儿童原发性肾病综合征106例复发时动态血压影响因素分析

Influencing factors of ambulatory blood pressure in 106 relapsing children with primary nephrotic syndrome

目的探讨并分析儿童原发性肾病综合征(PNS)复发时动态血压的影响因素。方法回顾性纳入上海交通大学医学院附属上海儿童医学中心2015年12月至2021年8月间106例PNS患儿复发时的24 h动态血压(ABP)资料,分析性别、起病年龄、病程、肾功能、体质指数(BMI)、胆固醇、临床类型、对激素的治疗反应等因素与血压间的相关性。结果综合征(NS)患儿的动态血压(24 h收缩压和舒张压、日间收缩压和舒张压、夜间收缩压和舒张压)的数值及负荷在3组的水平:激素耐药型NS(SRNS)组>激素依赖型NS(SDNS)组>激素敏感型NS(SSNS)组。SRNS组与SSNS组间,收缩压差值、收缩压负荷、日间舒张压差值、舒张压负荷差异均有统计学意义(P<0.05);而与SDNS组相比,SRNS组仅在日间舒张压差值、日间收缩压负荷这二项差异具有统计学意义(P<0.05)。结论高胆固醇血症、肥胖易影响收缩压,而肾炎型NS易出现舒张压异常。SRNS组和SDNS组间的动态血压特点相近,而与SSNS组间存在差异。

Objective To explore and analyze the influencing factors of ambulatory blood pressure(ABP)in relapsing children with primary nephrotic syndrome(PNS).Methods Reports 24 h ABP of 106 relapsing children with PNS in our hospital from December 2015 to August 2021 were retrospectively analyzed to explore the relationship between blood pressure and gender,age of onset,course of disease,renal function,body mass index(BMI),cholesterol,clinical type and response to corticosteroid therapy.Results ABP parameters[24hSBP and 24hDBP and their load,daytime SBP(dSBP)and daytime DBP(dDBP)and their load,nighttime SBP(nSBP)and nighttime DBP(nDBP)and their load]levels in 3 groups:SRNS(steroid-resistant nephrotic syndrome)group>SDNS(steroid-dependent nephrotic syndrome)group>SSNS(steroid-sensitive nephrotic syndrome)group.There were statistical differences between SRNS group and SSNS group exceptΔ24hDBP andΔnDBP(P<0.05).And there were statistical differences between SRNS and SDNS group only inΔdDBP and dSBP load(P<0.05).Conclusion Hypercholesterolemia and obesity affect SBP,while nephritis NS is prone to abnormal DBP.The The characteristics of ABP parameters in SRNS group were similar those in the SDNS group,but significantly different from those in SSNS group.