目的：

探索无创中心动脉压对儿童原发性高血压左心室肥厚风险的诊断预测价值。

方法：

本研究采用病例对照研究，根据纳入及排除标准，回顾性收集179例2021年4月至2022年8月在首都儿科研究所附属儿童医院心血管内科住院的原发性高血压患儿的临床资料，包含一般临床资料、实验室资料、超声心动图资料，测量无创中心动脉压指标。依据超声心动图测量参数判定左心室肥厚（left ventricular hypertrophy，LVH），根据有无LVH，分为左心室肥厚组（LVH组，N=51例）和非左心室肥厚组（NLVH组，N=128例），LVH组根据几何构型分为向心性重塑组、离心性重塑组、向心性肥厚组。比较LVH组与NLVH组、不同LVH几何构型组研究对象的一般情况、无创中心动脉压（central aortic pressure，CAP）、外周动脉压差异。分析无创CAP与外周动脉压的相关性及差异性。采用相关性分析研究LVH的影响因素。采用logistic回归分析探索儿童原发性高血压LVH的危险因素，构建儿童原发性高血压LVH风险的列线图预测模型，采用校准曲线、C-index评估列线图模型的预测效能，然后绘制DCA曲线，验证该模型的临床适用度。

结果：

（1）本研究共纳入179例原发性高血压患儿，男146例（81.6%），肥胖者130例（72.6%），高血压2级127例（71.0%）。LVH组体重指数（body mass index，BMI）、肥胖占比、高血压2级占比高于NLVH组（P＜0.05），年龄、性别无统计学差异。

（2）无创中心收缩压与外周收缩压、中心舒张压与外周舒张压、中心脉压（central pulse pressure，CPP）与外周脉压呈显著正相关性（P均＜0.001）。从中心主动脉到外周动脉，收缩压、脉压升高显著，舒张压变化不大，差异有统计学意义（P＜0.05）。

（3）LVH组外周收缩压、外周脉压、中心收缩压、CPP均显著高于NLVH组（P＜0.05），两组外周舒张压、中心脉压无统计学差异。不同LVH几何构型组间无创中心动脉压及外周动脉压无统计学差异。

（4）左室质量指数（left ventricular mass index，LVMI）与BMI、外周收缩压、外周脉压、中心收缩压、CPP呈正相关性（P＜0.05），高密度脂蛋白与LVMI呈负相关性（P＜0.05）。相对室壁厚度（relative wall thickness，RWT）与BMI、外周收缩压、中心收缩压、空腹胰岛素、胰岛素抵抗呈正相关性（P＜0.05）。

（5）logistic回归分析结果显示BMI、CPP、中心收缩压、空腹胰岛素、脂肪肝是儿童原发性高血压LVH的危险因素（P＜0.05），CPP是LVH的独立危险因素（OR=1.07，95%CI=1.01~1.14，P＜0.05）。

（6）构建列线图预测模型评估危险因素联合一般临床资料（年龄、性别）对儿童高血压LVH风险的预测价值，列线图中风险分数越高，预测发生LVH的概率越大。

结论：

儿童高血压人群中，中心动脉压更能反映左心室后负荷血压变化。无创中心脉压、中心收缩压、体重指数、脂肪肝、空腹胰岛素是儿童原发性高血压发生左心室肥厚的危险因素，而无创中心脉压是独立危险因素。

Objective:

To explore the diagnostic and predictive value of noninvasive central aortic pressure in the risk of left ventricular hypertrophy in children with primary hypertension.

Method:

In this study, we conducted a case-control study to retrospectively collect the clinical data of 179 children with primary hypertension who were hospitalized in the Department of Cardiovascular Medicine of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from April 2021 to August 2022 according to the inclusion and exclusion criteria, including general clinical data, laboratory data, echocardiographic data,and measurement of noninvasive central aortic pressure index. Left ventricular hypertrophy (LVH) was determined on the basis of echocardiographic measurement parameters, and according to the presence or absence of LVH, the group was divided into the left ventricular hypertrophy group (LVH group, N=51 cases) and the non-left ventricular hypertrophy group (NLVH group, N=128 cases), and LVH group were divided into three different group including centripetal remodeling group, centrifugal remodeling group and centripetal hypertrophy group.

Compare the difference of general condition, noninvasive central aortic pressure (CAP) and peripheral arterial pressure between the LVH group and the NLVH group, and the LVH geometric configuration groups. Analyze the correlation and difference between noninvasive CAP and peripheral arterial pressure. Correlation analysis was used to study the influencing factors of LVH. Logistic regression analysis was used to explore the risk factors of LVH in children with primary hypertension, and a nomogram model was constructed to predict the risk of LVH in children with primary hypertension. The predictive efficacy of the nomogram model was evaluated by using calibration curves, C-index, and then DCA curves were drawed to validate the clinical applicability of the model.

Result:

(1)A total of 179 children with primary hypertension were included in this study, including 146 males (81.6%),130 obese children (72.6%),and 127 hypertension stage 2 (71.0%). Body mass index (BMI), the proportion of obesity and the proportion of hypertension stage 2 in LVH group were higher than those in NLVH group (P＜0.05), and there was no statistical difference in age and gender.

(2)There were significant positive correlations between noninvasive central systolic pressure and peripheral systolic blood pressure, central diastolic pressure and peripheral diastolic blood pressure, central pulse pressure (CPP) and peripheral pulse pressure (P < 0.001). From central aorta to peripheral artery, systolic blood pressure and pulse pressure increased significantly, while diastolic blood pressure did not change significantly (P < 0.05).

(3)Peripheral systolic blood pressure, peripheral pulse pressure, central systolic pressure and CPP in LVH group were significantly higher than those in NLVH group (P＜0.05), but peripheral diastolic blood pressure and central diastolic pressure were not significantly different between the two groups. There were no significant differences in noninvasive CAP and peripheral systolic blood pressure between different LVH geometry groups.

(4)Left ventricular mass index (LVMI) was positively correlated with BMI, peripheral systolic blood pressure, peripheral pulse pressure, central systolic pressure and CPP (P＜0.05), while high density lipoprotein was negatively correlated with LVMI (P＜0.05). Relative wall thickness (RWT) was positively correlated with BMI, peripheral systolic blood pressure, central systolic pressure, insulin and Insulin resistance (P＜0.05).

(5)Logistic regression analysis showed that BMI, CPP, central systolic pressure, insulin and fatty liver were risk factors for LVH in children with primary hypertension (P＜0.05), and CPP was an independent risk factor for LVH (OR=1.07, 95%CI=1.01~1.14). P＜0.05).

(6)Nomogram model was constructed to evaluate the predictive value of risk factors combined with general clinical data (age and sex) for LVH risk in children with hypertension. Patients with higher risk score in the nomogram model had higher probability of LVH.

Conclusion:

Central aortic pressure can reflect the changes of left ventricular afterload blood pressure. Noninvasive central pulse pressure, central systolic pressure, bosy mass index, fatty liver and insulin were risk factors for left ventricular hypertrophy in children with primary hypertension, while noninvasive central pulse pressure was an independent risk factor.