青少年原发性高血压临床特点分析与运动干预

Clinical analysis of characteristics in the adolescent patients with essential hypertensive disease and motor intervention

目的从临床角度探讨青少年原发性高血压(EH)发病影响因素,血压与左心室构型、内皮功能的相关性,并分析运动干预的效果。方法32例14～25岁轻中度高血压病患者,20例性别、年龄及体重指数匹配的志愿者作为对照;询问病史、个人史及家族史;监测卧、立位血压变化,给予8周有氧运动干预,干预前后行24h动态血压(ABPM)监测及心脏多普勒超声检查。结果青少年EH以脑力劳动者居多,家族史阳性发生率为94%(30/32),“母体效应”明显,为59%(19/32),高血压组肥胖的发生率高于对照组,出生体重犤(3.0±0.4)kg犦小于对照组犤(3.4±0.3)kg犦;卧立位血压变化明显大于对照组(t=4.9,P<0.05);ET水平高于对照组(t=9.4,P<0.05)。诊所血压与ABP呈正相关,左室重构指数CR与24h平均收缩压(24hSBP),白天平均收缩压(dSBP),夜间平均收缩压(nSBP)及卧立位血压变化(ΔBP)正相关(r=0.5,0.5,0.4);运动干预后诊所血压及24h平均收缩压、白天收缩压明显下降(t=3.5,4.2,P<0.05)。结论青少年EH具有明显的家族聚集性和“母体效应”;家族史阳性、出生体重偏低、肥胖及情绪急躁者为高危人群;体重指数收缩压及交感神经活性增加可能是青少年左室重构影响因素之一;有氧运动是一项适合治疗青少年高血压的有效干预措施。

Aim To investigate the correlation among episode, blood pressure, confi guration of left ventricle and endothelial function in the teenagers with essent ial hypertensive disease (EH), and analyze the effect of motor intervention.Meth ods Thirty-two adolescent patients with mild or moderate EH,aged 14-25 years,a nd twenty sex,age and body mass index (BMI) matched normotensive controls underw ent 8 week aerobic exercise intervention,inquired ill history,personal history a nd family history. Ambulatory blood pressure monitoring (ABPM) and pulsed Dopple r ultrasonography were applied in the all subjects for 24 hours.The supine posit ion blood pressure and standing position blood pressure were measured with an ar m sphygmomanometer after the subjects had rested for at least 15 minutes.Results Approximately 94%of adolescent patients of mental labor with EH have a positiv e family history of EH, with a significant matrix effect.The incidence of obesit y was higher and BMI was lower in the EH group compared with the control group.C linical blood pressure(CBP) was positively correlated with ABP. CR was positivel y correlated to the average systolic blood pressure (SBP),diurnal SBP,night SBP and changes of standing position and supine position BP in the EH patients (r=0. 5, 0.5, 0.4).The clinical BP, 24 hour average SBP and diurnal SBP were significa ntly lower after motor intervention, compared with those before motor interventi on.Conclusion Highly variability of blood pressure,a family history of hypertens ion and obesity are the significant characteristics of adolescent patients with EH.The lower BMI, positive family history,obesity and irascible adolescent perso ns are the high-risk group of EH.BMI,SBP and sympathetic nerve activity may be one of the influence factors of left ventricle reconstitution.Aerobic exercise i s an efficient intervention treatment for ZEH in adolescent.