儿童代谢综合征与原发性高血压靶器官损害的关系

Relationship between metabolic syndrome and target organ damage of essential hypertension in children

目的探讨儿童代谢综合征与原发性高血压靶器官损害的关系。方法对2007年1月至2015年12月在首都儿科研究所附属儿童医院确诊的165例原发性高血压的10岁及10岁以上患儿进行靶器官损害的评估,并将其分为代谢综合征组(58例)和无代谢综合征组(107例),比较两组患儿靶器官损害的情况,进行统计学分析。结果 165例患儿中,58例(35.2%)合并代谢综合征。代谢综合征组和无代谢综合征组总的靶器官损害发生率分别为84.5%(49/58)和60.7%(65/107),心脏损害发生率分别为48.3%(28/58)和30.8%(33/107),差异均有统计学意义(P<0.05)。糖耐量受损者靶器官损害发生率为86.1%(31/36),明显高于血糖正常者64.3%(83/129),差异有统计学意义(P<0.05)。应用多因素Logistic回归分析显示,代谢综合征、病程>6个月和平均舒张压≥80 mmHg(1 mm Hg=0.133 kPa)是靶器官损害的独立危险因素。结论儿童原发性高血压合并代谢综合征者发生靶器官损害概率明显高于无代谢综合征者,是靶器官损害的独立危险因素;对于原发性高血压患儿常规进行糖代谢等代谢指标检测利于早期发现靶器官损害,以采取有效干预措施。

Objective To study the relationship between metabolic syndrome and target organ damage of essential hypertension in children. Methods One hundred and sixty-five children older than 10 years were retrospectively enrolled,who were diagnosed with essential hypertension. All children received examinations of target organ damage. All children were divided into group with metabolic syndrome（Group A,58） and group without metabolic syndrome（Group B,107）. All data were collected and analyzed using statistic methods. Results In all recruited adolescents,58 patients were diagnosed with metabolic syndrome with the rate of 35.2%. The incidence of target organ damage in Group A（49/58） was significantly higher than Group B（65/107）（84.5% vs. 60.7%,P〈0.05）. The incidence of cardiovascular damage in Group A（28/58） was much higher than Group B（33/107）（48.3% vs. 30.8%,P〈0.05）. The incidence of target organ damage in patients with impaired glucose tolerance was 86.1%（31/36）,which was significantly higher than that of patients without it with the rate of 64.3%（83/129）（P〈0.05）. According to the results of multiple factors Logistic regression analysis, metabolic syndrome,course of disease longer than 6 months and elevated average diastolic pressure（≥80 mmHg） were independent risk factors for target organ damage. Conclusion Essential hypertension children complicated with metabolic syndrome have a much higher incidence of target organ damage than those without metabolic syndrome. Metabolic syndrome is an independent risk factor for target organ damage. The routine examination of metabolic index is beneficial for early diagnosis of target organ damage and effective interference can be performed.