收稿日期: 2022-02-07
网络出版日期: 2023-01-29
基金资助
上海市综合医院中西医结合专项项目(ZHYY-ZXYJHZX-202027);上海交通大学医学院科技基金项目(Jyh1912);上海儿童医学中心院级科研课题(HL-SCMC2018-3)
Clinical analysis of changes of ambulatory blood pressure in children with primary nephrotic syndrome
Received date: 2022-02-07
Online published: 2023-01-29
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。
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 . DOI: 10.16150/j.1671-2870.2022.05.011
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
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