欢迎访问《中国循证儿科杂志》官方网站，今天是
English Version
中国循证儿科杂志

中国循证儿科杂志 ›› 2012, Vol. 7 ›› Issue (1): 50-54.

• 论著 • 上一篇    下一篇

儿童肾血管性高血压29例诊断方法的回顾性分析

管娜   

  1. 北京大学第一医院
  • 收稿日期:2011-11-05 修回日期:2012-01-04 出版日期:2012-01-10 发布日期:2012-03-15
  • 通讯作者: 管娜

Retrospective analysis of the diagnostic methods for renovascular hypertension in 29 children

  1. Peking University First Hospital
  • Received:2011-11-05 Revised:2012-01-04 Online:2012-01-10 Published:2012-03-15

PDF

4077

摘要： 目的 探讨儿童肾血管性高血压（RVH）的早期诊断方法。 方法 回顾性分析北京大学第一医院1996年1月至2011年6月确诊的RVH患儿，分析贻误诊治情况，以及临床症状、影像学检查结果对RVH的诊断价值。 结果 ①29例确诊RVH患儿进入分析，其中男18例，女11例。起病年龄0.5~15岁，平均年龄（7.0±4.4）岁。从首发症状出现至确诊时间为15 d至7年，平均确诊时间11个月。9例（31.0%）患儿起病6个月后确诊，曾分别被误诊为胃肠炎、癫、肾脏和心脏疾病等。3例患儿以头痛伴呕吐起病，补液出现抽搐后发现高血压。首发症状以头痛（10例，34.5%）、呕吐（10例，34.5%）和抽搐（9例，31.0%）多见。起病时平均收缩压和舒张压分别为182和127 mmHg。②单侧肾动脉狭窄25例，双侧肾动脉狭窄4例。23例通过肾动脉造影确诊，其中17例单侧肾动脉狭窄患儿中10例超声检查显示双肾长径相差>1.5 cm；血管超声对肾动脉狭窄检出率为31.3%（5/16例）；CT对肾动脉狭窄检出率为50.0%（3/6例）；肾动态显像对肾功能受损检出率为93.8%（15/16例）。通过肾血管超声检查确诊4例，通过肾动脉超声检查及CT检查确诊1例，通过肾动脉超声检查和肾动脉MRA检查确诊1例。③16/18例（88.9％）卧位血浆肾素和血管紧张素水平增高。12/29例（41.4%）存在低钾血症。10/29例（34.5%）确诊为多发性大动脉炎。 结论 儿童RVH贻误诊断率较高，对于有头痛、呕吐和抽搐者应首先测量血压，尤其在补液治疗前。肾动态显像有助于早期发现患侧肾功能受损，血浆肾素和血管紧张素增高、低钾血症、双肾大小不对称对于诊断具有提示意义，肾血管超声和CT检查敏感度有限，可疑患儿应尽早行肾动脉造影检查。确诊RVH后应尽可能进行病因诊断，尤其应确定是否存在大动脉炎以指导治疗。

关键词: Children, Early diagnosis, Misdiagnosis, Renovascular hypertension, 儿童, 肾血管性高血压, 误诊, 早期诊断

Abstract: Objective To investigate the early diagnostic methods for renovascular hypertension(RVH) in children. Methods Children diagnosed as RVH in Peking University First Hospital from January 1996 to July 2011 were included. The data including early diagnosis and treatment, age, gender, clinical characteristics and imaging examination results were collected and analyzed retrospectively. Results Totally 29 children diagnosed as RVH were included aged from 0.5 to 15 years with a mean age of 7 years. There were 18 boys and 11 girls. The duration of diagnosis ranged from 15 days to 7 years, the average duration was 11 months. Nine children (31.0%) were diagnosed half year after some misdiagnosis such as gastritis, epilepsy, renal and cardiac diseases. Hypertension was found in 3 children due to convulsion after fluid injection. The most common onset symptoms included headache (34.5%), vomiting (34.5%), and convulsion (31.0%). The mean blood pressure was 182/127mmHg. Twenty five children were diagnosed as unilateral renal vascular stenosis and 4 children were diagnosed as bilateral renal vascular stenosis. Twenty three children were diagnosed by renal arterial angiography, 4 children were diagnosed by renal arterial ultrasound examination, 1 child was diagnosed by renal arterial ultrasound examination combined with computed tomography, 1 child was diagnosed by renal arterial ultrasound examination and MRA. Among the children diagnosed by renal angiography, the difference in bilateral renal size exceeded 1.5 cm in 10/17 children. The renal arterial ultrasound and CT examination detected 31.3%(5/16) and half (3/6) renal vascular hypertension respectively. Renography examination showed that 93.8% (15/16) of children with RVH had compromised renal function. Elevated serum renin and angiotensin were seen in 88.9%(16/18) patients. Hypokalemia was observed in 41.4% (12/29) of them. Ten children (34.5%) were diagnosed as Takayasu disease, 3 of them received nephrectomy, and 2 relapsed. Conclusions The misdiagnosis of RVH patients was common. Blood pressure should be monitored for children with symptoms of headache, vomiting and convulsion especially before fluid injection. Renography was a sensitive method for detection of compromised renal function. For children with hypertension, renal ultrasound could be used as a screening tool. The difference of bilateral renal size exceeding 1.5 cm deserved further investigation of RVH. High serum renin and angiotensin and hypokalemia had suggestive roles for RVH. Renal arterial ultrasound and CT examinations were not sensitive enough. For children who were suspected as RVH, renal arterial angiography should be performed as early as possible. Etiology diagnosis should be made especially for Takayasu arteritis.