Objective: To investigate the influence of change in blood pressure status from childhood to adulthood on renal damage. Methods: Data were obtained from Beijing Blood Pressure Cohort initiated from 1987. 3 198 children and adolescents aged 6-18 years from 6 primary and 6 middle schools in Chaoyang, Xicheng and Haidian Districts of Beijing were enrolled at baseline by using a cluster random sampling method, and 1 222 participants were followed up during 2010-2012. The measurements included weight, height, and blood pressure at baseline and microalbumin, serum creatinine, cystatin C and blood pressure at follow-up. Based on blood pressure status in childhood and adulthood, the participants were divided into four groups: participants with normal blood pressure in both childhood and adulthood, participants with elevated blood pressure in childhood but normal blood pressure in adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood, and participants with elevated blood pressure in both childhood and adulthood. Multivariate linear regression model was used to investigate the association of change in blood pressure from childhood to adulthood on renal dysfunction. Results: The prevalence of elevated blood pressure in childhood and adulthood was 17.9% and 39.9%, respectively. The P(50) (P(25)-P(75)) of microalbumin was 5.7(3.0-12.0) mg/L, and the concentration of eGFR and cystatin C were (118.0±19.8)% and (0.734±0.184)mg/L, respectively. With adjustment for sex, baseline age and follow-up years, compared with participants with persistently normal blood pressure from childhood to adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood had significantly higher levels of microalbumin (β=0.502, 95%CI: 0.320-0.684) and cystatin C (β=0.049, 95%CI: 0.025-0.073). After adjustment for sex, baseline age, follow-up duration, and adult BMI, smoking and drinking, participants with normal blood pressure in childhood and elevated blood pressure in adulthood had higher levels of adult urine microalbumin (β=0.322, 95%CI: 0.128-0.516) and cystatin C (β=0.032, 95%CI:0.007-0.057). Conclusion: An increase in blood pressure during childhood and adulthood has an adverse impact on renal functional damage in adulthood. These findings underscore the importance of maintaining normal blood pressure during life course to prevent the development of chronic kidney disease.
目的： 探讨儿童期至成年期血压变化对肾脏早期损害的影响。 方法： 研究对象来源于国家"七五"科技攻关项目"北京儿童血压队列"，采用整群抽样方法，于1987年在北京市朝阳区、西城区及海淀区抽取中、小学校各6所，将3 198名6~18岁学生纳入研究，并于2010—2012年进行随访和体检，最终共纳入1 222名研究对象。研究内容主要包括基线期的身高、体重和血压的测量，以及随访期的尿微量白蛋白、肌酐、胱抑素C和血压的测定。根据儿童期及成年期血压状态，将研究对象分为4组：儿童期（基线时点）至成年期（随访时点）持续血压正常组、儿童期血压正常高值/高血压-成年期血压正常组、儿童期血压正常-成年期血压正常高值/高血压组及儿童至成年期持续血压正常高值/高血压组，采用多元线性回归分析儿童至成年期血压变化与成年期肾脏损害相关指标的关联。 结果： 儿童期、成年期的血压正常高值/高血压检出率分别为17.9%（219例）、39.9%（486例）。成年期尿微量白蛋白的P(50)（P(25)~P(75)）为5.7（3.0~12.0）mg/L，肾小球滤过率及胱抑素C分别为（118.0±19.8）%、（0.734±0.184）mg/L。以儿童期至成年期持续血压正常组为参照，调整性别及年龄后，儿童期血压正常-成年期血压正常高值/高血压组的尿微量白蛋白及胱抑素C的β（95%CI）值分别为0.502 (0.320~0.684)、0.049 (0.025~0.073)。进一步调整性别、年龄、成年BMI、吸烟及饮酒后，儿童期血压正常成年期血压正常高值/高血压组尿微量白蛋白和胱抑素C的β（95%CI）值分别为0.322 (0.128~0.516)、0.032 (0.007~0.057)。 结论： 血压正常的儿童在成年期血压若升高，其肾脏损害的危险增高，维持正常血压水平对于预防慢性肾病有重要意义。.
Keywords: Child; Cohort Study; Hypertension; Renal insufficiency, chronic.