无创中心动脉压与儿童原发性高血压左心室肥厚的关系

The relationship between non-invasive central aortic pressure and left ventricular hypertrophy in children with essential hypertension

    摘要
  • 摘要:
    目的 在原发性高血压儿童中探索无创中心动脉压与左心室肥厚（LVH）的关系，评估无创中心动脉压对LVH的早期诊断价值。
    方法 回顾性收集2021年4月至2022年8月在首都医科大学附属首都儿童医学中心心血管内科住院的169例原发性高血压患儿的临床资料，采用SphygmoCor CVMS中心血压评定系统检测无创中心动脉压。依据超声心动图测量参数判定LVH。根据有无LVH，分为LVH组和非LVH组（NLVH组）。比较两组的临床资料。采用logistic回归分析探索LVH的影响因素。构建LVH风险的列线图模型，采用受试者操作特征（ROC）曲线、校准曲线评估列线图模型的诊断效能，采用决策曲线分析（DCA）验证模型的临床适用度。
    结果 共纳入169例原发性高血压患儿，其中LVH组51例，NLVH组118例。LVH组外周收缩压（129.71±10.64）比（123.59±11.17）mmHg，t=−3.31，P＜0.01、外周脉压（57.18±10.67）比（51.77±9.75）mmHg，t=−3.21，P＜0.01、中心收缩压（107.47±8.56）比（103.13±8.67）mmHg，t=−3.00，P＜0.01、中心脉压（32.90±6.75）比（29.14±5.94）mmHg，t=−3.63，P＜0.01高于NLVH组。多因素logistic回归分析结果显示，无创中心脉压升高是LVH的独立危险因素（OR＝1.12，95%CI 1.04～1.21，P＜0.05）。以年龄、性别、体重指数、高血压级别、中心收缩压、中心脉压、空腹胰岛素、脂肪肝、高尿酸血症构建列线图模型。ROC曲线显示，列线图模型的曲线下面积（AUC）为0.80（95%CI 0.72～0.87），灵敏度为73.5%，特异度为76.7%。校准曲线显示该模型具有良好的校准度，DCA曲线显示该模型具有良好的临床实用性。
    结论 无创中心脉压升高是儿童原发性高血压发生LVH的独立危险因素。无创中心脉压对儿童原发性高血压LVH具有良好的诊断价值。

     

    Abstract:
    Objective To analyse the relationship between non-invasive central aortic pressure and left ventricular hypertrophy (LVH) and to explore the predictive value of non-invasive central aortic pressure in the early diagnosis of LVH in children with essential hypertension (EH).
    Methods The clinical data of 169 children with EH who were hospitalized in the Department of Pediatric Cardiology, Capital Center for Children's Health, Capital Medical University from April 2021 to August 2022 were retrospectively collected, and the non-invasive central aortic pressure was detected by SphygmoCor CVMS central blood pressure assessment system. LVH was determined based on echocardiographic parameters. Patients were divided into LVH group and non-LVH group (NLVH group). The clinical data of the two groups were compared. Logistic regression analysis was used to explore the influence factors of LVH, and a nomogram model for predicting LVH risk was constructed. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the prediction efficiency of the nomogram model, and decision curve analysis (DCA) was conducted to verify the clinical applicability of the model.
    Results A total of 169 children with EH were included in this study, including 51 cases in LVH group and 118 cases in NLVH group. The peripheral systolic blood pressure (129.71±10.64) vs (123.59±11.17) mmHg, t=−3.31, P＜0.01, peripheral pulse pressure (57.18±10.67) vs (51.77±9.75) mmHg, t=−3.21, P＜0.01, central systolic blood pressure (107.47±8.56) vs (103.13±8.67) mmHg, t=−3.00, P＜0.01, and central pulse pressure CPP: (32.90±6.75) vs (29.14±5.94) mmHg, t=−3.63, P＜0.01 in the LVH group were significantly higher than those in the NLVH group. Multivariate logistic regression analysis showed that elevated non-invasive CPP was the independent risk factor for LVH (OR＝1.12, 95%CI 1.04–1.21, P＜0.05). The nomogram model was constructed based on age, gender, body mass index, grade of hypertension, central systolic blood pressure, CPP, fasting insulin, fatty liver disease, and hyperuricemia. ROC curve analysis showed that the area under the curve (AUC) was 0.80 (95%CI 0.72–0.87), with a sensitivity of 73.5% and a specificity of 76.7%. The calibration curve showed a good model calibration, and the DCA demonstrated a favorable clinical utility.
    Conclusion Elevated non-invasive CPP is an independent risk factor for LVH, and non-invasive CPP has a good diagnostic predictive value for LVH in children with EH.

     

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