原发性肾病综合征患儿动态血压与肾损害的关系

Ambulatory blood pressure monitoring in children with primary nephrotic syndrome and its relationship with renal damage

目的研究原发性肾病综合征(PNS)患儿24h动态血压监测(ABPM)数值的异常变化,探讨PNS患儿24h动态血压(ABP)与肾损害指标的关系,从而揭示血压对肾脏的损害机制。方法采用动态血压监测仪对114例PNS患儿进行24h动态血压监测,与随机血压(CBP)比较,并分析血压与肾损害的关系。结果 114例PNS患儿ABP与CBP呈现不同的组合关系,从而出现不同的分类诊断,而且ABPM敏感度高。通过ABPM发现隐匿性高血压和白大衣性高血压,尤其隐匿性高血压发病率高。ABPM发现PNS患儿24h动态血压节律的减低,非杓型血压(non-dipper)发病率高。PNS患儿的ABP均值、负荷、非杓型血压与肾损害密切正相关。结论 ABPM与CBP存在不平行性,ABPM具有更高的阳性率,更能反映血压变化趋势。ABPM的应用有利于发现24h动态血压节律减低的non-dipper患儿,给积极防治肾损害提供依据。

Objective To investigate the anomaly values of ambulatory blood pressure monitoring （ABPM） in children with primary nephrotie syndrome （PNS）, to explore the relationship between ABPM and renal injury, and to reveal the role of hlood pressure （BP） in kidney damage. Methods 24-hour ABMP was recorded and compared with casual blood pressure （CBP） in 114 ehildren with PNS. The correlation hetween ABPM, CBP and renal danmges were analyzed. Results The range of agreement of ABPM with CBP was wide in ehildren with PNS. More masked hypertension and white eoat hypertension were found by ABPM, especially the masked hypertension. The variability of ABPM was reduced and non-dipper was increased in children with PNS. The mean BP, BP loads and non-dipper were elosely correlated with renal injury in children with PNS. Conclusions ABPM was unparalleled with CBP. Application of ABPM eouht find the reduced variahility of BP and non-dipper for promoting early preventinn of renal damage.