scr was negatively correlated with dDBP,nDBP and 24 hDBP,and urinary protein was positively correlated with dSBP、dDBP、nSBP、nDBP、24hSBP、24hDBP.