McGlothan Kim R, Wyatt Robert J, Ault Bettina H, Hastings Margaret C, Rogers Taurus, DiSessa Thomas, Jones Deborah P
University of Tennessee Health Science Center, Memphis, TN, USA.
Pediatr Transplant. 2006 Aug;10(5):558-64. doi: 10.1111/j.1399-3046.2006.00521.x.
Hypertension is common in children with end-stage renal disease who have undergone renal transplantation. We performed ambulatory blood pressure monitoring (ABPM) in renal allograft recipients who were on stable maintenance immunosuppressive medications and were more than six months post-transplant. Echocardiographic measurement of left ventricular mass index (LVMI) was obtained at the time of ABPM. Twenty-nine children with a mean age of 14.8 yr (8-18 yr) were evaluated 4.3 yr (0.6-12.8 yr) after deceased donor (n = 13) or living donor (n = 16) transplantation. BP levels were higher during sleep compared with when awake using the 95th percentile to standardize mean BP for each period: mean BP was expressed as a standard deviation score (SDS) for each time period, awake vs. sleep: systolic (s) BP SDS were 0.43 +/- 1.3 vs. 1.29 +/- 1.2 (p < 0.001) and diastolic (d) BP SDS were 0.04 +/- 1.3 vs. 1.34 +/- 1.2 (p < 0.001). Significant differences between awake and sleep BP were also confirmed using the mean BP for each period expressed as a BPI. Hypertension (HTN) during sleep was more common than awake HTN. Based upon BPI, 21% had sHTN when awake compared with 48% during sleep and 7% had dHTN when awake compared with 41% during sleep (p < 0.05). Based upon mean BP load, 38% had sHTN when awake compared with 55% during sleep and 21% demonstrated dHTN when awake compared with 52% during sleep (p < 0.05). Left ventricular mass (LVM) was abnormally increased in six of 17 children (35%); LVM was not correlated with BP. Children prescribed angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) had significantly lower systolic BP compared with those on calcium channel blocking agents (CCB). Mean sSDS was -0.11 +/- 1.1 in those children on ACEi/ARB compared with 1.6 +/- 1.2 in those on CCB (p = 0.02): sSDS during sleep was significantly lower in the ACEi/ARB group compared with CCB (0.70 +/- 1.1 vs. 2.0 +/- 1.1, p = 0.04). Isolated nocturnal HTN is more common than daytime HTN among clinically stable pediatric renal allograft recipients. Detection and treatment of nocturnal HTN in pediatric allograft recipients could potentially affect graft survival.
高血压在接受肾移植的终末期肾病儿童中很常见。我们对处于稳定维持性免疫抑制治疗且移植后超过6个月的肾移植受者进行了动态血压监测（ABPM）。在进行ABPM时，通过超声心动图测量左心室质量指数（LVMI）。对29名平均年龄为14.8岁（8 - 18岁）的儿童进行了评估，这些儿童在接受尸体供体（n = 13）或活体供体（n = 16）移植后4.3年（0.6 - 12.8年）。使用第95百分位数将每个时间段的平均血压标准化，睡眠期间的血压水平高于清醒时：每个时间段的平均血压表示为标准差分数（SDS），清醒与睡眠时：收缩压（s）SDS分别为0.43±1.3与1.29±1.2（p < 0.001），舒张压（d）SDS分别为0.04±1.3与1.34±1.2（p < 0.001）。使用每个时间段以血压指数（BPI）表示的平均血压也证实了清醒和睡眠血压之间的显著差异。睡眠期间的高血压（HTN）比清醒时的HTN更常见。基于BPI，清醒时21%的儿童有收缩期HTN，而睡眠时为48%；清醒时7%的儿童有舒张期HTN，而睡眠时为41%（p < 0.05）。基于平均血压负荷，清醒时38%的儿童有收缩期HTN，而睡眠时为55%；清醒时21%的儿童有舒张期HTN，而睡眠时为52%（p < 0.05）。17名儿童中有6名（35%）左心室质量（LVM）异常增加；LVM与血压无关。与服用钙通道阻滞剂（CCB）的儿童相比，服用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（ACEi/ARB）的儿童收缩压显著更低。服用ACEi/ARB的儿童平均收缩期SDS为 - 0.11±1.1，而服用CCB的儿童为1.6±1.2（p = 0.02）：ACEi/ARB组睡眠期间的收缩期SDS显著低于CCB组（0.70±1.1与2.0±1.1，p = 0.04）。在临床稳定的小儿肾移植受者中，孤立性夜间高血压比白天高血压更常见。检测和治疗小儿移植受者的夜间高血压可能会影响移植物存活。
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