Wiraboonchai Boonsita, Khongkhatithum Chaiyos, Nimkarn Norrarath, Chantarogh Songkiat, Saisawat Pawaree, Tangnararatchakit Kanchana, Pirojsakul Kwanchai
Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand.
BMC Pediatr. 2025 Jul 17;25(1):558. doi: 10.1186/s12887-025-05909-w.
Hypertensive encephalopathy (HE) is characterized by a severe increase in blood pressure, leading to neurological symptoms such as severe headache, seizure, and mental status change. Prompt medical treatment is crucial, often leading to full recovery without long-term neurological deficits. However, untreated cases can result in serious complications. This study aimed to describe the clinical characteristics and outcomes of children who developed HE.
A retrospective review of medical records in patients aged < 18 years diagnosed with HE in Ramathibodi Hospital was conducted. Data were collected, including demographics, underlying conditions, clinical presentations, blood pressure levels during HE, medications used, diagnostic investigations, and outcomes. Patients with pre-existing neurological symptoms or incomplete data were excluded. Data between the groups with kidney diseases and non-kidney diseases were compared.
Fifty-three patients (26 males) were included with a mean age of 8.9 ± 4 years and a median follow-up time of 47.8 months. Kidney disease (51%) was the most common cause of hypertension. Patients with kidney disease were older (10.3 vs. 7.5 years, = 0.01), had a shorter duration between the diagnosis of underlying conditions and development of HE (70 vs. 457 days, = 0.04), and a larger proportion of females (66.7% vs. 34.6%, = 0.02). Neither clinical manifestations, such as generalized tonic-clonic seizures, headaches, and mental status changes, nor survival were different between the kidney and non-kidney groups. Five patients who developed recurrent episodes of HE had the underlying diseases involving endothelial injuries, such as small vessel vasculitis, and were on calcineurin inhibitors after hematopoietic stem cell transplantation (HSCT).
Patients with kidney diseases were older and developed HE earlier, but there was no difference in survival between the kidney and non-kidney groups. Recurrent episodes of HE were detected in patients with small vessel vasculitis or taking calcineurin inhibitors after HSCT, prompting the pediatricians to be vigilant for blood pressure control in these patients.
高血压脑病（HE）的特征是血压严重升高，导致严重头痛、癫痫发作和精神状态改变等神经症状。及时的医学治疗至关重要，通常可实现完全康复且无长期神经功能缺损。然而，未经治疗的病例可能导致严重并发症。本研究旨在描述发生HE的儿童的临床特征和结局。
对拉玛蒂博迪医院诊断为HE的18岁以下患者的病历进行回顾性研究。收集的数据包括人口统计学资料、基础疾病、临床表现、HE发作时的血压水平、使用的药物、诊断检查及结局。排除既往有神经症状或数据不完整的患者。比较肾病组和非肾病组之间的数据。
纳入53例患者（26例男性），平均年龄8.9±4岁，中位随访时间47.8个月。肾病（51%）是高血压最常见的病因。肾病患者年龄较大（10.3岁对7.5岁，P = 0.01），基础疾病诊断至发生HE的时间较短（70天对457天，P = 0.04），女性比例较高（66.7%对34.6%，P = 0.02）。肾病组和非肾病组在临床表现（如全身强直阵挛性发作、头痛和精神状态改变）及生存率方面均无差异。5例发生HE复发的患者，其基础疾病涉及内皮损伤，如小血管血管炎，且在造血干细胞移植（HSCT）后使用钙调神经磷酸酶抑制剂。
肾病患者年龄较大且较早发生HE，但肾病组和非肾病组在生存率方面无差异。在小血管血管炎患者或HSCT后使用钙调神经磷酸酶抑制剂的患者中检测到HE复发，提示儿科医生应对这些患者的血压控制保持警惕。
