直立性高血压儿童24h动态血压变化

Changes of 24 h ambulatory blood pressure monitoring in children with orthostatic hypertension

目的 回顾性分析直立性高血压（OHT）儿童24 h动态血压（ABPM）变化。方法 选择2008年1月至2013年12月以不明原因晕厥及先兆晕厥为主诉儿童，经直立倾斜试验（HUTT）确诊为 OHT者43例（OHT组）。男25例，女18例；年龄（11.56±1.88）岁。根据年龄和性别匹配同期以不明原因晕厥或先兆晕厥为主诉，经HUTT诊断为单纯血管迷走性晕厥（VVS）者49例。男28例，女21例；年龄（11.16 ±2.18）岁。每例儿童在HUTT前或后1 d内记录ABPM。结果 1.ABPM 参数：日间平均收缩压在OHT组高于 VVS组（t=2.332，P 〈0.05），OHT组全天平均收缩压、全天平均舒张压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、收缩压昼夜差值及舒张昼夜差值与 VVS组比较差异均无统计学意义（t=1.975、1.334、1.540、1.156、0.617、0.957及0.969，P均〉0.05）。2.HUTT 3 min内血压变化：HUTT 3 min内舒张压改变在OHT组高于VVS组（t=2.132，P 〈0.05），平卧位收缩压及舒张压、3 min内收缩压及舒张压、3 min内收缩压改变与VVS组比较差异均无统计学意义（t=1.101、0.030、2.062、1.632及1.811，P均 〉0.05）。3.血压类型：OHT组及 VVS组均以“非勺型血压”分布为主，2组间差异无统计学意义（χ2=0.005，P 〉0.05）。结论 OHT儿童日间平均收缩压、HUTT 3 min内舒张压明显增高，血压类型以“非勺型血压”为主，可能与自主神经功能紊乱有关。

Objective To retrospectively analyze the changes of 24 h ambulatory blood pressure monitoring （ABPM） in children with orthostatic hypertension （OHT）. Methods The patients from Jan. 2008 to Dec. 2013 were selected,who had the chief complain of unexplained syncope and pre-syneope, through the head-up tilt test （HUTF） diagnosed as OHT [ n = 43, male 25 cases ,female 18 cases, aged （ 11.56 ± 1.88 ） years old ] according to the age and gender match,chief complaint of unexplained syncope or pre-syncope,through the HUTT diagnosed as simple vasovagal syncope （VVS） [ n = 49,male 28 cases, female 21 cases, aged （11.16 ± 2.18 ） years old ]. The ABPM was recorded of every child 1 d before or after HUTT. Results 1. ABPM parameters：daytime mean systolic pressure was higher in OHT group than that in VVS group （t = 2. 332,P 〈 0.05） , but 24 hour mean systolic pressure,24 hour mean diastolic pressure,daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, systolic pressure differences and diastolic pressure differences in the daytime and nighttime had no statistical differences between OHT group and VVS group （ t = 1. 975,1. 334,1. 540,1. 156,0.617,0. 957 and 0. 969, all P 〉 0.05 ）. 2. Blood pressure change in 3 rain of HUTT ： the diastolic blood pressure change in 3 rain of HUTT in OHT group was higher than that in the VVS group （t = 2. 132,P 〈 0.05） ,but the systolic blood pressure and diastolic blood pressure in horizontal position, systolic blood pressure and diastolic blood pressure in 3 rain of HUTF, the systolic blood pressure change in 3 rain of HUTT had no statistical differences between OHT group and VVS group （t = 1. 101,0. 030,2. 062,1. 632 and 1. 811 ,all P 〉 0.05）. 3. Blood type：＂ non-dipper blood pressure＂ was the main blood type in OHT group and VVS group, and there was no statistically significant difference between the 2 groups （χ^2 = 0. 005, P 〉 0.05 ）. Conclusions In OHT children, daytime mean systolic pressure and diastolic blood pressure change in 3 min of HUTT increased, and ＂non-dipper blood pressure＂ is the main blood type. These may be associated with autonomic nerve dysfunction.