【摘要】 目的 探讨福辛普利治疗儿童和青少年原发性高血压的降压效果及相关影响因素。方法 总结2018年1月至2020年12月应用福辛普利治疗的原发性高血压患儿152例的临床资料，根据用药4周后的降压效果分为血压达标组（n=98）和未达标组（n=54）,比较两组患儿的临床资料，分别采用多因素logistic回归分析和受试者工作特征（ROC）曲线分析血压达标的相关因素及预测指标。结果 患儿血压控制率为64.5%（98/152）。与治疗前相比，治疗后收缩压[中位数(P₂₅～P₇₅)为126（120～130）比140（135～147）mmHg,Z=-9.865,P<0.001]及舒张压[74（69～80）比82（76～90）mmHg,Z=-7.792,P<0.001]降低。与血压达标组比较，未达标组治疗前平均收缩压[144（140～154）比140（132～145）mmHg,Z=-4.021,P<0.001]和舒张压[85（80～91）比80（72～90）mmHg,Z=-2.413,P=0.016]较高，治疗后平均收缩压下降差值较低[10（6～15）比18（10～22）mmHg,Z=-4.258,P<0.001],肾损害的发生率较高（46.3%比29.6%,χ²=4.241,P=0.039）,福辛普利的剂量较高[（0.29±0.09）比（0.24±0.08）mg/kg,t=-2.819,P=0.006]。多因素logistic回归分析显示，治疗前平均收缩压与血压达标独立相关（OR=1.053,95%CI 1.007～1.101,P=0.025）。ROC曲线分析显示，治疗前收缩压切点值取141.5 mmHg时，预测福辛普利治疗后血压未达标的灵敏度和特异度分别为68.5%和62.2%。结论 原发性高血压儿童和青少年福辛普利治疗4周后可有效降低血压，降压效果与治疗前血压水平和肾损害相关，治疗前收缩压水平对血压达标与否具有一定的预测价值。更多还原

【Abstract】 Objective To investigate the antihypertensive effect of fosinopril and the related influencing factors in children and adolescents with essential hypertension. Methods The clinical data of 152 children with essential hypertension treated with fosinopril from January 2018 to December 2020 were summarized. They were divided into blood pressure（BP） attainment group（n=98） and the non-attainment group（n=54） according to the 4-week antihypertensive effect. The clinical data of the two groups were compared. Factors related to the antihypertensive efficacy and their predictive value were analyzed using multiple logistic regression analysis and receiver operating characteristic（ROC） curve analysis respectively. Results BP control rate was 64.5%（98/152）. The average systolic blood pressure（SBP） and diastolic blood pressure（DBP） after treatment were lower than those before treatment [median(P₂₅-P₇₅): 126（120-130） vs 140（135-147） mmHg, Z=-9.865, P<0.001; 74（69-80） vs 82（76-90） mmHg, Z=-7.792, P<0.001]. Compared with the BP attainment group, the SBP and DBP in the non-attainment group before treatment were significantly higher [144（140-154） vs 140（132-145） mmHg, Z=-4.021, P<0.001; 85（80-91） vs 80（72-90） mmHg, Z=-2.413, P=0.016], the decrease of SBP after treatment was lower [ 10（6-15） vs 18（10-22） mmHg, Z=-4.258, P<0.001], and the renal damage rate and fosinopril dosage were higher(renal damage rate: 46.3% vs 29.6%, χ²=4.241, P=0.039; fosinopril dosage:（0.29±0.09） vs（0.24±0.08） mg/kg, t=-2.819, P=0.006]. Multiple logistic regression analysis showed that the systolic blood pressure before treatment was independently associated with antihypertensive efficacy（OR=1.053, 95%CI 1.007-1.101,P=0.025）. ROC curve analysis showed that the sensitivity and specificity of predicting BP non-attainment after fosinopril treatment were 68.5% and 62.2%, respectively, using a cut-off value of 141.5 mmHg. Conclusions Four-week fosinopril treatment can effectively reduce BP in children and adolescents with essential hypertension. The antihypertensive effect is related to BP before treatment and renal injury. The SBP level before treatment has some predictive value for the attainment of blood pressure targets.更多还原