PRACA ORYGINALNA
24-godzinny pomiar ciśnienia tętniczego u dzieci z nadciśnieniem tętniczym pierwotnym i wtórnym do miąższowych chorób nerek
 
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Katedra i Klinika Pediatrii i Nefrologii, Warszawski Uniwersytet Medyczny
AUTOR DO KORESPONDENCJI
Piotr Skrzypczyk
Katedra i Klinika Pediatrii i Nefrologii, Warszawski Uniwersytet Medyczny, ul. Marszałkowska 24, 00-576 Warszawa
 
Med Og Nauk Zdr. 2013;19(1):49–54
SŁOWA KLUCZOWE
STRESZCZENIE ARTYKUŁU
Wprowadzenie i cel pracy:
Wprowadzenie: Badanie ABPM (ang. ambulatory blood pressure monitoring) cechuje się większą czułością w wykrywaniu. Ocena różnic w zapisie ABPM u dzieci z NT pierwotnym (NTP) i nerkopochodnym (NTN).

Materiał i metody:
Badaniem objęto 64 nieleczonych hipotensyjnie dzieci w wieku od 6,2 do 18,0 śr. 14,2±3,3 lat z NTP (n=31) i NTN (n=33) w przebiegu: nefropatii pozapalnej (n=21), glomerulopatii (n=4), torbielowatych chorób nerek (n=4), innych (n=4). Oceniano: wiek rozpoznania NT, BMI Z-score, parametry biochemiczne, GFR wg Schwartza (ml/min/1,73m2), ABPM: w okresie 24h, aktywności (a) i spoczynku (r), śr. ciśnienie skurczowe (SBP), rozkurczowe (DBP) (mm Hg), ładunek (SBPL/24h, SBPL/a, SBPL/r, DBPL/24h, DBPL/a, DSBPL/r) (%), ciśnienie tętna (PP/24h, PP/a, PP/r) (mm Hg), spadek nocny (DIP SBP, DIP DBP) (%), zmienność (SD SBP, SD DBP), wskaźnik sztywności tętnic (AASI).

Wyniki:
Pacjenci z NTP vs. pacjenci z NTN byli znamiennie starsi, mieli wyższe BMI Z-score, GFR (p<0,05), niższe LDBP/r (p=0,05) i wyższe PP/24h i PP/a (p<0,05). W grupie z NTP wykazano tendencje do większych śr. wartości DIP SBP (p=0,08) i DIP DBP (p=0,06). Nie wykazano różnic między grupami w SD SBP, SD DBP i AASI. W całej grupie 64 dzieci stwierdzono korelacje PP/24h, PP/a i PP/r z wiekiem (r=0,40; r=0,41; r=0,33, p<0,01), BMI Z-score (r=0,30; r=0,28; r=0,35, p<0,05) i cholesterolem HDL (r=-0,40; r=-0,38; r=-0,44, p<0,05), AASI z BMI Z-score (r=0,27, p<0,05), cholesterolem HDL (r=-0,35, p<0,05), DIP SBP (r=-0,29, p<0,05), DIP DBP (r=-0,45, p<0,0001).

Wnioski:
1) Dzieci z NT wtórnym do chorób nerek w zapisie ABPM mogą cechować się wysokim ładunkiem ciśnienia rozkurczowego w spoczynku i niskim spadkiem nocnym ciśnienia. 2) U dzieci z NT wykazano, że sztywność tętnic jest zależna od wskaźnika masy ciała i zaburzeń lipidowych.


Introduction:
Introduction. Ambulatory blood pressure monitoring (ABPM) detects blood pressure disturbances more sensitively compared to casual blood pressure (BP) measurements. Assessment of differences in ABPM results in children with primary hypertension (PH) and renal parenchymal hypertension (RH).

Material and Methods:
Study group consisted of 64 untreated children aged from 6.2 to 18.0 mean 14.2±3.3 years with PH (n=31) and RH (n=33) secondary to: nephropathy due to renal scarring (n=21), glomerulopathies (n=4), cystic kidney diseases (n=4), other (n=4). Following parameters were evaluated: age of recognition of AH, BMI Z-score, biochemical parameters, GFR ac. to Schwartz [mL/min/1,73m2], ABPM: during 24h, activity (a) and resting (r) period mean systolic (SBP) and diastolic BP (DBP) [mm Hg], load (SBPL/24h, SBPL/a, SBPL/r, DBPL/24h, DBPL/a, DSBPL/r) [%], pulse pressure (PP/24h, PP/a, PP/r) [mm Hg], nocturnal BP dip (DIP SBP, DIP DBP) [%], variability (SD SBP, SD DBP), ambulatory arterial stiffness index (AASI).

Results:
Patients with PH were significantly older, had higher BMI Z-score, GFR (p<0.05), lower LDBP/r (p=0.05) and higher PP/24h and PP/a (p<0.05) vs. patients with RH. In group with PH trend toward higher DIP SBP (p=0.08) and DIP DBP (p=0.06) values was found. No differences in SD SBP, SD DBP and AASI between the groups were found. In whole group of 64 children PP/24h, PP/a and PP/r correlated with age (r=0.40; r=0.41; r=0.33, p<0.01), BMI Z-score (r=0.30; r=0.28; r=0.35, p<0.05) and HDL cholesterol (r=–0.40; r=–0.38; r=–0.44, p<0.05), AASI correlated with BMI Z-score (r=0.27, p<0.05), HDL cholesterol (r=–0.35, p<0.05), DIP SBP (r=–0.29, p<0.05) and DIP DBP (r=-0.45, p<0.0001).

Conclusions:
1) Children with arterial hypertension secondary to renal diseases may be characterized by high diastolic blood pressure load during resting period and low nocturnal blood pressure dip. 2) In children with arterial hypertension arterial stiffness is related to body mass index and lipid disturbances

 
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