原发性高血压患儿血压变异性与靶器官损伤的关系研究

摘要

Objective To investigate the correlation between blood pressure variability (BPV) and target organ damage in children with essential hypertension.Methods A retrospective review identified 144 children (104 boys (72.2％) and 40 girls (27.8％),age (11.7 ± 2.5)years) diagnosed with essential hypertension at Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2013 to June 2018.Data on indicators for assessing fundus,cardiac,and renal damages obtained included 24-hour ambulatory blood pressure monitoring,BPV,fundus oculi examination,electrocardiogram,echocardiography,renal function,24-hour urine protein quantitation,urine microalbumin,serum and urine β2-microglobulin.According to the existence of target organ damage,subjects were divided into target organ damage group and non-target organ damage group.Comparison between groups was analyzed using independent sample t test,chi square test and pearson correlation analysis.Results The study included 144 children.There were 108 children (75.0％) diagnosed with phase 1 hypertension and 36 children (25.0％) diagnosed with phase 2 hypertension.Patients in target organ damage group (n=86,59.7％) had a higher coefficient of 24 h diastolic BPV (14.5％±3.2％ vs.13.2％ ±2.5％ t=2.558,P=0.012),a higher coefficient of daytime systolic BPV (8.2％ ± 2.1％ vs.7.4％ ± 2.0％,t=2.253,P=0.026) and a higher coefficient of daytime diastolic BPV (12.8％±3.4％ vs.11.1％±2.4％,t=3.188,P=0.002) compared with patients in non-target organ damage group (n=58,40.3％).The coefficients of daytime systolic BPV and daytime diastolic BPV were significantly associated with cardiac damage (r=0.190,P=0.023;r=0.366,P＜0.01) and renal damage (r=0.167,P=0.046;r=0.167,P=0.045).The coefficient of daytime diastolic BPV was positively correlated with left ventricular mass index (r=0.366,P＜0.01).Conclusions There is a correlation between BPV and target organ damage in children with essential hypertension.Daytime BPV is strongly associated with cardiac and renal damage,and daytime diastolic BPV may predict early cardiac hypertrophy.As a noninvasive method,daytime BPV can provide evidence for early identification of hypertensive target organ damage.%目的 了解原发性高血压患儿血压变异性(BPV)与靶器官损伤的相关性.方法 选取2013年1月至2018年6月于首都儿科研究所附属儿童医院住院的诊断为原发性高血压的144例患儿进行病例对照研究,男104例(72.2％),女40例(27.8％),年龄(11.7±2.5)岁.进行24 h动态血压监测,计算血压变异系数,并完善眼底、心电图、超声心动图、肾功能、24 h尿蛋白定量、尿微量白蛋白、血及尿β2-微球蛋白检查,作为评估眼底、心脏、肾脏损伤的指标.根据是否存在靶器官损伤将研究对象分为靶器官损伤组和无靶器官损伤组,观察血压变异系数与靶器官损伤的相关性,组间比较采用独立样本t检验或x2检验,相关分析采用Pearson法.结果 144例患儿中高血压1期108例(75.0％),2期36例(25.0％).靶器官损伤组86例(59.7％),无靶器官损伤组58例(40.3％).靶器官损伤组24h舒张压变异系数、日间收缩压变异系数、日间舒张压变异系数均明显高于无靶器官损伤组[(14.5±3.2)％比(13.2±2.5)％,(8.2±2.1)％比(7.4±2.0)％,(12.8±3.4)％比(11.1±2.4)％],差异均有统计学意义(t=2.558,P=0.012;t=2.253,P=0.026;t=3.188,P=0.002).血压变异系数与不同靶器官损伤的相关性分析显示:日间收缩压变异系数和日间舒张压变异系数与心脏(r=0.190,P=0.023;r=0.366,P＜0.01),肾脏(r=0.167,P=0.046;r=0.167,P=0.045)损伤具有相关性,其中日间舒张压变异系数与左心室质量指数呈正相关(r=0.366,P＜0.01).结论 儿童原发性高血压BPV与靶器官损伤具有相关性,其中日间BPV与心脏及肾脏损伤密切相关,日间舒张压变异性可预测早期心脏肥厚,为临床无创早期识别高血压靶器官损伤提供依据.