中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
17期
1314-1316
,共3页
林瑶%石琳%米杰%刘杨%张明明%丛晓辉
林瑤%石琳%米傑%劉楊%張明明%叢曉輝
림요%석림%미걸%류양%장명명%총효휘
高血压%靶器官%儿童%青少年
高血壓%靶器官%兒童%青少年
고혈압%파기관%인동%청소년
Hypertension%Target organ%Child%Adolescent
目的 对儿童原发性高血压靶器官损害的临床特点进行分析研究.方法 对2007年1月至2013年10月于首都儿科研究所附属儿童医院住院诊断为原发性高血压的86例患儿进行眼底、心电图、超声心动图、血脂、血糖、胰岛素、C肽、血尿酸、肾功能、尿微量清蛋白、血及尿β2-微球蛋白等检查,记录结果并进行统计学分析.结果 86例患儿中男68例(79.1％),女18例(20.9％),平均年龄(12.3±2.4)岁.高血压Ⅰ期46例(53.5％),Ⅱ期40例(46.5％).13.5％(7/52例)的患儿存在眼底病变,21.0％(17/81例)存在心电图异常,此外,37.0％(30/81例)的患儿V5导联R波电压超过同年龄组平均值.2.6％(2/78例)的患儿超声心动图检查提示分别为左心室增大和左心室后壁厚度增加.肾脏受累以血肌酐和尿微量清蛋白升高为著,其发生率分别为40.2％(33/82例)和39.7％(23/58例);代谢紊乱以血尿酸、三酰甘油升高、脂肪肝和糖代谢异常为主要表现,发生率分别为87.5％(56/64例)、32.5％(25/77例)、22.1％(19/86例)和36.1％(30/83例).86例患儿中58例(67.4％)合并肥胖症.肥胖者与体质量正常者比较,前者靶器官损害发生率高于后者(98.3％比82.1％,x2 =5.291,P=0.021),且前者发生糖代谢紊乱的比例显著升高(45.5％比17.9％,x2=6.123,P=0.013).病程超过0.5年者发生糖代谢紊乱的比例较病程0.5年内者显著升高(50.0％比25.5％,x2=5.788,P=0.021).结论 儿童原发性高血压大部分在诊断时即已出现靶器官损害,心电图和超声心动图检查是早期发现心脏受累的有效手段.血尿酸及尿微量清蛋白检测可作为早期预警及筛查指标,加强对肥胖儿童的血压监测,有望早期发现儿童高血压,以采取措施降低靶器官损害的发生.
目的 對兒童原髮性高血壓靶器官損害的臨床特點進行分析研究.方法 對2007年1月至2013年10月于首都兒科研究所附屬兒童醫院住院診斷為原髮性高血壓的86例患兒進行眼底、心電圖、超聲心動圖、血脂、血糖、胰島素、C肽、血尿痠、腎功能、尿微量清蛋白、血及尿β2-微毬蛋白等檢查,記錄結果併進行統計學分析.結果 86例患兒中男68例(79.1％),女18例(20.9％),平均年齡(12.3±2.4)歲.高血壓Ⅰ期46例(53.5％),Ⅱ期40例(46.5％).13.5％(7/52例)的患兒存在眼底病變,21.0％(17/81例)存在心電圖異常,此外,37.0％(30/81例)的患兒V5導聯R波電壓超過同年齡組平均值.2.6％(2/78例)的患兒超聲心動圖檢查提示分彆為左心室增大和左心室後壁厚度增加.腎髒受纍以血肌酐和尿微量清蛋白升高為著,其髮生率分彆為40.2％(33/82例)和39.7％(23/58例);代謝紊亂以血尿痠、三酰甘油升高、脂肪肝和糖代謝異常為主要錶現,髮生率分彆為87.5％(56/64例)、32.5％(25/77例)、22.1％(19/86例)和36.1％(30/83例).86例患兒中58例(67.4％)閤併肥胖癥.肥胖者與體質量正常者比較,前者靶器官損害髮生率高于後者(98.3％比82.1％,x2 =5.291,P=0.021),且前者髮生糖代謝紊亂的比例顯著升高(45.5％比17.9％,x2=6.123,P=0.013).病程超過0.5年者髮生糖代謝紊亂的比例較病程0.5年內者顯著升高(50.0％比25.5％,x2=5.788,P=0.021).結論 兒童原髮性高血壓大部分在診斷時即已齣現靶器官損害,心電圖和超聲心動圖檢查是早期髮現心髒受纍的有效手段.血尿痠及尿微量清蛋白檢測可作為早期預警及篩查指標,加彊對肥胖兒童的血壓鑑測,有望早期髮現兒童高血壓,以採取措施降低靶器官損害的髮生.
