高血压儿童心血管结构和功能早期改变的病例对照研究  

Impacts of hypertension on early changes of cardiovascular structure and function among children： a case-control study

作　　者：刘琴[1] 董虹孛[2] 孟玲慧[1] 程红[1] 闫银坤[2] 刘军廷[1] 米杰[2] 

机构地区：[1]首都儿科研究所流行病学研究室,北京100020 [2]北京协和医学院研究生院

出　　处：《中华流行病学杂志》2015年第4期332-336,共5页Chinese Journal of Epidemiology

基　　金：国家自然科学基金（81172746）;国家科技支撑计划（2012BA103803）

摘　　要：目的比较原发性高血压及血压正常儿童的心血管结构和功能情况，分析原发性高血压儿童心血管结构及功能的早期改变及其影响因素。方法对经过非同日3个时点电子血压计筛查的213名6—18岁原发性高血压儿童（病例组）检测心脏结构和血管功能，并采用性别、年龄成组匹配，以197名血压正常儿童为对照组进行病例对照分析。结果（1）病例组左心室舒张末期内径（LVEDd）、收缩末期内径（LVESd）、左心室质量（LVM）、左心室质量指数（LVMI）均高于对照组（均P〈0．05），但两组间颈动脉内膜中层厚度（cIMT）、相对室壁厚度（RWT）、踝-臂脉搏波传导速度（baPWV）的差异无统计学意义（均P〉0．05）。（2）不同年龄及肥胖程度儿童中，病例组LVEDd、LVESd、LVM、LVMI均高于对照组（均P〈0．05），但两组间cIMT、RWT的差异无统计学意义（均P〉0．05）；而baPWV在低年龄儿童中，病例组检测值低于对照组（P〈0．05）。（3）多元线性回归发现，高血压是LVMI的主要影响因素，而RWT的主要影响因素是年龄和BMI。结论无临床症状的低龄高血压儿童已发生左心室罩构．但尚未发现血管结构和功能的改变。Objective To assess the cardiovascular structure and function in children with confirmed primary hypertension, and to explore the impact of hypertension and related risk factors on cardiovascular structure and function of children. Methods Parameters related to cardiac structure, vascular structure and function were measured in 213 hypertensive children, who were confirmed upon repeated measurements on separate occasions. A total of 197 healthy children were recruited as controls. Results 1 ） In hypertensive children, left ventricular end-diastolic diameter （LVEDd）, left ventricular end-systolic diameter （LVESd）, left ventricular mass （LVM）, left ventricular mass index （LVMI） , left ventricular posterior wall thickness （LVPT） and interventricular septal thickness （IVST） were all significantly higher than their counterparts （P〈 0.05）. No statistical differences were found in carotid intima-media thickness （cIMT）, relative wall thickness （RWT） and brachial ankle pulse wave velocity （ba-PWV）. 2） Compared with controls, LVEDd, LVESd, LVM, LVMI were all significantly higher in hypertensive children （P〈0.05）, regardless of age group or weight-status. No statistical differences were found in ccIMT and RWT, while ba-PWV was statistically higher in controls among children aged 6-12 years. 3 ） Data from multiple linear regression analysis noticed that LVMI was associated with age, sex, BMI and hypertension while RWT was associated with age and BMI. Conclusion In children with primary hypertension, changes of vascular structure and function were not shown but left ventricular remodeling and early changes of function had been developed in children under 12 years old.

关 键 词：原发性高血压 儿童 心室结构 左心室质量 颈动脉内膜中层厚度 血管硬化 

分 类 号：R725.4[医药卫生—儿科]