高血压患儿病因及其靶器官损害相关因素分析

Retrospective analysis of etiology and target organ damage in children with hypertension

目的分析儿科原发性与继发性高血压患儿的临床资料,为鉴别原发性高血压与继发性高血压,并探讨原发性高血压患儿靶器官早期损害诊断与治疗。方法回顾性分析本医院自1992-01至2016-05确诊为高血压的住院患儿,按照病因分为原发性高血压和继发性高血压,分别对其一般情况、继发性高血压病因、原发性高血压靶器官损害的情况进行统计学分析。结果 (1)原发性高血压患儿平均11.76岁,体重指数BMI均值26.90 kg/m2,高于继发性高血压患儿平均年龄(7.38岁)及BMI均值(19.94 kg/m2),差别具有统计学意义(P=0.000)。(2)继发性高血压患儿在婴幼儿期、学龄前期、学龄期及青春期高血压患儿的构成比分别为94.7%、48.3%、17.0%、8.6%,发病年龄越早,继发性高血压的可能性越大,随着年龄增长,原发性高血压检出率逐渐增多。(3)分析继发性高血压病因:肾脏病变仍为继发性高血压首要病因,占59.42%,继发性高血压平均血压水平高于原发性高血压。(4)82.0%入院诊断原发性高血压的患儿已出现靶器官损害,血、尿β2微球蛋白升高可作为监测原发性高血压早期肾脏损害的敏感指标;平均舒张压水平升高和空腹胰岛素升高患儿更易出现原发性高血压靶器官损害。结论继发性高血压发病年龄早,血压水平高,其首要病因为肾实质及肾血管疾病。儿童原发性高血压大部分在诊断时即已出现靶器官损害,血、尿β2微球蛋白检测可作为肾脏早期受损的筛查指标。平均舒张压升高和空腹胰岛素升高患儿更易出现原发性高血压靶器官损害。

Objective To analyze the clinical data of children with primary hypertension and secondary hypertension in order to provide reference for accurate diagnosis and for early detection of target organ damage in case of primary hypertension. Methods All the children who were diagnosed with hypertension and hospitalized between January 1992 and May 2016 were enrolled in this study.Hypertension was classified as primary and secondary based on the etiology of hypertension. Data was analyzed with SPSS 17. 0 software. Results（ 1） The average age of primary hypertension patients was 11. 76 years old,and the mean BMI was 26. 90 kg/m2,which were higher than those of secondary hypertension patients with statistically significant difference（ P = 0. 000）.（ 2） The composition ratio of secondary hypertension during infancy,preschool period,school age and adolescence was 94. 7% 、48. 3% 、17. 0% and8. 6% respectively. Adolescents were more vulnerable to primary hypertension than children of other ages.（ 3） 59. 42% of secondary hypertension patients had kidney disease. Blood pressure was higher in secondary hypertension patients.（ 4） Target organ damage was present during diagnosis in most of the patients with primary hypertension. Elevated levels of serum or urine β2-microglobulin could be an earlier indicator of kidney damage. In the target organ damage group,the mean diastolic blood pressure and insulin level were higher. Conclusions Patients with secondary hypertension were younger than patients with primary hypertension,and blood pressure was higher. The causes of secondary hypertension are mainly kidney and vascular lesions. Target organ damage can be detected during diagnosis in most of the patients with primary hypertension. The higher diastolic blood pressure and insulin levels,the more likely target organ damage can be.