vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v14i1.1270vsp-86Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПУЛЬСОВОЕ АРТЕРИАЛЬНОЕ ДАВЛЕНИЕ И ПОКАЗАТЕЛИ РЕМОДЕЛИРОВАНИЯ СОСУДОВ: ПОИСК РАННИХ ПРИЗНАКОВ РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИИ У ДЕТЕЙPULSATILE ARTERIAL PRESSURE (PAP) AND VASCULAR REMODELLING INDICES: SEARCH OF EARLY SYMPTOMS OF CARDIOVASCULAR PATHOLOGY IN CHILDRENКожевниковаО. В.KozhevnikovaO. V.

кандидат медицинских наук, заведующая отделением инструментальной и лабораторной диагностики КДЦ НИИППиВЛ НЦЗД 

fd@nczd.ruНамазова-БарановаЛ. С.Namazova-BaranovaL. S.namazova@nczd.ruЛогачёваО. С.LogachevaO. S.fd@nczd.ruСюткинаЕ. В.SyutkinaE. V.fd@nczd.ruАнтоноваЕ. В.AntonovaE. V.fd@nczd.ruАбашидзеЭ. А.AbashidzeE. A.fd@nczd.ruАйсинаВ. А.AisinaV. A.fd@nczd.ruБалабановА. С.BalabanovA. S.fd@nczd.ruВашакмадзеН. Д.VashakmadzeN. D.fd@nczd.ruГеворкянА. К.GevorkyanA. K.fd@nczd.ruНаучный центр здоровья детей, Москва, Российская ФедерацияРоссияScientific Centre of Children’s Health, Moscow, Russian FederationRussian FederationНаучный центр здоровья детей, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Российская Федерация Российский национальный исследовательский медицинский университит им. Н.И. Пирогова, Москва, Российская ФедерацияРоссияScientific Centre of Children’s Health, Moscow, Russian Federation Sechenov First Moscow State Medical University, Russian Federation Pirogov Russian National Research Medical University, Moscow, Russian FederationRussian FederationНаучный центр здоровья детей, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Российская ФедерацияRussian FederationScientific Centre of Children’s Health, Moscow, Russian Federation Sechenov First Moscow State Medical University, Russian FederationRussian Federation201514022015141Вопросы современной педиатрии119123Copyright © Кожевникова О.В., Намазова-Баранова Л.С., Логачёва О.С., Сюткина Е.В., Антонова Е.В., Абашидзе Э.А., Айсина В.А., Балабанов А.С., Вашакмадзе Н.Д., Геворкян А.К., 20152015Кожевникова О.В., Намазова-Баранова Л.С., Логачёва О.С., Сюткина Е.В., Антонова Е.В., Абашидзе Э.А., Айсина В.А., Балабанов А.С., Вашакмадзе Н.Д., Геворкян А.К.Kozhevnikova O.V., Namazova-Baranova L.S., Logacheva O.S., Syutkina E.V., Antonova E.V., Abashidze E.A., Aisina V.A., Balabanov A.S., Vashakmadze N.D., Gevorkyan A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/86Цель исследования

Цель исследования: определить нормативы пульсового артериального давления (ПАД) у здоровых детей и возможность использования ПАД в качестве индикатора состояния сосудов у детей с повышенным индексом массы тела (ИМТ). Методы: представлены результаты неинвазивной артериографии у детей в возрасте 3–17 лет с нормальным (практически здоровые дети, n =291) и повышенным ИМТ (n =211). Группу детей с нормальным ИМТ формировали при диспансерных осмотрах в школах и детских садах. Дети с повышенным ИМТ (вторичный характер избыточного веса и ожирения исключены) наблюдались амбулаторно. Анализ ПАД проведен в учетом возраста, пола, роста и ИМТ. Изучалась взаимосвязь ПАД с другими показателями гемодинамики и ремоделирования сосудов. Результаты: получены перцентильные таблицы ПАД у здоровых детей с разбивкой по возрастным и ростовым группам. ПАД выше 90-го перцентиля выявлен у 7,2% практически здоровых, у 7,7% детей с избыточным весом и 22,4% детей с ожирением. Показана зависимость показателя ПАД от возраста, роста и ИМТ. Установлена связь высокого ПАД у детей с избыточной массой тела с признаками ремоделирования стенки сосудов. Заключение: представленные перцентильные таблицы значений ПАД у здоровых детей с нормальным ИМТ могут быть использованы для обнаружения повышенного ПАД у детей в группах риска по развитию сердечно-сосудистых заболеваний.

