Objective: To examine the plasma fibroblast growth factor-23 (FGF-23) concentration in children with primary hypertension and to investigate the association between plasma FGF-23 and subclinical cardiovascular damages,and to identify its predictive value for diagnosis. Methods: With prospective study,77 patients (61 males and 16 females) who were diagnosed as primary hypertension with the average age of (11.8±2.2) years were enrolled with informed consent in Children's Hospital,Capital Institute of Pediatrics from October 2016 to December 2017. Carotid wall intima-media thickness (cIMT) measured by Doppler ultrasound and left ventricular hypertrophy (LVH) identified by echocardiography were assessed as parameters of subclinical cardiovascular damages. Patients were divided into increased cIMT group (n=18) and normal cIMT group (n=46) (64 patients with complete data of cIMT). According to left ventricular geometry,patients were divided into LVH group (n=27) and normal geometry group (n=50). Concentration of plasma FGF-23 was detected in all children by enzyme linked immunosorbent assay test. Mann-Whitney U test was used to compare plasma levels of FGF-23 between groups. Kendall's tau-b correlation coefficient was used to analyze the correlation between plasma FGF-23 and cIMT/LVH. Receiver operating characteristic (ROC) curve was used to analyze the value of plasma FGF-23 in the prediction of subclinical cardiovascular damage. Results: The concentration of plasma FGF-23 in the increased cIMT group was higher than that in the normal cIMT group (55.6 (46.2,63.5) vs. 48.6 (39.4, 57.3) ×10(3) RU/L, Z=-2.143, P=0.032) . Also, plasma FGF-23 showed positive correlation with cIMT(r=0.222, P=0.032). According to ROC curve analysis,the cutoff value of plasma FGF-23 for prediction of increased cIMT was 53.9×10(3) RU/L (55.6% sensitivity and 71.7% specificity). The concentration of plasma FGF-23 in the LVH group was significantly higher than that in normal geometry group (55.0 (46.8, 65.7) vs. 48.2 (39.5, 56.0)×10(3) RU/L, Z=-2.375, P=0.018). And,plasma FGF-23 was correlated positively with LVH (r=0.224, P=0.018). The concentration of plasma FGF-23 in patients with concentric remodeling (n=10) was significantly higher than that of the normal geometry group (56.9 (49.6, 66.3) vs. 48.2 (39.5,56.0) ×10(3) RU/L, Z=-2.093, P=0.036). According to ROC curve analysis,the cutoff value of plasma FGF-23 for prediction of LVH was 49.1×10(3) RU/L (70.4% sensitivity and 60.0% specificity). Conclusion: The concentration of plasma FGF-23 in children with primary hypertension was correlated positively with LVH and cIMT and had certain predictive value of diagnosis for subclinical cardiovascular damages.
目的： 探讨原发性高血压儿童血浆成纤维细胞生长因子23（FGF-23）水平与亚临床心血管损伤的关系及其诊断预测价值。 方法： 前瞻性研究。以2016年10月至2017年12月在首都儿科研究所附属儿童医院被诊断为原发性高血压且未经治疗的77例患儿为研究对象，男61例、女16例，年龄（11.8±2.2）岁，应用彩色多普勒超声及超声心动图检测，以颈动脉内膜-中层厚度（cIMT）和左心室肥厚（LVH）作为亚临床心血管损伤的评估指标，将研究对象分为cIMT增厚组（18例）和cIMT正常组（46例）(64例患儿cIMT资料完整)；LVH组（27例）和正常构型组（50例）。应用酶联免疫吸附测定（ELISA）检测血浆FGF-23水平。采用Mann-WhitneyU检验比较各组血浆FGF-23水平；采用Kendall′s tau-b相关系数分析血浆FGF-23与cIMT及LVH的相关性；采用受试者工作特征(ROC)曲线分析血浆FGF-23对亚临床心血管损伤的诊断预测价值。 结果： 18例cIMT增厚组患儿血浆FGF-23水平较46例cIMT正常组高[55.6（46.2，63.5）比48.6（39.4，57.3）×10(3) RU/L，Z=-2.143，P=0.032]，FGF-23与cIMT正相关（r=0.222，P=0.032）；ROC曲线显示血浆FGF-23为53.9×10(3) RU/L时，诊断cIMT的灵敏度和特异度分别为55.6%和71.7%。27例LVH组患儿血浆FGF-23水平高于50例正常构型组[55.0（46.8，65.7）比48.2（39.5，56.0）×10(3) RU/L，Z=-2.375，P=0.018]，FGF-23与LVH正相关（r=0.224，P=0.018）。向心性重塑者（10例）血浆FGF-23水平显著高于正常构型者[56.9（49.6，66.3）比48.2（39.5，56.0）×10(3) RU/L,Z=-2.093，P=0.036]。ROC曲线显示血浆FGF-23为49.1×10(3) RU/L时，诊断LVH的灵敏度和特异度分别为70.4%和60.0%。 结论： 血浆FGF-23水平与LVH及cIMT增厚正相关，并对其具有一定的诊断预测价值。.
Keywords: Child; Fibroblast growth factors; Hypertension; Hypertrophy, left ventricular.