Ubertini Graziamaria, Bizzarri Carla, Grossi Armando, Gimigliano Fabrizio, Ravà Lucilla, Fintini Danilo, Cappa Marco
Department of Pediatrics, Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, School of Medicine, University of Rome Tor Vergata, P.zza S. Onofrio 4, 00165 Rome, Italy.
Int J Pediatr Endocrinol. 2009;2009:383610. doi: 10.1155/2009/383610. Epub 2010 Feb 7.
High steroid doses are often necessary in congenital adrenal hyperplasia (CAH) to suppress androgens and may increase blood pressure (BP). We evaluated 24-hour BP profile (ambBP), BP during exercise (excBP), and echocardiography in 20 young CAH patients. Systolic and diastolic BP during ambBP and excBP was normal in all patients. None presented myocardial hypertrophy. Nocturnal diastolic BP was affected by testosterone (P: .016, 95% CI: 0.002 to 0.021, beta = 0.01). Left ventricular mass (LVM ) was affected by height SDS (P: .007, 95% CI: 2.67 to 14.17, beta = 8.42), age (P: < .0001, 95% CI: 2.12 to 5.82, beta = 3.97), and testosterone (P: .008, 95% CI: 0.01 to 0.09, beta = 0.053). Left ventricular mass index (LVMI) correlated with BMI SDS (P: .044, 95% CI: 0.09 to 6.17, beta = 3.13) and testosterone (P: .031, 95% CI: 0.002 to 0.035, beta = 0.018). Hydrocortisone dose did not influence ambBP, excBP, or myocardial hypertrophy.
先天性肾上腺皮质增生症（CAH）患者通常需要高剂量类固醇来抑制雄激素，这可能会导致血压升高。我们评估了20例年轻CAH患者的24小时血压曲线（动态血压，ambBP）、运动期间血压（运动血压，excBP）和超声心动图。所有患者的动态血压和运动血压中的收缩压和舒张压均正常。无一例出现心肌肥厚。夜间舒张压受睾酮影响（P = 0.016，95%可信区间：0.002至0.021，β = 0.01）。左心室质量（LVM）受身高标准差积分（SDS）影响（P = 0.007，95%可信区间：2.67至14.17，β = 8.42）、年龄影响（P < 0.0001，95%可信区间：2.12至5.82，β = 3.97）和睾酮影响（P = 0.008，95%可信区间：0.01至0.09，β = 0.053）。左心室质量指数（LVMI）与体重指数标准差积分（BMI SDS）相关（P = 0.044，95%可信区间：0.09至6.17，β = 3.13）和睾酮相关（P = 0.031，95%可信区间：0.002至0.035，β = 0.018）。氢化可的松剂量不影响动态血压、运动血压或心肌肥厚。
