代谢综合征是慢性肾脏病儿童左心室肥厚的危险因素。
Metabolic syndrome as risk factor for left ventricular hypertrophy in children with chronic kidney disease.
机构信息
Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
Department of Pediatric Cardiology, Jagiellonian University Medical College, Kraków, Poland.
出版信息
Front Endocrinol (Lausanne). 2023 May 31;14:1215527. doi: 10.3389/fendo.2023.1215527. eCollection 2023.
BACKGROUND
The metabolic syndrome (MS), a cluster of clinical and biochemical abnormalities including insulin resistance, dyslipidemia and hypertension, is often diagnosed in chronic kidney disease (CKD) children. Left ventricular hypertrophy (LVH) is a major target organ damage in hypertension and an important cardiovascular risk factor in CKD patients. We aimed to identify the most significant risk factors of LVH in children with CKD.
METHODS
Children with CKD stage 1-5 were enrolled in the study. MS was diagnosed according to De Ferranti (DF) as ≥3 from 5 criteria. Ambulatory blood pressure measurements (ABPM) and echocardiographic evaluation were performed. LVH was defined as ≥95th percentile of LV mass index related to height and age. Clinical and laboratory parameters included: serum albumin, Ca, HCT, cystatin C, creatinine, estimated glomerular filtration rate (eGFR) based on Schwartz formula, triglycerides, high-density lipoprotein (HDL), proteinuria, BMI standard deviation score (SDS), height SDS, waist circumference, ABPM data.
RESULTS
71 children (28 girls/43 boys) with median age 14.05 (25%-75%:10.03-16.30) years and median eGFR 66.75 (32.76-92.32) ml/min/1.73m2 were evaluated. CKD stage 5 was diagnosed in 11 pts (15.5%). MS (DF) was diagnosed in 20 pts (28.2%). Glucose ≥ 110 mg/dL was present in 3 pts (4.2%); waist circumference ≥75th pc in 16 pts (22.5%); triglycerides ≥ 100 mg/dL in 35 pts (49.3%); HDL < 50mg/dL in 31 pts (43.7%) and BP ≥ 90th pc in 29 pts (40.8%), respectively. LVH was detected in 21 (29.6%) children. In univariate regression the strongest risk factor for LVH was CKD stage 5 (OR 4.9, p=0.0019) and low height SDS (OR 0.43,p=0.0009). In stepwise multiple logistic regression analysis (logit model) of the most important risk factors for LVH in CKD children, only three were statistically significant predictors: 1)MS diagnosis based on DF criteria (OR=24.11; 95%CI 1.1-528.7; p=0.043; Chi2 = 8.38,p=0.0038); 2), high mean arterial pressure (MAP SDS) in ABPM (OR=2.812; 95%CI 1.057-7.48; p=0.038;Chi2 = 5.91, p=0.015) and 3) low height SDS (OR=0.078; 95%CI 0.013-0.486;p=0.006; Chi2 = 25.01, p<0.001).
CONCLUSIONS
In children with chronic kidney disease LVH is associated with the cluster of multiple factors, among them the components of MS, hypertension, stage 5 CKD and growth deficit were the most significant.
背景
代谢综合征（MS）是一种包括胰岛素抵抗、血脂异常和高血压在内的临床和生化异常的综合征，在慢性肾脏病（CKD）儿童中经常被诊断。左心室肥厚（LVH）是高血压的主要靶器官损伤，也是 CKD 患者重要的心血管危险因素。我们旨在确定 CKD 儿童中 LVH 的最重要危险因素。
方法
纳入 CKD 1-5 期的患儿。根据 De Ferranti（DF）标准，≥3 项 5 项标准即可诊断为 MS。进行动态血压监测（ABPM）和超声心动图评估。LVH 定义为与身高和年龄相关的左心室质量指数≥第 95 百分位数。临床和实验室参数包括：血清白蛋白、Ca、HCT、胱抑素 C、肌酐、基于 Schwartz 公式的估计肾小球滤过率（eGFR）、甘油三酯、高密度脂蛋白（HDL）、蛋白尿、BMI 标准差评分（SDS）、身高 SDS、腰围、ABPM 数据。
结果
共评估了 71 名中位数年龄为 14.05 岁（25%-75%：10.03-16.30 岁）和中位数 eGFR 为 66.75ml/min/1.73m2（32.76-92.32ml/min/1.73m2）的患儿。11 名患儿（15.5%）诊断为 CKD 5 期。20 名患儿（28.2%）诊断为 MS（DF）。3 名患儿（4.2%）血糖≥110mg/dL；16 名患儿（22.5%）腰围≥75 百分位数；35 名患儿（49.3%）甘油三酯≥100mg/dL；31 名患儿（43.7%）HDL<50mg/dL；29 名患儿（40.8%）BP≥90 百分位数。21 名患儿（29.6%）检测到 LVH。在单变量回归中，LVH 的最强危险因素是 CKD 5 期（OR 4.9，p=0.0019）和低身高 SDS（OR 0.43，p=0.0009）。在 CKD 儿童中 LVH 的最重要危险因素的逐步多元逻辑回归分析（logit 模型）中，只有三个是统计学上显著的预测因素：1）基于 DF 标准的 MS 诊断（OR=24.11；95%CI 1.1-528.7；p=0.043；卡方=8.38，p=0.0038）；2）ABPM 中的平均动脉压高（MAP SDS）（OR=2.812；95%CI 1.057-7.48；p=0.038；卡方=5.91，p=0.015）和 3）低身高 SDS（OR=0.078；95%CI 0.013-0.486；p=0.006；卡方=25.01，p<0.001）。
结论
在患有慢性肾脏病的儿童中，LVH 与多种因素有关，其中 MS 成分、高血压、CKD 5 期和生长缺陷是最重要的。
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