青少年高血压病的临床特点分析与研究

目的 :探讨青少年高血压病的发病、影响因素及其临特床特点。方法 :32例 14～ 2 5岁轻中度高血压病 (EH)患者 (男 2 3例、女 9例 ) ,2 0例性别、年龄及体重指数匹配的志愿者作为对照 ,询问病史、个人史及家族史 ;监测卧、立位血压变化 ,测定血、尿常规及生化检查 ,放射免疫法测定血清内皮素 (ET) ,酶法测定一氧化氮 (NO)水平 ,2 4h动态血压 (ABPM)监测及心脏多谱勒超声检查。结果 :青少年EH以脑力劳动者居多 ,家族史阳性发生率为 93 8%,“母体效应”明显 (5 9 4 %) ,高血压组肥胖的发生率高于对照组 ,出生体重小于对照组 ,白细胞计数及卧立位血压变化明显大于对照组 (P <0 0 5 ) ;ABPM勺型节律者 6 9 7%,非勺型者31 3%;ET水平高于对照组 (P <0 0 5 ) ,NO两组间的差别无统计学意义。左室重构的发生高于对照组 (P <0 0 1) ,BMI、ET、NO与收缩期平均血压、白天、夜间收缩期血压及最大收缩期血压呈正相关。结论 :青少年EH具有明显的家族聚集性和“母体效应” ;家族史阳性的肥胖者更易患病 ,易受情绪及心理因素的影响 ,血压多变 ;出生体重偏低、外周血白细胞数量增加可能是青少年易患高血压的危险因素之一 ,动态血压监测与诊所血压具有较好的相关性 ;BMI、SBP是LVM增加的早期影响因素之一 ,交感神经功能紊

A study of clinical characteristcs of the adclcscent patients with essential hypertension

Objective:We investigated the clinical characteristics of the adolescent patients with EH including the characteristics of ambulatory blood pressure monitoring(ABPM)and the carly change of heart geometry and function.Mothods:Thirty-two patients with mild to moderate EH and twenty normotensive controls were studied.ABPM and two-dimensionally guided M-mode echocardiography and pulsed Doppler were applied.We measured supine position blood pressure and standing position blood pressure with and arm sphygmomanometer after the subject had rested for at least 15 min,plasma levels of endothelin(ET),nitric oxide(NO)were measured by way of radio immunoassay or enzymatic assay.The number of leucocyte were measured,the data of birth weight was provided by subject'parents.Resuts:The morbidity is higher in adolescent males with EH than females.Approximately 94% of adolescent patients with EH have a positive family history of EH.Obesity and overweight which are noted in as many as 40.7% of patients,are the most significant abnormalitis of the adolcscent patients with EH,compared with controls.Birth weight is significantly smaller in adolesccnt paticnts with EH than controls(P<0.05).The data of leucocyte and plasma level of endothelin(ET)are significantly higher in adolescent patients with EH than controls(P<0.01).Plasrnal level of ET is positively related to LVM,IVST in EH patients.Clinical blood pressure(CBP),ABP and blood pressure load are signilicantly higher in EH group than in control group.The mean difference of systolic and diastolic blood prcssure between standing position and supine position is significantly higher in EH group than in control group(P<0.01).Conclusion:Highly variability of blood pressure,a family history of hypertension and obesity are the significant characteristics of adolescent essential hypertension.The quantity of leucocyte might be a risk marker of EH.The low birth weight of adolescent patients with EH could be related to the incidence rate of EH.Sympathetic nervous system dysfunction could also the be found in adolescent essential hypertension.BMI and SBP could be related with LVMI.