基于不同血压参照标准的儿童高血压检出率比较

唐努; 陈亚军; 谭蔚清; 邓鹭; 卢少敏; 谈敏怡; 曾霞; 蔡莉

doi:10.16462/j.cnki.zhjbkz.2019.02.008

基于不同血压参照标准的儿童高血压检出率比较

doi: 10.16462/j.cnki.zhjbkz.2019.02.008

唐努¹,
陈亚军¹,
谭蔚清²,
邓鹭²,
卢少敏¹,
谈敏怡¹,
曾霞¹,
蔡莉^1, ,

1.
510080 广州, 中山大学公共卫生学院妇幼卫生系
2.
510080 广州, 广州市中小学卫生健康促进中心

基金项目:

国家自然科学基金面上项目 81673193

详细信息

通讯作者:
蔡莉, E-mail: caili5@mail.sysu.edu.cn

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2018-09-25
- 修回日期: 2018-11-26
- 刊出日期: 2019-02-10

The comparison of hypertension prevalence among children based on different references of hypertension

1.
Deprtment of Maternal and Child Health, Department of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2.
Guangzhou Primary and Secondary School Health Promotion Center Guangzhou 510080, China

Funds:

National Natural Science Foundation of China 81673193

More Information

Corresponding author: Cai Li, E-mail: caili5@mail.sysu.edu.cn

摘要

摘要: 目的探究不同高血压（high blood pressure，HBP）参照标准对广州市7~12岁儿童进行HBP诊断的差异性，为儿童HBP参照标准的应用提供参考。方法于2017年3月~5月，通过分层整群随机抽样，选取广州市7~12岁小学生7698人进行问卷调查及体格测量。儿童HBP诊断分别采用5种标准：米杰2010、米杰2017、马军2017、美国2004和美国2017标准。结果上述5种标准对于广州市7-12岁儿童HBP的检出率分别为17.08%、19.23%、12.59%、9.84%、18.31%。基于米杰2017标准的HBP检出率略高于米杰2010标准，但都明显高于马军2017标准；与米杰2010标准比较，米杰2017标准对高收缩压和高舒张压的诊断一致性均高于马军2017标准。与美国2017标准比较，米杰2017标准对高收缩压的诊断一致性高于马军2017标准（Kappa值：0.846 vs.0.727），但对高舒张压的诊断一致性则相反（Kappa值：0.833 vs.0.849）。结论广州市7~12岁儿童HBP检出率水平较高。基于米杰2017标准的儿童HBP检出率最高，其次为美国2017标准，且两者的HBP诊断一致性很高；马军2017与米杰2010或美国2017标准的诊断一致性均低于米杰2017标准。
- 儿童 /
- HBP /
- 参照标准
Abstract: Objective To compare the differences in the hypertension prevalence among children aged 7-12 in Guangzhou based on different references of hypertension. Methods A total of 7698 children aged 7-12 years old in Guangzhou were recruited by stratified cluster random sampling method. Demographic information such as gender and age was collected by questionnaire. Children's height, weight, and blood pressure were objectively measured. There were five references for diagnosing children's hypertension: Mi 2010, Mi 2017, Ma 2017, America 2004, and America 2017 reference. Results Based on the references above, the prevalence of hypertension for children aged 7-12 in Guangzhou reached a very high level. The prevalence of hypertension, high systolic blood pressure (SBP) and high diastolic blood pressure (DBP) based on Mi 2017 reference were all higher than those based on Mi 2010 reference, but both of them were distinctly higher than Ma 2017 reference. Compared with Mi 2010 reference, the agreement of diagnosis of high SBP and high DBP were both higher for Mi 2017 than those for Ma 2017. The agreement of high SBP was higher between Mi 2017 and America 2017 than that between Ma 2017 and America 2017 (Kappa: 0.846 vs. 0.727). Conclusion The prevalence of hypertension in children aged 7-12 in Guangzhou reachs a very high level. The prevalence of hypertension based on Mi 2017 reference is the highest and follows with America 2017 reference, and the agreement between them is excellent. Compared with Mi 2010 or America 2017 reference, the agreement for Ma 2017 is lower than that for Mi 2017 reference, respectively.
- Children /
- Hypertension /
- Reference

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图 1 不同参照标准下2017年广州市7~12岁学生男女生HBP检出率

注：a.男生；b.女生

Figure 1. The prevalence of hypertension among boys and girls aged 7-12 years in Guangzhou in 2017 based on different references

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表 1 各儿童HBP参照标准

Table 1. The diagnosis principles of different references of hypertension among children

