CAJ | 학술논문

目的探讨儿童肾血管性高血压的临床特点与影像学特征.方法回顾性分析2005年1月至2012年12月经肾动脉造影确诊为肾血管性高血压的儿童14例(男7例,女7例；年龄0.8～14岁,平均8.7岁)的临床资料.结果起病时平均血压为187/127 mm Hg(1 mm Hg =0.133 kPa)；临床首发症状分别为头痛29％ (4/14)、高血压脑病36％ (5/14)、心功能不全征象14％(2/14)和呕血7％(1/14);无症状仅体检发现高血压者14％ (2/14).肾动脉造影显示了肾动脉狭窄的解剖部位与分布,其中双侧肾动脉病变14％ (2/14);单一肾动脉主干或副肾动脉狭窄50％ (7/14)；多发性狭窄43％ (6/14),均累及肾段动脉以及细小叶间动脉、弓状动脉.与肾动脉造影结果相对照,50％ (7/14)患者在肾动脉计算机体层摄影或磁共振血管造影术的检查中被漏诊,尤其是肾内分支动脉狭窄.结论在儿科临床实践中强调血压的测量对于早期识别儿童肾血管性高血压是极为重要的.由于儿童肾血管性高血压往往为多发性肾动脉狭窄,多累及肾内分支动脉,肾动脉造影是诊断儿童肾血管性高血压可靠的影像手段.
목적 탐토인동신혈관성고혈압적림상특점여영상학특정.방법 회고성분석2005년1월지2012년12월경신동맥조영학진위신혈관성고혈압적인동14례(남7례,녀7례；년령0.8～14세,평균8.7세)적림상자료.결과 기병시평균혈압위187/127 mm Hg(1 mm Hg =0.133 kPa)；림상수발증상분별위두통29％ (4/14)、고혈압뇌병36％ (5/14)、심공능불전정상14％(2/14)화구혈7％(1/14);무증상부체검발현고혈압자14％ (2/14).신동맥조영현시료신동맥협착적해부부위여분포,기중쌍측신동맥병변14％ (2/14);단일신동맥주간혹부신동맥협착50％ (7/14)；다발성협착43％ (6/14),균루급신단동맥이급세소협간동맥、궁상동맥.여신동맥조영결과상대조,50％ (7/14)환자재신동맥계산궤체층섭영혹자공진혈관조영술적검사중피루진,우기시신내분지동맥협착.결론 재인과림상실천중강조혈압적측량대우조기식별인동신혈관성고혈압시겁위중요적.유우인동신혈관성고혈압왕왕위다발성신동맥협착,다루급신내분지동맥,신동맥조영시진단인동신혈관성고혈압가고적영상수단.
Objective To characterize the clinical and angiographic features in children with renovascular hypertension.Method Clinical data of 14 children (7 male,7 female; age 0.8-14 years,mean 8.7 years),who were diagnosed with renovascular hypertension by renal angiography in our institute from January 2005 to December 2012 were collected and retrospectively analyzed.Result The mean blood pressure at the diagnosis was 187/127 mm Hg.Chief complaints of symptomatic patients were headache (29％,4/14),hypertensive encephalopathy (36％,5/14),signs of congestive heart failure (14％,2/14) and hematemesis (7％,1/14).Renovascular hypertension was found incidentally in 14％ (2/14) of patients who were asymptomatic.Conventional renal angiography elucidated the anatomical distribution of lesions in the renal arterial system.It was found that 14％ (2/14) of patients had bilateral disease,50％ (7/14) had single stenosis at main or accessory renal artery,while multiple stenoses was seen in 43％ (6/14) of children,with involvement of segmental renal artery and small interlobar or arcuate vessels.Compared with catheter angiography,50％ (7/14) of patients with renovascular hypertension,especially intrarenal arterial disease,were missed on computed tomography angiography or magnetic resonance angiography.Conclusion It is mandatory to emphasize blood pressure measurement in pediatric clinical practice for early recognition of renovascular hypertension.As children with renovascular hypertension display involvement of multiple arteries,including in smaller intrarenal arteries,digital subtraction angiography is the only method that can reliably diagnose pediatric renovascular hypertension.