 

 

Objective: To determine the standards of pulsatile arterial pressure (PAP) in healthy children and the possibility to use PAP as an indicator of the condition of vessels in children with increased body mass index (BMI). Methods: The results of non-invasive arteriography in children aged 3–17 years with normal (apparently healthy children, n =291) and increased BMI (n =211) are presented. A group of children with normal BMI was formed by dispensary examinations in schools and kindergartens. Children with increased BMI (secondary nature of overweight and obesity are excluded) were observed as outpatients. The PAP analysis was carried out in regard to age, sex, height, and BMI. The interaction of PAP with other hemodynamics and vascular remodelling indices was investigated. Results: PAP percentile tables in healthy children by age and growth groups are obtained. PAP above the 90th percentile is diagnosed in 7.2% of apparently healthy children, in 7.7% of overweight and in 22.4% of obese children. The dependence of the PAP rate on age, height and BMI is shown. The connection of high PAP in overweight children with signs of the vascular wall remodelling is established. Conclusion: The presented percentile tables of PAP rates in healthy children with normal BMI can be used to detect increased PAP in children at risk of cardiovascular disease developing.

детииндекс массы телаожирениепульсовое артериальное давлениеартериографиясердечно-сосудистые заболеванияпрофилактикаchildrenbody mass indexobesitypulsatile arterial pressurearteriographycardiovascular diseasespreventionReferencesBaranov А.А. Sostoyanie zdorov'ya detei v Rossiiskoi Federatsii [Health Condition of Children in the Russian Federation]. Pediatriya im. G.N. Speranskogo = PEDIATRIYA-MOSCOW. 2012;91:3.Baranov А.А. Sostoyanie zdorov'ya detei v Rossiiskoi Federatsii [Health Condition of Children in the Russian Federation]. Pediatriya im. G.N. Speranskogo = PEDIATRIYA-MOSCOW. 2012; 91: 3.Leont'eva I.V. Sovremennoesostonie problem diagnostiki, lecheniya i profilaktiki pervichnoy arterial'noy gipertonii u detey i podrostkov [Current Problems of Diagnosis, Treatment and Prevention of Essential Hypertension in Children and Adolescents]. Rossiiskii Vestnik Perinatologii i Pediatrii = Russian Bulletin of Perinatology and Pediatrics. 2002;1:38–39.Leont'eva I.V. Sovremennoesostonie problem diagnostiki, lecheniya i profilaktiki pervichnoy arterial'noy gipertonii u detey i podrostkov [Current Problems of Diagnosis, Treatment and Prevention of Essential Hypertension in Children and Adolescents]. Rossiiskii Vestnik Perinatologii i Pediatrii = Russian Bulletin of Perinatology and Pediatrics. 2002; 1: 38–39.Aleksandrov A.A. Povyshennoe arterial'noe davlenie v detskom i podrostkovom vozraste (yuvenil'naya arterial'naya gipertoniya) [High Blood Pressure in Childhood and Adolescence (Juvenile Hypertension)]. Rossiiskii meditsinskii zhurnal = Russian Medical Journal. 1997;9:559–565.Aleksandrov A.A. Povyshennoe arterial'noe davlenie v detskom i podrostkovom vozraste (yuvenil'naya arterial'naya gipertoniya) [High Blood Pressure in Childhood and Adolescence (Juvenile Hypertension)]. Rossiiskii meditsinskii zhurnal = Russian Medical Journal. 1997; 9: 559–565.Hidvegi E., Illyes М., Benczur B., Bochke R.М., Radgeber L., Lekkei G., Molnar F.T., Ciraki А. Referentnye znacheniya skorosti rasprostraneniya pul'sovoy volny po aorte u zdorovykh detey v vozraste ot 3 do 18 let [Reference Values of Pulse Wave Velocity in Healthy Children Aged 3 to 18]. Pediatricheskaya farmakologiya = Pediatric pharmacology. 2013;10(2):64–71.Hidvegi E., Illyes М., Benczur B., Bochke R.М., Radgeber L., Lekkei G., Molnar F.T., Ciraki А. Referentnye znacheniya skorosti rasprostraneniya pul'sovoy volny po aorte u zdorovykh detey v vozraste ot 3 do 18 let [Reference Values of Pulse Wave Velocity in Healthy Children Aged 3 to 18]. Pediatricheskaya farmakologiya = Pediatric pharmacology. 2013; 10 (2): 64–71.McEniery C. M., Spratt M., Munnery M., Yarnell J., Lowe G. D., Rumley A., Gallacher J., Ben-Shlomo Y., Cockcroft J. R., Wilkinson I. B. An analysis of prospective risk factors for aortic stiffness in men: 20-year follow-up from the Caerphilly prospective study. Hypertension. 