[Construction of a risk prediction model for vascular function damage in children with primary hypertension].

摘要

Objective: To investigate the risk factors of vascular function damage in children with primary hypertension and establish a risk prediction model. Methods: In this retrospective case-control study, a total of 117 children aged 6-17 years with primary hypertension, hospitalized at Capital Center for Children's Health, Capital Medical University, between February 2024 and October 2025 were included. Flow mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) were used as indicators of vascular function impairment. The children were divided into a vascular function damage group and a normal vascular function group according to the presence or absence of vascular function damage. Independent samples t-test or Mann-Whitney U test was used for intergroup comparison of measurement data, χ2 test or Fisher's exact test was used for enumeration data. Differences in clinical, laboratory and vascular function-related indicators were compared between the two groups. Multivariate Logistic regression was employed to identify independent risk factors, based on which a nomogram was constructed. The predictive performance was verified by the receiver operating characteristic (ROC) curve. Results: Among 117 hypertensive children, there were 92 (78.6%) males and 25 (21.4%) females, with the age of (13.0±2.1) years at admission. There was 58 (49.6%) with vascular function damage. The body fat percentage, 24 h mean systolic blood pressure, daytime systolic blood pressure, nocturnal systolic blood pressure, low-density lipoprotein, total cholesterol, triglycerides, homocysteine, folic acid, fasting insulin, uric acid and cfPWV levels in the vascular function damage group (58 cases) were significantly higher than those in the normal group (59 cases), while the FMD level in the vascular function damage group was significantly lower than that in the normal group (all P<0.05). Multivariate Logistic regression identified that: nocturnal systolic blood pressure (SBP) (OR=1.06, 95%CI 1.01-1.10, P=0.019), serum low-density lipoprotein (LDL) (OR=5.51,95%CI 2.41-12.58,P<0.001), and homocysteine (OR=1.11,95%CI 1.03-1.19,P=0.005) were independent risk factors for vascular function damage. A nomogram prediction model was constructed accordingly, and the Logistic regression equation was: Logit(P)=-10.73+0.05×nocturnal systolic blood pressure+1.71×low-density lipoprotein+0.10×homocysteine. The ROC curve for the nomogram showed an area under curve of 0.82 (95%CI 0.74-0.89, P<0.001), with a sensitivity of 0.76 and a specificity of 0.71. Conclusion: Nocturnal systolic blood pressure, low-density lipoprotein and homocysteine are independent risk factors for vascular function damage in children with primary hypertension. 目的： 探讨原发性高血压患儿血管功能损伤的影响因素，构建风险预测模型。 方法： 病例对照研究。选取2024年2月至2025年10月在首都医科大学附属首都儿童医学中心住院的6~17岁原发性高血压患儿117例为研究对象，以血流介导的血管舒张功能（FMD）和颈-股动脉脉搏波传导速度（cfPWV）作为血管功能损伤的评估指标，根据患儿是否存在血管功能损伤分为血管功能损伤组与血管功能正常组，组间比较采用独立样本t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法，比较两组临床、实验室及血管功能相关指标的差异。采用多因素Logistic回归筛选独立危险因素并构建列线图模型，通过受试者工作特征（ROC）曲线评价预测效能。 结果： 117例患儿中男92例（78.6%），女25例（21.4%），就诊时年龄（13.0±2.1）岁。58例（49.6%）患儿存在血管功能损伤。血管功能损伤组（58例）患儿体脂率、24 h平均收缩压、日间收缩压、夜间收缩压、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、同型半胱氨酸、叶酸、空腹胰岛素、尿酸以及cfPWV水平均高于血管功能正常组（59例），FMD水平低于血管功能正常组（均P<0.05）。多因素Logistic分析显示，夜间收缩压（OR=1.06，95%CI 1.01~1.10，P=0.019）、血清低密度脂蛋白胆固醇（OR=5.51，95%CI 2.41~12.58，P<0.001）和同型半胱氨酸（OR=1.11，95%CI 1.03~1.19，P=0.005）均为血管功能损伤独立危险因素。依此构建列线图预测模型，Logistic回归方程为：Logit（P）=-10.73+0.05×夜间收缩压+1.71×低密度脂蛋白胆固醇+0.10×同型半胱氨酸，ROC曲线显示曲线下面积0.82（95%CI 0.74~0.89，P<0.001），灵敏度和特异度分别为0.76和0.71。 结论： 夜间收缩压、低密度脂蛋白胆固醇、同型半胱氨酸是原发性高血压患儿血管功能损伤的独立危险因素。.