原发性肾病综合征儿童24小时动态血压与肾素-血管紧张素-醛固酮水平的关系

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摘要目的：应用24 h动态血压监测(24 h ABPM)探讨原发性肾病综合征（PNS）儿童血压变化并探讨肾素-血管紧张素-醛固酮系统（RAAS）致24 h动态血压（ABP）变化的机制。方法：对114例PNS儿童进行24 h ABP和随机血压（CBP）监测，并检测血浆肾素（PRA）、血管紧张素II（AngII）和醛固酮（ALD）水平及与24 h ABP相关关系。结果：114例PNS儿童动态血压升高101例（88.6%），轻度、重度隐匿性高血压45例（39.5%），非杓型血压80例(70.2%)。收缩压（SBP）血压指数与负荷大于舒张压（DBP）血压指数与负荷。PNS儿童睡眠血压指数与负荷大于醒时血压指数与负荷。PNS儿童男性血压DBP指数与负荷均大于女性儿童DBP指数与负荷。PNS组卧位血PRA、AngII、ALD水平高于正常对照组，同时PNS儿童血压升高组卧位血AngII水平高于血压正常组。AngII与SBP、DBP指数和负荷均明显正相关。结论：PNS儿童发生高血压的比例较高，其中隐匿性高血压、非杓型血压占较大比例，SBP升高较DBP明显, 睡眠血压升高更明显，男性DBP升高较女性更明显。PNS儿童RAAS水平升高可能主要通过AngII使血压上升。［中国当代儿科杂志，2010，12（10）：788-792］

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关键词 ：原发性肾病综合征, 动态血压监测, 肾素-血管紧张素-醛固酮系统, 儿童

Abstract：OBJECTIVE: To investigate the changes of blood pressure by 24-hour ambulatory blood pressure (ABP) monitoring in children with primary nephrotic syndrome (PNS) and explore the relationship of the changes in blood pressure with rennin-angiotensin-aldosterone system (RAAS) in these children. METHODS: ABP and casual blood pressure (CBP) monitoring were performed in 114 children with PNS. Plasma levels of rennin activity (PRA), angiotensin II (AngII) and aldosterone (ALD) were measured. The correlation of plasma levels of PRA, AngII and ALD with ABP was evaluated. RESULTS: Of the 114 children with PNS, 101 (88.6%) presented elevated blood pressure. Mild or severe masked hypertension was found in 45 children (39.5%). Eighty (70.2%) children showed non-dipper blood pressure. The index and load of systolic blood pressure were higher than those of diastolic blood pressure. The blood pressure index and blood pressure load during sleep were higher than those during wakefulness. The boy presented higher diastolic blood pressure index and load than girls. Decubitus blood PRA, AngII and ALD levels in children with PNS were significantly higher than normal controls. The group with elevated blood pressure presented significantly higher decubitus blood PRA, AngII and ALD levels than the group with normal blood pressure. AngII level was significantly positively correlated with the index and load of both systolic blood pressure and diastolic blood pressure. CONCLUSIONS: The children with PNS present a high incidence of hypertension, with a large percentage of masked hypertension and non-dipper blood pressure. Systolic blood pressure increases more significantly than diastolic blood pressure. Blood pressure during sleep increases more significantly than that during wakefulness. Diastolic blood pressure increases more significantly in boys than in girls. RAAS activity is elevated and the elevated RAAS activity might increase the blood pressure mainly by AngII in children with PNS.［Chin J Contemp Pediatr, 2010, 12 (10):788-792］

Key words： Primary nephrotic syndrome Ambulatory blood pressure monitoring Renin-angiotensin-aldosterone system Child

PACS:

R692

引用本文:

徐志泉,易著文,党西强等. 原发性肾病综合征儿童24小时动态血压与肾素-血管紧张素-醛固酮水平的关系[J]. 中国当代儿科杂志, 2010, 12(10): 788-792.

XU Zhi-Quan,YI Zhu-Wen,DANG Xi-Qiang et al. Relationship of 24-hour ambulatory blood pressure and rennin-angiotensin-aldosterone system in children with primary nephrotic syndrome[J]. CJCP, 2010, 12(10): 788-792.

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http://www.zgddek.com/CN/ 或 http://www.zgddek.com/CN/Y2010/V12/I10/788

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