Background Pulmonary hypertension （PH） is a common complication of congenital heart disease （CHD）.Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of...Background Pulmonary hypertension （PH） is a common complication of congenital heart disease （CHD）.Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of novel biomarkers cannot be overlooked.The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.Methods Between September 2012 and April 2013,we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution.Standard right heart catheterizations were performed in all cases.Seventy-seven cases were associated with PH.The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode,respectively.Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase （MTHFR）,cystathionine β-synthase （CBS）,and cystathionine gamma-lyase （CSE）.Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.Results The difference in the levels of homocysteine,folic acid,vitamin B12,hydrogen sulfide,as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant （all P ＜0.05）.Homocysteine had the best sensitivity and specificity to predict PH （P ＜0.001）.Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide,and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different （all P ＜0.05）.Based on the ROC curve,homocysteine had the best sensitivity and specificity to predict obstructive PH （P=0.032）,while CSE had the most significant sensitivity and specificity to predict the dynamic PH （P=0.008）.Conclusions Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD.The underlying mechanism involved t展开更多
Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pres...Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5%in China(CN)and 4.6%in the United States(US),whereas the obesity prevalence was 7.4%and 18.6%,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95%CI=0.78–0.88;US:OR=0.72,95%CI=0.64–0.81);ISH(CN:OR=0.87,95%CI=0.80–0.94;US:OR=0.71,95%CI=0.62–0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN w展开更多
Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hy...Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.展开更多
文摘Background Pulmonary hypertension （PH） is a common complication of congenital heart disease （CHD）.Although risk stratification is vital for prognosis and therapeutic guidance,the need for understanding the role of novel biomarkers cannot be overlooked.The aim of the present study was to investigate the changes of homocysteine and hydrogen sulfide levels and find potential biomarkers for early detection and treatment.Methods Between September 2012 and April 2013,we prospectively collected data on 158 pediatric patients with left to right shunt CHD at our institution.Standard right heart catheterizations were performed in all cases.Seventy-seven cases were associated with PH.The levels of homocysteine and hydrogen sulfide were detected with fluorescence polarization immunoassay and a sensitive silver-sulphur electrode,respectively.Enzyme-linked immunosorbent assay was used to determine the expression of methylenetetrahydrofolate reductase （MTHFR）,cystathionine β-synthase （CBS）,and cystathionine gamma-lyase （CSE）.Radioimmunoassays were used to obtain folic acid and vitamin B12 levels.Results The difference in the levels of homocysteine,folic acid,vitamin B12,hydrogen sulfide,as well as the MTHFR and CSE expression between patients with PH and without PH were statistically significant （all P ＜0.05）.Homocysteine had the best sensitivity and specificity to predict PH （P ＜0.001）.Subgroup analysis showed that the levels of homocysteine and hydrogen sulfide,and the expression of CSE and MTHFR between patients with dynamic and obstructive PH were significantly different （all P ＜0.05）.Based on the ROC curve,homocysteine had the best sensitivity and specificity to predict obstructive PH （P=0.032）,while CSE had the most significant sensitivity and specificity to predict the dynamic PH （P=0.008）.Conclusions Increased levels of homocysteine and decreased levels of hydrogen sulfide were significantly negatively correlated in PH associated with CHD.The underlying mechanism involved t
基金the National Natural Science Foundation of China(grant numbers:81973110 and 82204062).
文摘Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5%in China(CN)and 4.6%in the United States(US),whereas the obesity prevalence was 7.4%and 18.6%,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95%CI=0.78–0.88;US:OR=0.72,95%CI=0.64–0.81);ISH(CN:OR=0.87,95%CI=0.80–0.94;US:OR=0.71,95%CI=0.62–0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN w
文摘Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.
