合并蛋白尿的Ⅰ-Ⅱ期慢性肾脏病儿童动态血压变化的临床研究

doi:10.16150/j.1671-2870.2024.05.010

摘要/Abstract

摘要：

目的：探讨合并蛋白尿的Ⅰ-Ⅱ期慢性肾脏病（chronic kidney disease，CKD）儿童高血压发生率及动态血压的变化特点。方法：回顾性纳入我院2019年1月至2022年10月间收治的150例合并蛋白尿的Ⅰ-Ⅱ期CKD连续儿童病例的24 h动态血压报告，分析高血压发生率和不同肾脏疾病间的血压节律。根据患儿的血压情况，将其分为动态高血压组和动态血压正常组，比较2组间的年龄、性别、体重指数、CKD分期、蛋白尿和激素情况。结果：患儿的白大衣高血压发生率为2.67%，隐匿性高血压发生率为12.00%，动态高血压发生率为14.00%，诊室高血压发生率为7.33%。118例（78.67%）合并蛋白尿的Ⅰ-Ⅱ期CKD患儿的动态血压昼夜节律存在异常，但在不同肾脏疾病间不存在统计学差异（P>0.05）。大量蛋白尿组与非大量蛋白尿组间的诊室高血压发生率存在统计学差异（P<0.05），但血压昼夜节律不存在统计学差异（P>0.05）。动态高血压组与动态血压正常组在年龄、性别、体重指数、CKD分期、激素方面差异无统计学意义(P>0.05)，但动态高血压组的大量蛋白尿发生率高于动态血压正常组[13/21(61.9%)比30/129(23.2%)，P<0.001]。结论：近80.00%的合并蛋白尿的Ⅰ-Ⅱ期CKD患儿的血压昼夜节律发生改变，以非杓型和反杓型为主，与肾病种类及蛋白尿程度无关；动态高血压与蛋白尿程度相关，有助于指导临床合理使用降压药。

关键词: 动态血压, 儿童, 慢性肾脏病, 蛋白尿

Abstract:

Objective To investigate ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease (CKD) combined with proteinuria. Methods Ambulatory blood pressure (ABP) reports of 150 consecutive cases with stage Ⅰ-Ⅱ CKD combined with proteinuria in our hospital from January 2019 to October 2022 were analyzed retrospectively to find out the incidence of hypertension, the clinical characteristics of the rhythm of ABP among various renal diseases. Age, gender, body mass index, CKD stage, proteinuria and steroids were compared between ambulatory hypertension group and normal ambulatory blood pressure group. Results The incidence of white coat and masked hypertension was 2.67% and 12.00% respectively. The incidence of ambulatory hypertension was high (ambulatory hypertension 14% vs clinic hypertension 7.33%); 118 patients(78.67%) with stage Ⅰ-Ⅱ CKD combined with proteinuria have demonstrated abnormal ABP rhythms, but no statistically significant differences were observed among the various renal diseases (P>0.05). There was a significant difference in the incidence of clinic hypertension between the massive proteinuria and non-massive proteinuria groups (P<0.05), while no statistical significance was found in ABP rhythm (P>0.05). There were no significant differences in age, gender, body mass index, CKD stage and steroids between the ambulatory hypertension group and the normal ambulatory blood pressure group (P>0.05). However, the incidence of massive proteinuria in the ambulatory hypertension group was higher than that in the normal ambulatory blood pressure group [13/21(61.9%) vs. 30/129(23.2%)，P <0.001]. Conclusions The ABP rhythm can alter in 80.00% children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria, mainly in non-dipper and anti-dipping patterns, independent of the type of renal disease and the degree of proteinuria. Ambulatory hypertension is correlated with the degree of proteinuria, which may provide valuable guidance for the rational clinical use of antihypertensive medications.

Key words: Ambulatory blood pressure, Pediatrics, Chronic kidney disease, Proteinuria

中图分类号:

R544
R446

沈小钰, 沙莎, 殷蕾, 周纬, 茅幼英, 汪张娟, 孙燕, 吴燕. 合并蛋白尿的Ⅰ-Ⅱ期慢性肾脏病儿童动态血压变化的临床研究[J]. 诊断学理论与实践, 2024, 23(05): 531-536.

SHEN Xiaoyu, SHA Sha, YIN Lei, ZHOU Wei, MAO Youying, WANG Zhangjuan, SUN Yan, WU Yan. Clinical study of ambulatory blood pressure changes in children with stage Ⅰ-Ⅱ chronic kidney disease combined with proteinuria[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(05): 531-536.

图/表 3

表1

患儿的临床基本信息（n=150）

Item	$x -$ ±s/M(P25，P75)
Age（years）	11.01±2.57
Course（years）	2.47(1.25,3.68)
BP（mmHg）
24-hour SBP/DBP blood pressure	108.05±10.17/66.99±8.88
Daytime SBP/DBP	109.15±9.84/68.29±8.48
Nighttime SBP/DBP	104(97,112)/60(55,70.25)
Proteinuria（mg/kg）	19.63(2.42,59.77)
Massive proteinuria（n=43）	88.41(68.89,122.37)
Non-massive proteinuria（n=107）	4.87(1.70,21.85)

表1

表2

表3

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Item	Ambulatory hypertension （n=21）	Normal ambulatory blood pressure （n=129）	t/χ²	P
Age（years）	11.00±2.28	11.01±2.62	0.013	0.990
Gender			0.814	0.367
Male	10	75
Female	11	54
BMI			0.501	0.479
Overweight	3	31
Normal	18	98
CKD stage			0.535	0.464
StageⅠ	16	110
Stage Ⅱ	5	19
24-hour Proteinuria			13.192	<0.001
Massive proteinuria	13	30
Non-massive proteinuria	8	99
Corticosteroid			0.030	0.863
Take	16	96
Not take	5	33