慢性肾脏病儿童合并左心室肥厚的危险因素分析

Risk factors of left ventricular hypertrophy in children with chronic kidney diseases

目的探讨慢性肾脏病(CKD)患儿临床特征及合并左心室肥厚(LVH)的危险因素。方法纳入符合CKD诊断标准的患儿549例,收集所有患儿的临床资料,分析其病因构成、起病症状、并发症及治疗方式;根据是否合并LVH对患儿进行分组,比较两组患儿年龄、性别、病程、体质量指数(BMI)、血红蛋白(Hb)、血磷、血钙、血碳酸氢根(HCO-3)水平及CKD分期;将差异有统计学意义的因素纳入单因素及多因素logistic回归模型;筛选出CKD患儿合并LVH的危险因素。结果各年龄段CKD患儿比较,>6~≤12岁年龄段发病率最高,其次是<3岁年龄段幼儿,而<3岁CKD患儿的发病原因以先天性肾脏和尿路畸形(CAKUT)占比最高(P<0.01);与CKD 1期患儿相比,CKD 2—5期患儿中CAKUT在病因中所占比例较高(P<0.01),在无症状起病中比例最高(95.19%);CKD 5期患儿中低体质量、高血压、贫血、高磷血症的发生率高于CKD 2—4期患儿(P<0.05);LVH和非LVH的CKD患儿在Hb、血磷、血HCO-3水平以及CKD分期比较,差异具有统计学意义(P<0.05);多因素logistic回归分析表明,Hb≤90 g/L、CKD 2—5期、高血压是CKD患儿发生LVH的危险因素(OR=9.081、19.116、31.041,P<0.05)。结论<3岁CKD患儿的发病原因以CAKUT为主,Hb≤90 g/L、CKD分期、高血压是CKD患儿发生LVH的危险因素。

Objective To investigate the clinical features and risk factors for combined left ventricular hypertrophy(LVH)in children with chronic kidney disease(CKD).Methods The clinical data such as age,gender,etiology,onset of symptoms,laboratory indices,auxiliary examination,and treatment of 549 children with CKD,and their general conditions,etiological composition,complications,and treatment were collected and analyzed.The children were grouped according to whether they had combined LVH or not,and the age,sex,disease duration,body mass index(BMI),hemoglobin,blood phosphorus,blood calcium,bicarbonate(HCO-3)level,and CKD stage were compared between the two groups,and the factors with statistically significant differences were included in the single-factor and multi-factor logistic regression models to screen out the risk factors for combined LVH in children with CKD.Results Among the children with CKD of all ages,the incidence rate was the highest in the age group of 6-≤12 years old,followed by children in the age group of<3 years old,and congenital kidney and urinary tract malformations(CAKUT)accounted for the highest proportion of the causes of CKD in children aged<3 years(P<0.01).Compared with children with CKD stage 1,CKD stages 2-5 had a higher proportion of CAKUT in the etiology(P<0.01)and the highest proportion in asymptomatic onset(95.19%).The incidences of low body weight,hypertension,anemia and hyperphosphatemia in CKD stage 5 were higher than those in CKD stages 2-4(P<0.05).There were statistically significant differences in Hb,serum phosphorus,serum HCO-3 levels and CKD stage among LVH and non-LVH CKD patients(P<0.05).Multivariate logistic regression analysis showed that Hb≤90 g/L,CKD stages 2-5,and hypertension were risk factors for LVH in children with CKD(OR=2.564,19.116,31.041;P<0.05).Conclusion The primary cause of CKD in children under 3 years old is mainly CAKUT.Factors such as Hb≤90 g/L,stage of CKD,and hypertension are risk factors for LVH in children with CKD.