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临近置换治疗的儿童心血管风险概况的变化
Priyanka Khandelwal1, Jonas Hofstetter2, Karolis Azukaitis3
1Division of Pediatric Nephrology, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK.
EClinicalMedicine
|July 25, 2024
概括
患有慢性病 (CKD),即将接受置换疗法 (KRT) 的儿童心血管损伤显著增加. 针对血压和BMI等可修改的风险因素的早期干预可以防止这种渐进的损伤.
科学领域:
- 儿科脏病学 儿科脏病学
- 在CKD中心血管健康
- 慢性病进展 慢性病进展
背景情况:
- 在接受透析和移植的儿童中观察到显著的心血管 (CV) 发病率.
- 然而,在开始替代疗法 (KRT) 之前,患有慢性病 (CKD) 的儿童的心血管损伤的演变在很大程度上是未知的.
研究的目的:
- 探索在KRT启动之前的时期,对患有CKD的儿童进行心血管损伤的负担,进展和预测因素.
- 评估可修改的心血管风险因素对心血管损伤进展的影响.
主要方法:
- 两个多中心队列 (4C和3H研究) 的前性评估,包括在KRT开始时248名儿童和在KRT开始前两年间纵向157名儿童.
- 评估心血管损伤使用动脉内膜介质厚度 (cIMT) 标准偏差得分 (SDS),脉冲波速率 (PWV-SDS),左心室 (LV) 质量和缩功能障碍.
- 纵向分析采用混合效应模型,将可修改的心血管风险因素与心血管测量的变化联系起来.
主要成果:
- 在KRT开始时观察到心血管损伤的高患病率,包括升高的cIMT-SDS (43%),PWV-SDS (25%),LV缩 (49%) 和心功能障碍 (33%).
- 在KRT之前的一年里,大动脉硬和LV增大显著增加.
- 腹筋血压升高和BMI与心血管损伤增加密切相关. 79%的儿童在KRT开始时有超过三个可修改的CV风险因素.
结论:
- 患有CKD的儿童在KRT之前的几年中经历了心血管风险因素的逐渐累积和实质性心血管损伤.
- 这种心血管损伤在很大程度上可以通过早期和有效地管理可修改的风险因素来预防.
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