Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.
目的： 分析儿童原发性高血压临床特征及左心室肥厚（LVH）的影响因素。 方法： 回顾性队列研究。分析2019年1月至2022年9月在首都儿科研究所附属儿童医院住院的诊断为原发性高血压的430例患儿的临床特征和实验室检查结果，通过超声心动图测量评估LVH，并将其分为LVH组和左心室构型正常组，采用独立样本t检验或Mann-Whitney U检验比较组间一般情况、实验室指标、动态血压参数等的差异。采用Spearman相关系数分析临床指标、血压、血糖、血脂等生化及代谢指标与LVH的相关性；采用多因素逐步Logistic回归分析LVH的独立危险因素；应用受试者工作特征（ROC）曲线分析联合指标对LVH的诊断价值。 结果： 430例原发性高血压患儿中，男342例（79.5%），女88例（20.5%），就诊时年龄（12.6±2.3）岁，123例（28.6%）存在LVH。LVH组体质指数（BMI）［（30.0±5.2）比（26.2±4.3）kg/m2］、2级高血压比例［75.6%（93/123）比59.6%（183/307）］、24 h平均收缩压（24 h SBP）［（131±10）比（128±10）mmHg，1 mmHg=0.133 kPa］、日间收缩压［（135±11）比（131±11）mmHg］、夜间收缩压［（128±11）比（123±10）mmHg］、胆固醇水平［（4.0±0.7）比（3.9±0.7）mmol/L］、尿酸水平［（447±81）比（426±91）μmol/L］、高胰岛素血症发生率［69.9%（86/123）比59.0%（181/307）］均高于正常构型组，差异均有统计学意义（均P<0.05）。LVH组患儿病程5年及以上者所占比例高于正常构型组，差异有统计学意义（χ2=8.90，P=0.031）。LVH相关性分析显示，BMI、24 h SBP、日间收缩压、夜间收缩压、甘油三酯、尿酸和血清钠浓度与LVMI均有相关性（r=0.43、0.20、0.18、0.18、0.18、0.16、0.12，均P<0.05）。BMI、高胰岛素血症、胆固醇水平与RWT均有相关性（r=0.22、0.12、0.16，均P<0.05）。多因素逐步Logistic回归分析显示BMI（OR=1.17，95%CI 1.10~1.25）和24 h SBP（OR=1.04，95%CI 1.01~1.08）均是LVH的独立危险因素（均P<0.05）。ROC曲线分析显示，联合BMI、24 h SBP诊断LVH的曲线下面积为0.72（95%CI 0.67~0.77，P<0.05），灵敏度和特异度分别为71.5%和64.8%。 结论： BMI、24 h SBP是原发性高血压患儿早期心脏损伤的独立危险因素，联合BMI、24 h SBP对原发性高血压患儿LVH具有一定的诊断价值。早期加强对以上指标的监测，警惕亚临床心脏损伤的发生。.