儿童肾脏疾病170例动态血压监测的临床分析

Clinical analysis of ambulatory blood pressure monitoring in 170 children with kidney diseases

目的探讨动态血压监测(ABPM)在儿童肾脏疾病中的特点、优势及动态血压与临床指标的相关性。方法总结2012年3月至2018年3月于首都儿科研究所附属儿童医院肾脏内科住院且完成ABPM的肾脏疾病患儿的临床资料,分析患儿随机血压、ABPM指标,比较其在不同临床分组中的情况。结果1.在170例患儿中,随机血压升高69例(40.6%);动态高血压患儿54例(31.8%),其中43例(25.3%)符合严重的动态高血压;白大衣高血压患儿17例(10.0%);隐匿性动态性高血压患儿41例(24.1%);139例(81.8%)昼夜血压节律紊乱。2.结合ABPM,发现血压异常患儿163例(95.9%),较随机血压检测出的比例(69例,40.6%)显著升高,差异有统计学意义(χ2=149.176,P<0.001);应用降血压药物治疗的40例患儿中,结合ABPM发现38例(95.0%)存在血压异常,显著高于随机血压的检测(17例,42.5%),差异有统计学意义(χ2=10.208,P=0.001)。3.Logistic回归分析显示,病程>3个月、肥胖和肾病水平蛋白尿是出现动态血压升高的危险因素,以上指标的比值比分别为5.345、3.530和6.560。肾功能异常患儿血压昼夜节律紊乱的比例(89.7%,52/58例)较肾功能正常患儿(75.9%,85/112例)显著升高,差异有统计学意义(χ2=4.626,P=0.031)。结论肾脏疾病患儿高血压常见,ABPM可及时发现血压异常,并识别出白大衣高血压。肾病水平蛋白尿和肥胖是肾脏疾病患儿出现动态血压升高的危险因素,肾功能异常和夜间血压节律紊乱有关。

Objective To investigate the features and advantages of ambulatory blood pressure monitoring(ABPM)applied in children with kidney diseases as well as the correlation between ambulatory blood pressure and clinical indicators.Methods The clinical data of children with kidney diseases who were hospitalized and received ABPM in Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2012 to March 2018 were collected.Clinical blood pressure and ABPM indicators were analyzed and compared between different clinical groups.Results(1)Among 170 cases enrolled,69 cases(40.6%)were hypertension by measuring clinical blood pressure,54 cases(31.8%)were ambulatory hypertension,43 cases(25.3%)of whom had severe ambulatory hypertension,17 cases(10.0%)had white coat hypertension,41 cases(24.1%)were defined as masked hypertension,and 139 cases(81.8%)had impaired circadian rhythm of blood pressure.(2)Ninety-five point nine percent(163/170 cases)were detected of abnormal blood pressure by ABPM,and the rate was significantly higher than that detected by clinical blood pressure(40.6%,69/170 cases)(χ2=149.176,P<0.001).In the 40 cases who were administrated with antihypertensive drugs,95.0%(38 cases)were detected to have anomalous blood pressure by ABPM,significantly more than that detected by clinical blood pressure(42.5%,17/40 cases)(χ2=10.208,P=0.001).(3)Logistic regression analysis indicated that a prolonged clinical course of more than 3 months,obesity and nephrotic-range proteinuria were the risk factors of ambulatory hypertension,and the odd ratios were 5.345,3.530 and 6.560,respectively.Circadian rhythm disorders of blood pressure were more common in the children with abnormal renal function than in those with normal renal function[89.7%(52/58 cases)vs.75.9%(85/112 cases)],and the difference was statistically significant(χ2=4.626,P=0.031).Conclusions Children with kidney diseases have a high incidence of hypertension.ABPM plays a key role in detecting hypertension and recognizing white coat hypertension.Nephrotic-range proteinuria and obesity are risk factors for ambulance hypertension,and abnormal renal function is associated with nocturnal blood pressure disorders.