2010; 56: 36–43.McEniery C.M., Spratt M., Munnery M., Yarnell J., Lowe G.D., Rumley A., Gallacher J., Ben-Shlomo Y., Cockcroft J.R., Wilkinson I.B. An analysis of prospective risk factors for aortic stiffness in men: 20-year follow-up from the Caerphilly prospective study. Hypertension. 2010; 56: 36–43.Franklin S. S., Lopez V. A., Wong N. D., Mitchell G. F., Larson M. G., Vasan R. S., Levy D. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 2009; 119: 243–250.Franklin S.S., Lopez V.A., Wong N.D., Mitchell G.F., Larson M.G., Vasan R.S., Levy D. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 2009; 119: 243–250.Staessen J. A., Gasowski J., Wang J. G., Thijs L., Den Hond E., Boissel J. P., Coope J., Ekbom T., Gueyffier F., Liu L., Kerlikowske K., Pocock S., Fagard R. H. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000; 355: 865–872.Staessen J.A., Gasowski J., Wang J.G., Thijs L., Den Hond E., Boissel J.P., Coope J., Ekbom T., Gueyffier F., Liu L., Kerlikowske K., Pocock S., Fagard R.H. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000; 355: 865–872.Nichols W. V., O’Rourke M. F. McDonald’s Blood Flow in Arteries: Theoretic, Experimental, and Clinical Principles. 3rd edn. London, UK: E. Arnold. 1990. P. 77–142, 216–269, 398–411.Nichols W.V., O’Rourke M.F. McDonald’s Blood Flow in Arteries: Theoretic, Experimental, and Clinical Principles. 3rd edn. London, UK: E. Arnold. 1990. P. 77–142, 216–269, 398–411.Kelly R., Tunin R., Kass D. Effect of reduced aortic compliance on left ventricular contractile function and energetics in vivo. Circ. Res. 1992; 71: 490–502.Kelly R., Tunin R., Kass D. Effect of reduced aortic compliance on left ventricular contractile function and energetics in vivo. Circ. Res. 1992; 71: 490–502.Benetos A., Rudnichi A., Safar M., Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998; 32: 560–564.Benetos A., Rudnichi A., Safar M., Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998; 32: 560–564.Blacher J. A. Staessen X., Girerd J. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch. Intern. Med. 2000; 160: 1085–1089.Blacher J.A. Staessen X. Girerd J. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch. Intern. Med. 2000; 160: 1085–1089.Millar J. A., Lever A. F., Burke V. Pulse pressure as a risk factors for cardiovascular events in the MRS Mild Hypertension Trial. Hypertension. 1999; 17: 1065–1072.Millar J.A., Lever A.F., Burke V. Pulse pressure as a risk factors for cardiovascular events in the MRS Mild Hypertension Trial. Hypertension. 1999; 17: 1065–1072.Lakatta E. G., Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: Aging arteries: a «Set Up» for vascular disease. Circulation. 2003; 107: 139–146.Lakatta E.G., Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: Aging arteries: a «Set Up» for vascular disease. Circulation. 2003; 107: 139–146.Zachariah J. P., Graham D. A., de Ferranti S. D., Vasan R. S., Newburger J. W., Mitchell G. F. Temporal Trends in Pulse Pressure and Mean Arterial Pressure During the Rise of Pediatric Obesity in US Children. J. Am. Heart Assoc. 2014; 3: e000725 originally.Zachariah J.P., Graham D.A., de Ferranti S.D., Vasan R.S., Newburger J.W., Mitchell G. F. Temporal Trends in Pulse Pressure and Mean Arterial Pressure During the Rise of Pediatric Obesity in US Children. J. Am. Heart Assoc. 2014; 3: e000725 originally.Jiang X., Srinivasan S. R., Urbina E., Berenson G. S. Hyperdynamic circulation and cardiovascular risk in children and adolescent: The Bogalusa heart study. Circulation. 1995;91:1101–1106.Jiang X., Srinivasan S.R., Urbina E., Berenson G.S. Hyperdynamic circulation and cardiovascular risk in children and adolescent:The Bogalusa heart study. Circulation. 1995; 91: 1101–1106.Strueva N.V., Poluektov M.G., Savel'yeva L.V., Mel'nichenko G.A. Ozhirenie i son [Obesity and Sleep]. Ozhirenie i metabolism = Obesity and Metabolism. 2013;3. Available at: http://cyberleninka.ru/article/n/ozhirenie-i-son (accessed: 03.12.2014).Strueva N.V., Poluektov M.G., Savel'yeva L.V., Mel'nichenko G.A. Ozhirenie i son [Obesity and Sleep]. Ozhirenie i metabolism = Obesity and Metabolism. 