这位患有高血压的孩子是否患有二次高血压? : 理性的临床检查系统审查
James T Nugent1,2, Kuan Jiang2, Melissa C Funaro3
1Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
JAMA
|March 28, 2023
概括
在儿童和青少年中发现二次高血压至关重要. 家庭病史,年龄较小,体重较低以及特定的血压模式等因素增加了对二次原因的怀疑.
科学领域:
- 儿童科和心脏病学
- 高血压的诊断准确性
背景情况:
- 目前的指导方针建议对所有儿童和青少年进行二次高血压原因的评估.
- 要避免不必要的诊断测试,必须区分初级高血压和二级高血压.
研究的目的:
- 评估临床病史,体检和24小时门诊血压监测 (ABPM) 的诊断效用,以区分儿科患者 (≤21岁) 的初级和二级高血压.
主要方法:
- 在主要数据库 (MEDLINE,PubMed Central,Embase,Web of Science,Cochrane Library) 进行了系统的文献搜索,截至2022年1月.
- 包括的研究描述了患有初级和二级高血压的儿科患者的临床特征.
- 用随机效应建模合成数据,以计算各种临床发现的灵敏度,特异性和概率比率 (LR).
主要成果:
- 这项元分析包括了30项研究,共有4210名参与者;二次高血压的患病率在初级保健中为9. 0%,在分专科诊所中为44%.
- 二次高血压的强有力的指标包括家族史上的二次高血压 (LR,4. 7),低体重百分位 (LR,4. 5),早产史 (LR,2. 3 - 2. 8) 和年龄≤6岁 (LR,2. 2 - 2. 6).
- 显著的实验室发现是微白蛋白尿症 (LR, 13) 和血清尿酸低 (LR, 2. 1- 6. 3). 在ABPM (LR,4. 8) 上增加的白天心压和夜间心压也表明了二次高血压.
- 肥胖 (LR,0.34) 和任何高血压的家族史 (LR,0.42) 降低了二次高血压的可能性.
结论:
- 没有单一的临床征兆或症状可以确定二次高血压与初级高血压的区别.
- 包括二次高血压家族史,年龄较小,体重较低和特定的ABPM发现因素的组合增加了对二次高血压的怀疑.
- 这些发现有助于指导诊断策略,减少对初级高血压的不必要测试.
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