紫癜性肾炎患儿动态血压与临床指标及病理的相关性  

Characteristics of dynamic blood pressure and its correlation with clinical and pathological features in children with Henoch-Schönlein purpura nephritis

作　　者：应蓓[1] 李宇红[1] 邵晓珊[1] 邱杰[1] 郑莎莎[1] 张晓婵 刘远辉[1] 唐勇 YING Bei;LI Yuhong;SHAO Xiaoshan;QIU Jie;ZHENG Shasha;ZHANG Xiaochan;LIU Yuanhui;TANG Yong(Department of Nephrology of Guiyang Maternity and Child Care Hospital,Guiyang 550003,Guizhou,China)

机构地区：[1]贵阳市妇幼保健院肾脏科,贵州贵阳550003

出　　处：《临床儿科杂志》2021年第12期895-899,共5页Journal of Clinical Pediatrics

基　　金：2019年贵州省卫生健康委科学技术基金项目(No.gzwjkj2019-1-006)。

摘　　要：目的观察紫癜性肾炎(HSPN)患儿不同病理分级以及肾功能损害对于昼夜血压节律变化尤其夜间血压的影响。方法回顾分析121例经肾活检确诊HSPN患儿的临床资料,观察患儿24小时动态血压变异特点。按肾活检病理表现将患儿分为Ⅰ~Ⅱ级组及Ⅲ~Ⅵ级组,按估算的肾小球滤过率(eGFR)将患儿分为eGFR<60 mL/(min·1.73m^(2))组及eGFR≥60 mL/(min·1.73m^(2))组,比较不同组间动态血压水平及临床指标的差异。结果121例HSPN患儿中男68例、女53例,平均年龄(8.8±2.3)岁。动态血压监测提示异常血压类型105例(86.8%),高血压发生率31.4%,仅夜间高血压发生率明显大于仅日间高血压发生率(P<0.05)。HSPN患儿肾活检病理分级示Ⅰ级2例、Ⅱ级36例、Ⅲ级73例、Ⅳ级7例、Ⅴ级3例、Ⅵ级0例。与Ⅰ~Ⅱ级组相比,Ⅲ~Ⅵ级组患儿24 h平均收缩压及舒张压、日间平均收缩压及舒张压、夜间平均收缩压及舒张压、24 h尿蛋白定量、血肌酐均显著升高,肉眼血尿持续时间更为延长,差异均有统计学意义(P<0.05)。与eGFR≥60 mL/(min·1.73m^(2))组相比,eGFR<60 mL/(min·1.73m^(2))组24 h平均收缩压及舒张压、日间平均收缩压及舒张压、夜间平均收缩压及舒张压、24 h尿蛋白定量、血肌酐均显著升高,肉眼血尿持续时间更为延长,差异均有统计学意义(P<0.05)。结论HSPN患儿异常血压类型发生率高,以夜间血压升高为主。HSPN患儿肾脏损害程度越重,则夜间血压越高、蛋白尿越严重、肉眼血尿持续时间越长。Objective To observe the effects of different pathological grades and renal impairment on circadian rhythm changes of blood pressure,especially nocturnal blood pressure in children with Henoch-Schönlein purpura nephritis(HSPN).Methods The clinical data of 121 children with HSPN diagnosed by renal biopsy were retrospectively analyzed,and the variation characteristics of 24-hour ambulatory blood pressure were observed.According to the pathology classification of renal biopsy,the children were divided into gradeⅠ-Ⅱand gradeⅢ-Ⅵgroups.According to the estimated glomerular filtration rate(eGFR),the children were divided into eGFR<60 mL/(min·1.73m^(2))group and eGFR≥60 mL/(min·1.73m^(2))group.The differences of ambulatory blood pressure levels and clinical indicators among different groups were compared.Results Among the 121 children with HSPN,there were 68 boys and 53 girls,with an average age of(8.8±2.3)years.There were 105 cases(86.8%)with abnormal blood pressure rhythms,and the incidence of hypertension was 31.4%.The incidence of nocturnal hypertension was significantly higher than that of daytime hypertension(P<0.05).The pathological grading of renal biopsy in HSPN children showed 2 cases of gradeⅠ,36 cases of gradeⅡ,73 cases of gradeⅢ,7 cases of gradeⅣ,3 cases of gradeⅤand 0 cases of gradeⅥ.Compared with gradeⅠandⅡgroups,24 h mean systolic and diastolic blood pressure,daytime mean systolic and diastolic blood pressure,night mean systolic and diastolic blood pressure,24 h urine protein quantity and blood creatinine were significantly increased,and gross hematuria duration was prolonged in gradeⅢandⅥgroups,with statistical significance(P<0.05).Compared with eGFR≥60 mL/(min·1.73m^(2))group,24 h mean systolic and diastolic blood pressure,daytime mean systolic and diastolic blood pressure,night mean systolic and diastolic blood pressure,24 h urine protein quantity and blood creatinine were significantly increased,and gross hematu ria duration was prolonged in eGFR<60 mL/(min·1.73m^

关 键 词：紫癜性肾炎 动态血压 临床表现 肾脏病理 儿童 

分 类 号：R726.9[医药卫生—儿科]