慢性肾脏病患儿的偶然血压与神经认知功能：慢性肾脏病患儿队列研究报告。
Casual blood pressure and neurocognitive function in children with chronic kidney disease: a report of the children with chronic kidney disease cohort study.
机构信息
Department of Pediatrics, University of Rochester Medical Center, Rochester, NewYork, USA.
出版信息
Clin J Am Soc Nephrol. 2011 Aug;6(8):1831-7. doi: 10.2215/CJN.00810111. Epub 2011 Jun 23.
BACKGROUND AND OBJECTIVES
Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction, and over half have hypertension. Data on the potential contribution of hypertension to CKD-associated neurocognitive deficits in children are limited. Our objective was to determine whether children with CKD and elevated BP (EBP) had decreased performance on neurocognitive testing compared with children with CKD and normal BP.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional analysis of the relation between auscultatory BP and neurocognitive test performance in children 6 to 17 years enrolled in the Chronic Kidney Disease in Children (CKiD) project.
RESULTS
Of 383 subjects, 132 (34%) had EBP (systolic BP and/or diastolic BP ≥90(th) percentile). Subjects with EBP had lower mean (SD) scores on Wechsler Abbreviated Scales of Intelligence (WASI) Performance IQ than those with normal BP (normal BP versus EBP, 96.1 (16.7) versus 92.4 (14.9), P = 0.03) and WASI Full Scale IQ (97.0 (16.2) versus 93.4 (16.5), P = 0.04). BP index (subject's BP/95(th) percentile BP) correlated inversely with Performance IQ score (systolic, r = -0.13, P = 0.01; diastolic, r = -0.19, P < 0.001). On multivariate analysis, the association between lower Performance IQ score and increased BP remained significant after controlling for demographic and disease-related variables (EBP, β = -3.7, 95% confidence interval [CI]: -7.3 to -0.06; systolic BP index, β = -1.16 to 95% CI: -2.1, -0.21; diastolic BP index, β = -1.17, 95% CI: -1.8 to -0.55).
CONCLUSIONS
Higher BP was independently associated with decreased WASI Performance IQ scores in children with mild-to-moderate CKD.
背景和目的
患有慢性肾脏病（CKD）的儿童存在认知功能障碍的风险，且半数以上患有高血压。关于高血压对儿童 CKD 相关神经认知缺陷的潜在影响的数据有限。我们的目的是确定患有 CKD 和血压升高（EBP）的儿童与患有 CKD 和正常血压的儿童相比，在神经认知测试中表现是否较差。
设计、地点、参与者和测量：这是一项横断面分析，研究了在慢性肾脏病儿童（CKiD）项目中纳入的 6 至 17 岁儿童中听诊血压与神经认知测试表现之间的关系。
结果
在 383 名受试者中，有 132 名（34%）存在 EBP（收缩压和/或舒张压≥第 90 百分位数）。与正常血压组相比，EBP 组的韦氏儿童智力量表简明版（WASI）表现智商的平均（标准差）得分更低（正常血压组与 EBP 组分别为 96.1（16.7）与 92.4（14.9），P = 0.03）和 WASI 全量表智商（97.0（16.2）与 93.4（16.5），P = 0.04）。血压指数（受试者血压/第 95 百分位数血压）与表现智商得分呈负相关（收缩压，r = -0.13，P = 0.01；舒张压，r = -0.19，P < 0.001）。多元分析显示，在控制人口统计学和疾病相关变量后，较低的表现智商得分与血压升高之间的关联仍然显著（EBP，β=-3.7，95%置信区间[CI]：-7.3 至-0.06；收缩压指数，β=-1.16，95% CI：-2.1，-0.21；舒张压指数，β=-1.17，95% CI：-1.8 至-0.55）。
结论
在轻度至中度 CKD 儿童中，较高的血压与 WASI 表现智商得分降低独立相关。
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