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目的探讨儿童肾血管性高血压(RVH)的临床特点。方法收集在本院住院治疗的10例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。采用SPSS 16.0软件进行统计学处理。结果先天性疾病占RVH患儿的80%(8/10例)。50%(5/10例)以头痛为首发症状,以高血压脑病起病者占30%(3/10例),60%(6/10例)患儿肾脏受累,70%(7/10例)患儿心脏受累。63%(5/8例)的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(P<0.05)。多层螺旋CT血管造影(MSCTA)与数字减影血管造影比较,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2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%的患儿联合应用2种以上抗高血压药物,1例行肾动脉血管成形术,1例行肾动脉支架置入,术后观察收缩压降低超过2 kPa,降压药物减量。结论 RVH患儿中先天性疾病占多数,其早期临床表现缺乏特异性,极易误诊、漏诊;RVH可造成患儿心、脑、肾等重要器官损害;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;血管内治疗儿童RVH有一定疗效。
Objective To investigate the clinical features of children with renovascular hypertension (RVH). Methods The clinical data of 10 children with RVH admitted to our hospital were collected and their etiological distribution, clinical manifestations, laboratory tests and treatment were retrospectively analyzed. SPSS 16.0 software was used for statistical analysis. Results Congenital diseases account for 80% (8/10) of RVH infants. Fifty percent (5/10 cases) had headache as their first symptom, 30% (3/10 cases) of hypertensive encephalopathy, and 60% (6/10 cases) of children had renal involvement, 70% (7/10 Cases of children with heart involvement. 63% (5/8 cases) of children with early morning plasma renin levels increased 5 cases of bilateral renal vein and inferior vena cava renin levels, showed that the narrow side of renal vein renin levels higher than the contralateral renal vein Vena cava, the difference was statistically significant (P <0.05). Compared with digital subtraction angiography, MSCTA in one case with renal artery stenosis did not detect left renal artery stenosis by multi-slice spiral CT angiography (MSCTA). Only two kinds of examination showed that the site and extent of renal artery stenosis were complete Consistent. RVH were severe, difficult to control hypertension, 80% of children combined with two or more antihypertensive drugs, 1 case of renal artery angioplasty, 1 case of renal artery stent placement, postoperative systolic blood pressure Reduce over 2 kPa, antihypertensive drug reduction. Conclusion RVH is the most common cause of congenital diseases in children. Its early clinical manifestations are lack of specificity and can be easily misdiagnosed and missed. RVH can cause heart, brain and kidney damage in important organs. The determination of renin levels can assist in the diagnosis. To some extent alternative to invasive selective renal artery angiography; endovascular treatment of children with RVH have a certain effect.