El-Gamasy Mohamed Abdelaziz, El-Shehaby Walid Ahmed, Mabrouk Maaly M
Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Clinical Pathology, Tanta Faculty of Medicine, Tanta, Egypt.
Ann Pediatr Cardiol. 2019 Jan-Apr;12(1):10-17. doi: 10.4103/apc.APC_12_18.
Cardiovascular morbidity (CVM) is the main etiology of mortality in children and adolescents with chronic kidney disease (CKD). CKD associated cardiovascular mortality is more common in children with diastolic cardiac dysfunction which was considered as an early indicator for death, while increased left ventricular mass (LVM) is a strong independent risk factor for these patients. Vitamin D deficiency was previously studied as one of the risk factors for CVM.
The aim of the work was to investigate the relationship between biomarkers of mineral bone disorder including serum 25(OH) Vitamin D3 (25-OH D3), phosphorus and calcium × phosphorus (Ca×Po4) product with diastolic cardiac function and LVM in children and adolescents with CKD.
This was a cross-sectional observational study. Participants were classified into two groups: Group I including 86 pediatric patients with CKD (stages 4 or 5) and Group II including 40 healthy controls. Group I was subdivided into IA included children with diastolic dysfunction and IB included cases without diastolic dysfunction. 25-OH D3 level was measured by enhanced chemiluminescence method and intact parathyroid hormone (iPTH) by electrochemiluminescence method. Parameters for diastolic function and LVM were assessed by Doppler echocardiography, tissue Doppler imaging, and M-mode echocardiography.
25-OH D3 level was significantly lower in Group I when compared to Group II. Diastolic dysfunction was present in 48.8% of the studied patients and was significantly associated with increased serum phosphorus and calcium-phosphorus product but not with decreased level of 25-OH D3. There was a significant positive correlation between LVM and iPTH.
Hyperphosphatemia and high Ca×Po4 product were considered of prognostic value as they predict early diastolic dysfunction and increased LVM in children with CKD.
心血管疾病（CVM）是慢性肾脏病（CKD）儿童和青少年死亡的主要原因。CKD相关的心血管死亡在舒张性心功能不全的儿童中更为常见，舒张性心功能不全被认为是死亡的早期指标，而左心室质量（LVM）增加是这些患者的一个强大独立危险因素。维生素D缺乏以前被研究为CVM的危险因素之一。
本研究旨在探讨矿物质骨代谢紊乱生物标志物，包括血清25(OH)维生素D3（25-OH D3）、磷和钙磷（Ca×Po4）乘积与CKD儿童和青少年舒张性心功能及LVM之间的关系。
这是一项横断面观察性研究。参与者分为两组：第一组包括86例CKD（4或5期）儿科患者，第二组包括40例健康对照。第一组又细分为IA组，包括舒张功能不全的儿童，IB组包括无舒张功能不全的病例。采用增强化学发光法测定25-OH D3水平，采用电化学发光法测定完整甲状旁腺激素（iPTH）。通过多普勒超声心动图、组织多普勒成像和M型超声心动图评估舒张功能和LVM参数。
与第二组相比，第一组的25-OH D3水平显著降低。48.8%的研究患者存在舒张功能不全，且与血清磷升高和钙磷乘积显著相关，但与25-OH D3水平降低无关。LVM与iPTH之间存在显著正相关。
高磷血症和高Ca×Po4乘积被认为具有预后价值，因为它们可预测CKD儿童的早期舒张功能不全和LVM增加。
