儿童原发性动脉高血压形成的微循环预测因子

D. Nechytaylo, T. M. Mikheeva, O. G. Buryak, O. Godovanets
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When comparing the quantitative capillaroscopic indicators of the nail bed between the groups, it was found that the children from the main group showed probable differences in individual indicators (reduced linear density, greater distance between capillaries, 2 times less number of anastomoses, change in the shape of capillaries) compared to the control group, which indicates on changes in peripheral microcirculation in children with elevated blood pressure.After conducting a correlation analysis of the obtained data, we found correlations between changes in the microcirculation of the nail bed and indicators of the functional state of the cardiovascular system in the form of changes in the linear density of capillaries and the distance between them, the presence of increased tortuosity of capillaries and \"sweetening\". 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引用次数: 1

摘要

介绍。儿童动脉性高血压的早期诊断问题已迫在眉睫。根据一些外国科学家的说法,在过去的十年里,世界上学龄儿童中这种疾病的发病率一直在上升。青春期前和青春期的儿童最容易发生动脉高血压,这在很大程度上是由这些儿童时期的植物功能障碍和微循环障碍所决定的。已经证明,微循环的变化是由动脉高血压的变异决定的,是靶器官受损程度的一个相当早期的标志。该研究的目的是研究儿童原发性动脉高血压形成的微循环预测因素。材料和方法。对来自切尔诺夫茨地区和切尔诺夫茨居民的113名学龄儿童进行了检查。接受检查的儿童被分为两组:主要组由30名患有动脉高血压的儿童组成,对照组由83名血压正常的儿童组成。采用带可拆卸袖口的自动血压计测量血压,于早晨在双臂上测量3次,每次间隔2分钟。结果根据年龄、性别和身高的百分位数表进行评估。美国儿科学会(American Academy of Pediatrics, AAR)的建议被用来诊断儿童高血压。用毛细镜检查甲床来评估被检查儿童周围微循环的状态。对微循环的定量和定性参数进行了评价。该研究遵循赫尔辛基宣言(1964-2013)、ICH GCP(1996)、欧盟第609号指令(1986年11月24日起)、乌克兰卫生部2009年9月23日第690号命令、2009年12月14日第944号命令、2012年8月3日第616号命令批准的“开展人类参与科学医学研究的伦理原则规则”进行。采用非参数评价方法对数据进行统计处理。使用Microsoft Office Excel和Statistica 10.0对数据进行数学处理。这项工作是在布科维尼安州立医科大学儿科、新生儿科和围产期医学系计划研究工作的框架内进行的:不同年龄组儿童病理状态下自主调节的时间生物学和适应性方面和特征,(№0122U002245,执行期限2022 - 2026)。在对比两组间甲床定量毛细血管镜指标时,发现主组患儿在个别指标(线密度降低、毛细血管间距增大、吻合口数量减少2倍、毛细血管形态改变)与对照组相比可能存在差异,提示高血压患儿外周血微循环的改变。在对获得的数据进行相关性分析后,我们发现甲床微循环的变化与心血管系统功能状态的指标之间存在相关性,表现为毛细血管的线性密度及其之间距离的变化,毛细血管扭曲度增加和“变甜”。因此,毛细血管线密度与收缩压水平(r=0.73, p<0.05)和舒张压水平(r=0.69, p<0.05)高度相关。在进行多因素分析时,可以追踪心血管系统状态指标变化与甲床毛细血管变化之间的明确关系。1. 甲床毛细血管微循环障碍反映了中枢血流动力学的变化,可能是儿童动脉高血压的早期征象。根据流行病学分析结果,确立了儿童原发性动脉性高血压发生的预测因素。这些因素是单位面积毛细血管数量减少(OR = 2.54;Rr = 2.12;95% CI 2.06-4.98)和病理性扭曲(OR = 1.75;Rr = 1.44;95% ci 1.18-2.63)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MICROCIRCULATORY PREDICTORS OF THE FORMATION OF PRIMARY ARTERIAL HYPERTENSION IN CHILDHOOD
Introduction. The problem of early diagnosis of arterial hypertension in children is extremely urgent. According to some foreign scientists, the prevalence of this disease among school-age children in the world has been increasing over the past ten years. Children of prepubertal and pubertal age are most prone to the development of arterial hypertension, which is largely determined by vegetative dysfunctions and microcirculation disorders characteristic of these periods of childhood.It has been proven that changes in microcirculation are determined by the variant of arterial hypertension and are a fairly early marker of the degree of damage to target organs.The aim of the study is to study microcirculatory predictors of the formation of primary arterial hypertension in childhood.Material and methods.113 school-age children from the residents of Chernivtsi region and Chernivtsi were examined. The examined children were divided into two groups: the main group consisted of 30 children with arterial hypertension and the control group - 83 children with a normal level of blood pressure.Blood pressure was measured with automatic pressure gauge with removable cuffs, in the morning on both arms, three times with an interval of 2 minutes. Results were evaluated according to percentile tables for age, sex, and height.The recommendations of the American Academy of Pediatrics (AAR) were used to diagnose hypertension in children.Capillaroscopic examination of the nail bed was used to assess the state of peripheral microcirculation in the examined children. Quantitative and qualitative parameters of microcirculation were evaluated.The research was carried out in compliance with the "Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation" approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (from 24.11.1986), orders of the Ministry of Health of Ukraine No. 690 from 23.09.2009, No. 944 from 14.12.2009, No. 616 from 03.08.2012.Statistical processing of the data was performed using nonparametric methods of evaluation. Mathematical processing of the data was performed using Microsoft Office Excel and Statistica 10.0.The work was performed within the framework of the planned research work of the Department of Pediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University: Chronobiological and adaptation aspects and features of autonomic regulation in pathological conditions in children of different age groups, (№ 0122U002245, term of execution 2022 - 2026).Results. When comparing the quantitative capillaroscopic indicators of the nail bed between the groups, it was found that the children from the main group showed probable differences in individual indicators (reduced linear density, greater distance between capillaries, 2 times less number of anastomoses, change in the shape of capillaries) compared to the control group, which indicates on changes in peripheral microcirculation in children with elevated blood pressure.After conducting a correlation analysis of the obtained data, we found correlations between changes in the microcirculation of the nail bed and indicators of the functional state of the cardiovascular system in the form of changes in the linear density of capillaries and the distance between them, the presence of increased tortuosity of capillaries and "sweetening". Thus, the linear density of capillaries had high correlations with the level of systolic blood pressure (r=0.73, p<0.05) and the level of diastolic blood pressure (r=0.69, p<0.05).When conducting a multifactorial analysis, a clear relationship between changes in the indicators of the state of the cardiovascular system, on the one hand, and the capillaries of the nail bed, on the other, can be traced.Conclusions. 1. Microcirculatory disorders in the capillaries of the nail bed reflect the changes in central hemodynamics and may be early signs of arterial hypertension in children.2. According to the results of the epidemiological analysis, the presence of predictors of the development of primary arterial hypertension in children was established. These factors are a reduced number of capillaries per unit area (OR = 2.54; RR = 2.12; 95% CI 2.06-4.98) and their pathological tortuosity (OR = 1.75; RR = 1.44; 95% CI 1.18-2.63).
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