Xu Zhi-Quan, Yi Zhu-Wen, Dang Xi-Qiang, Wu Xiao-Chuan, He Xiao-Jie
Laboratory of Pediatric Nephrology, Second Xiangya Hospital, Central South University, Changsha, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2010 Oct;12(10):788-92.
To investigate the changes of blood pressure by 24-hour ambulatory blood pressure (ABP) monitoring in children with primary nephrotic syndrome (PNS) and explore the relationship of the changes in blood pressure with rennin-angiotensin-aldosterone system (RAAS) in these children.
ABP and casual blood pressure (CBP) monitoring were performed in 114 children with PNS. Plasma levels of rennin activity (PRA), angiotensin II (AngII) and aldosterone (ALD) were measured. The correlation of plasma levels of PRA, AngII and ALD with ABP was evaluated.
Of the 114 children with PNS, 101 (88.6%) presented elevated blood pressure. Mild or severe masked hypertension was found in 45 children (39.5%). Eighty (70.2%) children showed non-dipper blood pressure. The index and load of systolic blood pressure were higher than those of diastolic blood pressure. The blood pressure index and blood pressure load during sleep were higher than those during wakefulness. The boy presented higher diastolic blood pressure index and load than girls. Decubitus blood PRA, AngII and ALD levels in children with PNS were significantly higher than normal controls. The group with elevated blood pressure presented significantly higher decubitus blood PRA, AngII and ALD levels than the group with normal blood pressure. AngII level was significantly positively correlated with the index and load of both systolic blood pressure and diastolic blood pressure.
The children with PNS present a high incidence of hypertension, with a large percentage of masked hypertension and non-dipper blood pressure. Systolic blood pressure increases more significantly than diastolic blood pressure. Blood pressure during sleep increases more significantly than that during wakefulness. Diastolic blood pressure increases more significantly in boys than in girls. RAAS activity is elevated and the elevated RAAS activity might increase the blood pressure mainly by AngII in children with PNS.
通过24小时动态血压（ABP）监测，研究原发性肾病综合征（PNS）患儿血压的变化，并探讨这些患儿血压变化与肾素 - 血管紧张素 - 醛固酮系统（RAAS）的关系。
对114例PNS患儿进行ABP和偶测血压（CBP）监测。检测血浆肾素活性（PRA）、血管紧张素II（AngII）和醛固酮（ALD）水平。评估PRA、AngII和ALD血浆水平与ABP的相关性。
114例PNS患儿中，101例（88.6%）血压升高。45例患儿（39.5%）存在轻度或重度隐蔽性高血压。80例（70.2%）患儿表现为非勺型血压。收缩压的指数和负荷高于舒张压。睡眠期间的血压指数和血压负荷高于清醒期间。男孩的舒张压指数和负荷高于女孩。PNS患儿卧位血PRA、AngII和ALD水平显著高于正常对照组。血压升高组的卧位血PRA、AngII和ALD水平显著高于血压正常组。AngII水平与收缩压和舒张压的指数及负荷均呈显著正相关。
PNS患儿高血压发病率高，隐蔽性高血压和非勺型血压比例大。收缩压升高比舒张压更显著。睡眠期间血压升高比清醒期间更显著。男孩舒张压升高比女孩更显著。PNS患儿RAAS活性升高，升高的RAAS活性可能主要通过AngII升高血压。
