Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study
Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study
复制标题
DOI：
10.1016/j.jpeds.2006.08.017
复制
发表时间：
2006-11-01
影响因子：
5.1
通讯作者：
Daniels, Stephen R.
中科院分区：
文献类型：
--
作者：
Mitsnefes, Mark M.;Kimball, Thomas R.;Daniels, Stephen R.
Objective.确定慢性肾脏病（CKD）儿童和青少年左心室肥大（LVH）和左心室几何结构的患病率和发生率，并确定与左心室质量（LVM）生长和LVH发展相关的变量。CKD儿童（肾小球滤过率[GFR] 15-89 mL/min/1.73 m（2））的2年纵向研究。31名受试者进行了基线和重复超声心动图检查。31名儿童中有6名（19%）在基线时患有LVH; LVH的死亡率在2年随访时增加到39%。在整个研究中，偏心LVH是最常见的几何模式。在25名最初左心室质量指数正常的儿童中，8名（32%）发展为新的左心室肥厚。与左心室质量指数正常的儿童相比，发生左心室肥厚的儿童在基线时平均甲状旁腺激素（iPTH）显著较高，血红蛋白和钙水平较低，随访期间iPTH的增幅显著较大。逐步回归分析显示，较低的初始LVM指数和血红蛋白水平以及随访期间iPTH和夜间收缩压（SBP）负荷的间隔增加独立预测了LVM指数的间隔增加。结论。在CKD的早期阶段，LVH在儿童中进展。更积极地控制贫血、血压和甲状旁腺功能亢进可能对预防这些患者发生LVH很重要。
Objective. To determine the prevalence and incidence of left ventricular hypertrophy (LVH) and LV geometry and identify variables associated with LV mass (LVM) growth and development of LVH in children and adolescents with chronic kidney disease (CKD).Study design. A 2-year longitudinal study of children with CKD (glomerular filtration rate [GFR] 15-89 mL/minute/1.73m(2)). Thirty-one subjects had baseline and repeated echocardiography.Results. Six (19%) of 31 children had LVH at baseline; die prevalence of LVH increased to 39% at 2-year follow-up. Eccentric LVH was the most common geometric pattern throughout the study. Among 25 children with initially normal LVM index, 8 (32%) developed new LVH. Children with incident LVH had significantly higher mean parathyroid hormone (iPTH), lower hemoglobin and calcium levels at baseline, and significantly larger increase in iPTH during a follow-up than children with normal LVM index. Stepwise regression analysis showed that lower initial LVM index and hemoglobin level and interval increase in iPTH and nighttime systolic blood pressure (SBP) load during a follow-up independently predicted interval increase in LVM index.Conclusions. LVH progresses in children during early stages of CKD. More aggressive control of anemia, BP, and hyperparathyroidism might be important in preventing the development of LVH in these patients.