儿童肾血管性高血压23例临床分析

Clinical analysis of 23 cases of childhood renovascular hypertension

目的分析儿童。肾血管性高血压的临床特点及治疗。方法回顾性分析2004年2月至2014年12月收治的〈14岁。肾血管性高血压患儿的临床资料。结果23例肾血管性高血压患儿，男15例、女8例，平均年龄（8．5±2．1）岁（0．6～14岁）。收缩压159．4-217．3mmHg，舒张压98．5-159．5mmHg。病因以肾动脉纤维肌发育不良和多发性大动脉炎为主。首发表现以头痛、呕吐、抽搐多见。立位和卧位的肾素、血管紧张素、醛固酮检查，大部分患儿有所增高。全部息儿均行D．受体阻滞剂和钙离子拮抗剂及血管紧张素转换酶抑制剂（ACEI）治疗，其中20例采用2种以上药物联合治疗。18例患儿经介入治疗后，血压维持正常17例、术后再狭窄1例，服用ACEI维持血压正常5例。结论儿童肾血管性高血压疾病易误诊、漏诊，但确诊后经介入治疗预后良好。

Objective To explore the clinical characteristics and treatment of childhood renovascular hypertension. Methods The clinical data of pediatric patients under 14 years old with renovascular hypertension （RVH） from February 2004 to December 2014 were retrospectively analyzed. Results Twenty-three pediatric patients （15 boys and 8 girls） with RVH were enrolled. The average age of the patients were 8.5±2.1 years （0.6-14 years）. The range of systolic blood pressure was 98.5-159.5 mmHg and the range of diastolic blood pressure was 159.4-217.3 mmHg. The main causes of RVH were renal artery fibromuscular dysplasia and Takayasu arteritis. The first presentation was headache, vomiting and convulsions. The levels of renin, angiotensin and aldosterone in the standing and supine positions were increased in most of the patients. All of the patients were treated with p-blockers, calcium antagonists and angiotensin converting enzyme inhibitors （ACED. Twenty patients were treated with more than two types of drugs. In 18 patients treated by interventional therapy, 17 maintained normal blood pressure and one had postoperative restenosis. Five patients took ACEI and maintained normal blood pressure. Conclusion Childhood renovascular hypertension is easy to be misdiagnosed or miss-diagnosed, but the prognosis is good by interventional treatment after diagnosis.