儿童原发性肾病综合征动态血压变化特点的临床分析

doi:10.16150/j.1671-2870.2022.05.011

摘要/Abstract

摘要：

目的：探讨儿童原发性肾病综合征（primary nephrotic syndrome，PNS）患者的动态血压变化特点。方法：回顾性分析上海儿童医学中心106例PNS患儿的24 h动态血压报告。结果：PNS患儿高血压发生率为60.4%（64/106），其中62例（58.5%）于夜间发生高血压，17例（16.0%）于日间发生高血压，PNS患儿夜间的高血压发生率高于日间（P<0.05）。夜间收缩压（systolic blood pressure，SBP）和舒张压（diastolic blood pressure，DBP）负荷均大于日间负荷[夜间SBP（52.32±36.87）%比日间SBP（19.41±19.70）%，夜间DBP（39.22±34.69）%比日间DBP（18.42±21.66）%, P<0.05]。106例患儿中，92例（86.8%）存在SBP和（或）DBP动态血压昼夜节律异常，且均以非杓型为主（68.9%），而SBP节律比DBP节律更易出现异常（79.2%比65.1%，P=0.022），SBP的夜间下降比值与DBP间比较差异具有统计学意义[SBP（3.52%±6.97%）比DBP（7.78%±9.18%），P<0.001]。白大褂高血压发生率为12.3%，隐匿性高血压发生率为14.2%。结论：PNS患儿易发生夜间高血压和昼夜血压节律异常，尤其SBP异常更多见。应重视PNS患儿的动态血压监测，尤其是夜间血压数值和血压节律，以指导临床治疗。

关键词: 动态血压, 儿童, 原发性肾病综合征

Abstract:

Objective: To explore the characteristics of the changes of ambulatory blood pressure (ABP) in the children with primary nephrotic syndrome (PNS). Methods: A total of 106 PNS children′s reports of 24-hour ambulatory blood pressure in Shanghai Children′s Medical Center were analyzed retrospectively. Results: The incidence of hypertension in PNS children was 60.4% (64/106), and 58.5% (62/106) children had nighttime hypertension, and 16.0% (17/106） children had daytime hypertension. The incidence of hypertension at night was higher than that in daytime(P<0.05). The loads of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at night were higher than those at the daytime (SBP 52.32%±36.87% vs 19.41%±19.70%, DBP 39.22%±34.69% vs 18.42%±21.66%, P<0.05). Among 106 children, 92(86.8%) had abnormal circadian rhythms in SBP and/or DBP ambulatory blood pressure, and most of them were non-dippers (68.9%). SBP rhythm was more likely to be abnormal than DBP rhythm (79.2% vs 65.1%, P=0.022). There was a statistical difference in the rate of blood pressure decline between SBP and DBP at night [SBP (3.52%±6.97%) vs DBP (7.78%±9.18%), P<0.001]. The incidence of white-coat hypertension was 12.3%, and the incidence of masked hypertension was 14.2%. Conclusions: PNS children are prone to nocturnal hypertension and abnormal circadian rhythm, especially SBP. 24 h ambulatory blood pressure is conducive to collecting blood pressure change information and to guide the rational use of antihypertensive drugs for PNS children.

Key words: Ambulatory blood pressure, Pediatric, Primary nephrotic syndrome

中图分类号:

R544

沈小钰, 沙莎, 殷蕾, 周纬, 骆凝馨, 王雪峰. 儿童原发性肾病综合征动态血压变化特点的临床分析[J]. 诊断学理论与实践, 2022, 21(05): 613-618.

SHEN Xiaoyu, SHA Sha, YIN Lei, ZHOU Wei, LUO Ningxin, WANG Xuefeng. Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(05): 613-618.

图/表 2

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分类	诊室血压	平均动态血压	血压负荷（%）
正常血压	<第95百分位	<第95百分位	<25
白大衣高血压	>第95百分位	<第95百分位	<25
隐匿性高血压	<第95百分位	>第95百分位	>25
高血压前期	>第95百分位	<第95百分位	25~50
动态高血压	>第95百分位	>第95百分位	25~50
严重动态高血压	>第95百分位	>第95百分位	>50

时段	SBP负荷（%）	DBP负荷（%）	t值	P值
24 h	31.52±22.84	25.54±23.93	1.861	0.064
日间	19.41±19.70	18.42±21.66	0.350	0.726
夜间	52.32±36.87	39.22±34.69	2.665	0.008
t值^*	-8.103	-5.236
P值^*	<0.001	<0.001

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