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目的探讨儿童原发性高血压与继发性高血压的血压特点,提高对儿童高血压的病因识别。方法选择2003年11月-2011年3月在首都医科大学附属北京安贞医院高血压科住院的高血压患儿为研究对象,按其病因分为原发性高血压和继发性高血压2组。患儿均常规测定身高、体质量、空腹血糖、血Cr、血尿酸、血脂及肾素、血管紧张素Ⅱ和醛固酮水平,并计算体质量指数(BMI)。行手测血压、24 h动态血压监测,分析2组间日间、夜间收缩压(SBP)及舒张压(DBP)水平、日间、夜间SBP及DBP血压负荷等指标。结果高血压患儿中男19例,女6例;年龄(12.4±2.5)岁。原发组患儿体质量和BMI均高于继发组患儿[(70.94±31.46)kg vs(45.93±14.62)kg;(24.98±6.96)kg.m-2 vs(19.13±4.89)kg.m-2],2组间差异均有统计学意义(P=0.013,0.031)。与原发组患儿比较,继发组患儿的日间平均DBP水平[(91.14±10.67)mmHg vs(79.06±10.42)mmHg(1 mmHg=0.133kPa)]、夜间平均DBP水平明显升高[(81.43±12.71)mmHg vs(66.83±12.49)mmHg],日间SBP负荷[(79.46±18.17)%vs(46.88±33.29)%],夜间SBP负荷[(89.02±15.74)%vs(54.22±27.91)%],日间DBP血压负荷[(62.87±31.33)%vs(30.94±27.36)%],差异均有统计学意义(Pa<0.05)。结论原发性高血压患儿多伴有肥胖。继发性高血压患儿动态血压监测中日间和夜间DBP水平增高、日间和夜间SBP负荷、日间DBP负荷高。在儿童中动态监测血压水平,可帮助鉴别病因。
Objective To explore the characteristics of blood pressure in children with essential hypertension and secondary hypertension to improve the etiological identification of hypertension in children. Methods From November 2003 to March 2011, hypertensive subjects admitted to Department of Hypertension, Beijing Anzhen Hospital, Capital Medical University, were divided into two groups: primary hypertension and secondary hypertension group. Children were routinely measured height, body mass, fasting blood glucose, blood Cr, blood uric acid, blood lipids and renin, angiotensin II and aldosterone levels, and calculate the body mass index (BMI). Blood pressure was measured by hand and ambulatory blood pressure monitoring was performed at 24 hours. SBP and DBP levels, daytime and night SBP and DBP blood pressure were measured. Results There were 19 males and 6 females with hypertension (12.4 ± 2.5) years old. The body mass and BMI in the primary group were significantly higher than those in the secondary group [(70.94 ± 31.46) kg vs (45.93 ± 14.62) kg and (24.98 ± 6.96) kg.m-2 vs (19.13 ± 4.89) kg, respectively. m-2], the differences between the two groups were statistically significant (P = 0.013,0.031). Compared with the primary group, the mean DBP level in the secondary group was significantly higher than that in the secondary group [(91.14 ± 10.67) mmHg vs (79.06 ± 10.42) mmHg (1 mmHg = 0.133 kPa) (81.43 ± 12.71) mmHg vs (66.83 ± 12.49) mmHg], day SBP load [(79.46 ± 18.17)% vs (46.88 ± 33.29)%], nighttime SBP load [(89.02 ± 15.74)% vs (54.22 ± 27.91 ) Daytime DBP blood pressure [(62.87 ± 31.33)% vs (30.94 ± 27.36)%], the difference was statistically significant (Pa <0.05). Conclusion Most children with essential hypertension are obese. Ambulatory blood pressure monitoring in children with secondary hypertension increased daytime and nighttime DBP levels, daytime and nighttime SBP loads, and daytime DBP loads. Dynamic monitoring of blood pressure levels in children can help identify the cause.