住院儿童高血压232例病因构成与临床分析

Etiology and clinical analysis of 232 hospitalized children with hypertension

目的分析近年来住院儿童高血压的病因构成及临床特点,分析原发性高血压靶器官损害的危险因素,为儿童高血压临床诊断提供依据.方法回顾性分析首都儿科研究所附属儿童医院2013 年4 月至2017年12月临床诊断"高血压"患儿的临床资料,包括一般情况、临床表现、实验室检查、辅助检查、靶器官损害评估等.结果 1.共232例患儿纳入本研究.其中男184例(79. 3%),女48例(20. 7%);高血压前期38例(16. 4%),高血压Ⅰ期126 例(54. 3%),高血压Ⅱ期68 例(29. 3%).2.病因构成:原发性高血压181 例(78%),继发性高血压51 例(22%);原发性高血压在学龄前期、学龄期及青春期占比分别为1. 6%(3 例)、21. 0%(38例)、77. 4%(140例).继发性高血压以肾实质性及肾血管性多见(43. 1%).3.原发性高血压临床表现以无症状或症状不明显为最多,共148例(64%),其次为头晕、头痛,胸痛、胸闷、心悸、视物模糊等.4.原发性高血压靶器官损害的危险因素包括剖宫产、糖代谢异常及体质量指数>24 kg/m2 .结论近年来,住院儿童高血压患者中原发性高血压比例增加;继发性高血压病因构成无明显变化;原发性高血压患儿就诊时多伴有靶器官损害.因此,将血压监测作为中小学生体检项目具有重要意义,以便早期发现高血压患儿,积极干预,改善预后.

Objective To analyze the etiology and clinical characteristics of hypertension in children;to ana-lyze the risk factors for primary hypertension with target organ damage,and to provide evidence for clinical diagnosis of hypertension in children. Methods Two hundred and thirty-two hospitalized children with hypertension at Children's Hospital Institute of Pediatrics from April 2013 to December 2017 were retrospectively analyzed,including general situa-tion,clinical manifestation,laboratory examination,auxiliary examination and damage assessment of target organs. Results (1)There were totally 232 eligible cases,consisting of 184 males(79. 3%)and 48 females(20. 7%). Among these children:38 cases(16. 4%),126 cases(54. 3%),and 68 cases(29. 3%)were diagnosed as prehypertension,hy-pertension in stageⅠ,and hypertension in stageⅡ,respectively.(2)The etiological composition of hypertension:there were 181 cases(78%)diagnosed as primary hypertension and 51 cases(22%)diagnosed as secondary hypertension, respectively;the proportion of the primary hypertension children during the period of preschool,school-age,and ado-lescent was 1. 6%(3 cases),21. 0%(38 cases)and 77. 4%(140 cases),respectively. The etiology of secondary hy-pertension was mostly of the renal parenchymal hypertension and renal vascular hypertension(43. 1%).(3)The clinical manifestations of primary hypertension were mostly of asymptomatic or mild symptoms,totally 148 cases(64%),and then dizziness,headache,chest pain,chest tightness,palpitation,blurred vision,and other clinical symptoms.(4)The high risk factors for primary hypertension with target-organ damage included cesarean section,glucose metabolism dis-turbance and body mass index >24 kg/m^2 . Conclusions In recent years,the proportion of primary hypertension among hospitalized children has increased. The changes in the etiology of secondary hypertension are not found. Primary hypertension children are often accompanied with target organ damage. It is of great significance to make blood pressure monitoring as a routine physical examination for primary and middle school students,so as to detect hypertension in children earlier,and make active intervention and improve the prognosis of hypertension in children.