儿童肾血管高血压的特殊临床表现及治疗

Special clinical manifestations and therapy for renal vascular hypertension in children

目的:阐明儿童高血压的特殊临床表现及肾血管性高血压的合理治疗。方法:26例患儿,确诊为肾血管性高血压。其中肾动脉纤维肌发育不良12例,多发性大动脉炎14例。肾动脉支架植入22例,肾动脉球囊成形术2例,患肾切除1例。术后随访3年。结果:介入治疗后血压持续正常21例,继续服用ACEI血压正常5例,支架术后再狭窄2例。肾功能、心功能、血浆肾素水平恢复正常。结论:①运动后发生晕厥、腹痛伴恶心呕吐、原因不明心功能不全的患儿应警惕高血压或高血压危象;②儿童肾血管性高血压的最佳治疗应选择肾动脉介入治疗;③儿童肾动脉支架植入不影响肾脏发育;④肾动脉直径<4mm应先行肾动脉球囊成形术。

Objective:To illustrate the special clinical manifestations of children hypertension and rational therapy for renal vascular hypertension.Methods: The etiological factors of renal vascular hypertension in 26 children were renal artery fiber hypogenesis(n=12) and Takayasu arteritis(n=14).Renal artery stent implantation was performed in 22 children,renal artery balloon angioplasty in 2,and nephrectomy in 1.Postoperative follow-up time was 3 years.Results: The postoperative blood pressure sustained normally in 21 children and also normal in 5 administrated with angiotensin-converting enzyme inhibitor.Restenosis after stent implantation was found in 2 children.Renal function,heart function and plasma renin returned to normal level in all the children.Conclusion: The children with syncope,nausea and vomiting after exercise,and agnogenic cardiac insufficiency should be considered as hypertension and hypertensive crisis.The best therapeutic regimen of renal vascular hypertension in children is vascular interventional treatment.Renal artery stent implantation doesn’t influence kidney growth in children.Renal artery balloon angioplasty should be performed for children with diameter of renal artery <4 mm.