목적 대인동원발성고혈압파기관손해적림상특점진행분석연구.방법 대2007년1월지2013년10월우수도인과연구소부속인동의원주원진단위원발성고혈압적86례환인진행안저、심전도、초성심동도、혈지、혈당、이도소、C태、혈뇨산、신공능、뇨미량청단백、혈급뇨β2-미구단백등검사,기록결과병진행통계학분석.결과 86례환인중남68례(79.1％),녀18례(20.9％),평균년령(12.3±2.4)세.고혈압Ⅰ기46례(53.5％),Ⅱ기40례(46.5％).13.5％(7/52례)적환인존재안저병변,21.0％(17/81례)존재심전도이상,차외,37.0％(30/81례)적환인V5도련R파전압초과동년령조평균치.2.6％(2/78례)적환인초성심동도검사제시분별위좌심실증대화좌심실후벽후도증가.신장수루이혈기항화뇨미량청단백승고위저,기발생솔분별위40.2％(33/82례)화39.7％(23/58례);대사문란이혈뇨산、삼선감유승고、지방간화당대사이상위주요표현,발생솔분별위87.5％(56/64례)、32.5％(25/77례)、22.1％(19/86례)화36.1％(30/83례).86례환인중58례(67.4％)합병비반증.비반자여체질량정상자비교,전자파기관손해발생솔고우후자(98.3％비82.1％,x2 =5.291,P=0.021),차전자발생당대사문란적비례현저승고(45.5％비17.9％,x2=6.123,P=0.013).병정초과0.5년자발생당대사문란적비례교병정0.5년내자현저승고(50.0％비25.5％,x2=5.788,P=0.021).결론 인동원발성고혈압대부분재진단시즉이출현파기관손해,심전도화초성심동도검사시조기발현심장수루적유효수단.혈뇨산급뇨미량청단백검측가작위조기예경급사사지표,가강대비반인동적혈압감측,유망조기발현인동고혈압,이채취조시강저파기관손해적발생.
Objective To study the clinical features of target organ damage in children with essential hypertension.Methods From Jan.2007 to Oct.2013,86 children were enrolled who were diagnosed as essential hypertension in the Children's Hospital Affiliated to Capital Institute of Pediatrics.All children received the following examinations:fundus oculi,electrocardiogram,echocardiography,serum triglyceride,glucose,insulin,C peptide,uric acid,renal function,urine microalbumin,serum and urine β2-microglobulin.All data were collected as standard procedure and analyzed by using statistic methods.Results In all recruited children,there were 68 boys (79.1％)and 18 girls (20.9％) with the average age of (12.3 ±2.4) years old.There were 46 children(53.5％) with grade Ⅰ hypertension and 40 (46.5％) with grade Ⅱ hypertension,13.5％ (7/52 cases) of the children with retinal vessel damage,21.0％ (17/81 cases) with abnormal electrocardiogram,and 2.6％ (2/78 cases) with left ventricular hypertrophy and increased left ventricular posterior w all thickness.Thirty-seven percent (30/81 cases) of the children had a higher voltage of R wave in V5 than average values at the same ages.Renal damage mainly included increased serum creatinine and microalbuminuria,with the rates of 40.2％ (33/82 cases) and 39.7％ (23/58 cases),respectively.Metabolic disorders mainly included 87.5％ (56/64 cases) hyperuricemia,32.5％ (25/77 cases) hypertriglyceridemia,22.1％ (19/86 cases) hepatic adipose infiltration,and 36.1％ (30/83 cases) hyperinsulinemia or sugar intolerance damage.There were 58 (67.4％) children wit h obesity.Compared with normal weight children,children with obesity had a higher rate of target organ damage(98.3％ vs 82.1％,x2 =5.291,P =0.021),and hyperinsulinemia or sugar intolerance damage(45.5％ vs 17.9％,x2 =6.123,P =0.013).Children with the course longer than 6 months showed a higher rate of hyperinsulinemia or sugar intolerance damage than the children with the course less than 6 months(50.0％ vs 25.5％,x2 =5.788,P =0.021).Conclusions Target organ damage caused by adolescent essential hypertension is present at diagnosis in most of these children.Electrocardiogram and echocardiography are effective measures for early detection of cardiac damage of hypertension.Serum uric caid and urine microalbumin can be used as early warning and screening indexes.To enhance blood pressure monitoring of children with obesity will be helpful for early diagnosis of essential hypertension,which will decrease the rate of target organ damage with earlier effective interference.
