儿童肾血管性高血压临床特点.pdfVIP

儿童肾血管性高血压临床特点 范树颖 张碧丽 王文红 张瑄 天津儿童医院 肾内科，天津 300074 摘要：目的：探讨儿童肾血管性高血压临床特点。方法：收集我院住院治疗 的10例肾血管性高血压（RVH ）患儿的临床资料，回顾性分析其病因分布、临 床表现、实验室检查、治疗情况。结果：先天性疾病占RVH患儿80%；临床多数 以头痛、头晕、呕吐为首发症状，以高血压脑病起病者占30%，60%患儿肾脏受 累，70%患儿心脏受累；63%患儿清晨血浆肾素水平增高，5例行双侧肾静脉及 下腔静脉肾素水平测定，显示狭窄侧肾静脉肾素水平高于对侧肾静脉及下腔静 脉，差异有统计学意义（P0.05 ）；多层螺旋CT血管造影（MSCTA ）与同时进 行的数字减影血管造影（DSA ）比较，仅1例双肾动脉狭窄患儿MSCTA检查漏诊 左肾动脉狭窄，余患儿两种检查方法显示的肾动脉狭窄部位和程度完全一致； RVH均为严重、药物难以控制的高血压，80%患儿联合应用2种以上抗高血压药 物；1例患儿例行肾动脉血管成形术(PTRA)，1例行肾动脉支架置入(PTRAS)，术 后观察收缩压降低超过15mmHg，降压药物减量。结论：RVH患儿中先天性疾病 占多数，其临床早期缺乏特异性症状，极易误诊、漏诊；RVH可造成患儿心、 脑、肾重要器官损害；测定肾素水平可以协助诊断；MSCTA在一定程度上可替 代有创性的选择性肾动脉造影；血管内治疗用于儿童RVH取得一定疗效。 关键词：儿童；肾血管性高血压；肾动脉狭窄 Clinical Characteristic of Children Renal Vascular Hypertension FAN Shu-ying, ZHANG Bi-li, WANG Wen-hong, LI Li （Department of Nephrology ，the Children’s Hospital of Tianjin, Tianjin 300074, China ） Abstract: objective: To expiore the clinical characteristics of children renal vascular hypertension. Methods: The clinical data of 10 patients with renal vascular hypertension(RVH) were collected in our hospital. The distribution of cause ,clinical manifestations,laboratory data and therapy were retrospectively analyzed. Results: Congenital disease accounting for 80%; The headache, dizzy and vomit were mostly common in clinical earlier period,because of hypertensive encephalopathy onste accounting for 30%, 60% patient’s 1 kidneys were to be involved in and 70% patient’s hearts were to be involved in; 63% patient’s renin level of morning blood plasm were increased, 5 patient’s renin level of both renal vein and inferior vena to be determined, it showed that renal vein renin level of narrow side is higher than contralateral renal vein and inferior vena, the difference has statistical significance （P0.05 ）;To compare mu