Mitsnefes Mark M, Kimball Thomas R, Kartal Janis, Witt Sandra A, Glascock Betty J, Khoury Philip R, Daniels Stephen R
Division of Nephrology and Hypertension and the Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
J Pediatr. 2006 Nov;149(5):671-5. doi: 10.1016/j.jpeds.2006.08.017.
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).
A 2-year longitudinal study of children with CKD (glomerular filtration rate [GFR] 15-89 mL/minute/1.73 m2). Thirty-one subjects had baseline and repeated echocardiography.
Six (19%) of 31 children had LVH at baseline; the 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.
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.
确定慢性肾脏病（CKD）儿童和青少年左心室肥厚（LVH）及左心室几何形态的患病率和发病率，并识别与左心室质量（LVM）增长及LVH发生发展相关的变量。
对CKD儿童（肾小球滤过率[GFR]为15 - 89 mL/分钟/1.73 m²）进行为期2年的纵向研究。31名受试者接受了基线及重复超声心动图检查。
31名儿童中，6名（19%）在基线时存在LVH；在2年随访时，LVH患病率增至39%。在整个研究过程中，离心性LVH是最常见的几何形态。在25名初始LVM指数正常的儿童中，8名（32%）出现了新的LVH。与LVM指数正常的儿童相比，发生LVH的儿童在基线时平均甲状旁腺激素（iPTH）显著更高，血红蛋白和钙水平更低，且随访期间iPTH的升高幅度显著更大。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。
在CKD早期阶段，儿童LVH会进展。更积极地控制贫血、血压和甲状旁腺功能亢进对于预防这些患者LVH的发生可能很重要。