2013; 3: http://cyberleninka.ru/article/n/ozhirenie-i-son (accessed: 03.12.2014).Vsemirnaya organizatsiya zdravookhraneniya. Global'naya strategiya po pitaniyu, fizicheskoy aktivnosti i zdorov'yu. Izbytochnyy ves i ozhirenie sredi detey [World Health Organization. Global Strategy on Diet, Physical Activity and Health. Overweight and Obese Children]. Available at: www.who.int/dietphysicalactivity/childhood/ru (accessed: 03.12.2014).Vsemirnaya organizatsiya zdravookhraneniya. Global'naya strategiya po pitaniyu, fizicheskoy aktivnosti i zdorov'yu. Izbytochnyy ves i ozhirenie sredi detey [World Health Organization. Global Strategy on Diet, Physical Activity and Health. Overweight and Obese Children]. Available at: www.who.int/dietphysicalactivity/childhood/ru (accessed: 03.12.2014).Rekomendatsii VNOK. Urovni SAD i DAD u mal'chikov i devochek v vozraste ot 1 do 17 let v zavisimosti ot protsentil'nogo raspredeleniya rosta [Recommendations of the Russian Society of Cardiology. SBP and DBP Levels in Boys and Girls aged 1 to 17 Depending on the Percentile Growth Distribution]. Available at: http://www.cardiosite.ru/recommendations/article.asp?id=6041 (accessed: 03.12.2014).Rekomendatsii VNOK. Urovni SAD i DAD u mal'chikov i devochek v vozraste ot 1 do 17 let v zavisimosti ot protsentil'nogo raspredeleniya rosta [Recommendations of the Russian Society of Cardiology. SBP and DBP Levels in Boys and Girls aged 1 to 17 Depending on the Percentile Growth Distribution]. Available at: http://www.cardiosite.ru/recommendations/article.asp?id=6041 (accessed: 03.12.2014).Horvath I. G., Nemeth A., Lenkey Z., Alessandri N., Tufano F., Kis P. et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J. Hypertens. 2010; 28: 2068–2075.Horvath I.G., Nemeth A., Lenkey Z., Alessandri N., Tufano F., Kis P. et al. Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. J. Hypertens. 2010; 28: 2068–2075.Weber T., Eber B, Zweiker R. et al. Pulswellengeschwindigkeit, zentraler Blutdruck und Augmentationsindex — «neue» Parameter zur Beschreibung eines Endorganschadens der arteriellen Strombahn bei Hypertonie. J. Hyperton. 2008; 12 (1): 7–13.Weber T, Eber B, Zweiker R. et al. Pulswellengeschwindigkeit, zentraler Blutdruck und Augmentationsindex — «neue» Parameter zur Beschreibung eines Endorganschadens der arteriellen Strombahn bei Hypertonie. J. Hyperton. 2008; 12 (1): 7–13.Wilkinson I. B., McEniery C. M. Arterial stiffness, endothelial function and novel pharmacological approaches. Clin. & Exp. Pharmacol. Physiol. 2004; 31 (11): 795–799.Wilkinson I.B., McEniery C.M. Arterial stiffness, endothelial function and novel pharmacological approaches. Clinical and experimental pharmacology and physiology. 2004; 31 (11): 795–799.Laurent S., Cockcroft J., Van Bortel L., Boutouyrie P., Giannattasio C., Hayoz D., Pannier B., Vlachopoulos C., Wilkinson I., Struijker-Boudier H. European Network for Non-invasive Investigation of Large Arteries Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur. Heart J. 2006; 27 (21): 2588–2605.Laurent S., Cockcroft J., Van Bortel L., Boutouyrie P., Giannattasio C., Hayoz D., Pannier B., Vlachopoulos C., Wilkinson I., Struijker-Boudier H.; European Network for Non-invasive Investigation of Large Arteries Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur. Heart J. 2006; 27 (21): 2588–2605.Hlaing W. M., Prineas R. J., Robert R. Prevalence of increased arterial pulse pressure among children and adolescents. Ann. Epidemiol. 2004; 14 (8): 602–603.Hlaing W.M., Prineas R.J., Robert R. Prevalence of increased arterial pulse pressure among children and adolescents. Ann. Epidemiol. 2004; 14 (8): 602–603.Li S., Chen W., Srinivasan S. R., Berenson G. S. Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart 26. Study. Hypertension. 2004; 43: 541–546.Li S., Chen W., Srinivasan S.R., Berenson G.S. Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart 26. Study. Hypertension. 2004; 43: 541–546.Sesso H. D., Rosner M. J., Hennekens C. H., Gaziano J. M., Manson J. E., Glynn, R. J. Systolic and diastolic blood pressure, pulse pressure and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension. 2000; 36: 801–817.Sesso H.D., Rosner M.J., Hennekens C.H., Gaziano J.M., Manson J.E., Glynn, R.J. Systolic and diastolic blood pressure, pulse pressure and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension. 2000; 36: 801–817.

The authors declare that there are no conflicts of interest present.