	正常血压	HBP前期	HBP
	正常血压	HBP前期	Stage1	Stage2
米杰2010^a		P₉₀≤~<P₉₅	P₉₅≤~<P₉₉	≥P₉₉
米杰2017^b	<P₉₀	P₉₀≤~<P₉₅或≥120/80 mmHg	P₉₅~P₉₉+5 mmHg	≥P₉₉+5 mmHg
马军2017^b		P₉₀≤~<P₉₅或120~139/80~89 mmHg	P₉₅~P₉₉+5 mmHg	≥P₉₉+5 mmHg
美国2004^b	<P₉₀	P₉₀≤~<P₉₅或≥120/80 mmHg	P₉₅~P₉₉+5 mmHg	≥P₉₉+5 mmHg
美国2017^b
1~13岁	<P₉₀	P₉₀≤~<P₉₅或120/80~≤P₉₅	P₉₅~P₉₉+12 mmHg或130/80~139/89 mmHg	≥P₉₉+12≥140/90 mmHg
>13岁	<120/<80mmHg	120/<80~129/<80 mmHg	130/80~139/89 mmHg	≥140/90 mmHg
注：^a表示性别和年龄别儿童血压参照标准；^b表示性别、年龄别和身高别的儿童血压参照标准。~表示两个界值之间的连续区间。

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表 2 2017年广州市7~12岁儿童基本情况列表(x±s)

Table 2. The basic characteristics of children aged 7-12 in Guangzhou in 2017

	男	女	总计	t值	P值
例数(岁，%)	4013(54.04)	3413(45.96)	7426
年龄分布(%)				12.74	0.026
7	702(9.45)	615(8.28)	1317(17.73)
8	751(10.11)	607(8.17)	1358(18.29)
9	809(10.89)	741(9.98)	1550(20.87)
10	721(9.71)	632(8.51)	1353(18.22)
11	631(8.50)	550(7.41)	1181(15.90)
12	399(5.37)	268(3.61)	667(8.98)
年龄(岁)	9.26±1.59	9.20±1.55	9.23±1.57	1.38	0.166
身高(cm)	139.5±11.44	139.6±11.71	139.55±11.57	-0.05	0.963
体重(kg)	35.14±11.11	33.03±10.00	34.17±10.66	8.51	<0.001
体质量指数(kg/m2)	17.67±3.44	16.61±2.98	17.18±3.28	14.06	<0.001
收缩压(mmHg)	103.6±11.53	100.9±11.41	102.36±11.55	10.05	<0.001
舒张压(mmHg)	65.28±8.72	65.07±8.33	65.19±8.54	1.05	0.294
注：P值表示男女生的各项指标差异是否具有统计学意义，检验水准为α=0.05

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表 3 各标准HBP检出率及其差异比较

Table 3. The comparison of prevalence of different references of hypertension

	HBP检出率(%)					P¹	P²	P³	P⁴	P⁵	P⁶	P⁷
	米杰2010	米杰2017	马军2017	美国2004	美国2017	P¹	P²	P³	P⁴	P⁵	P⁶	P⁷
男生
高SBP	9.92	10.57	7.41	6.95	13.47	0.026	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
高DBP	11.49	14.03	8.31	4.73	10.48	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
HBP	17.62	19.96	13.34	10.39	19.93	< 0.001	< 0.001	< 0.001	< 0.001	0.890	< 0.001	< 0.001
女生
高SBP	8.20	8.47	6.39	5.42	9.04	0.225	< 0.001	< 0.001	0.006	0.015	< 0.001	< 0.001
高DBP	11.60	13.83	7.68	5.45	10.51	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
HBP	16.44	18.37	11.70	9.20	16.41	< 0.001	< 0.001	< 0.001	0.929	< 0.001	< 0.001	< 0.001
总体
高SBP	9.13	9.60	6.94	6.25	11.43	0.011	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
高DBP	11.54	13.94	8.02	5.06	10.49	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
HBP	17.08	19.23	12.59	9.84	18.31	< 0.001	< 0.001	< 0.001	0.011	< 0.001	< 0.001	< 0.001
注：“P^1-4”表示米杰2017、马军2017、美国2004、美国2017标准分别与米杰2010标准比较的P值；“P^5-7”表示米杰2017、马军2017、美国2004标准分别与美国2017标准比较的P值。

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表 4 各HBP参照标准的一致性比较

Table 4. Comparison of diagnostic agreement based on different references of hypertension

	高SBP			高DBP			HBP
	n	%	Kappa	n	%	Kappa	n	%	Kappa
米杰2017与米杰2010			0.849^*			0.890^*			0.881^*
1组	6 635	89.35		6389	86.04		5946	80.07
2组	78	1.05		2	0.03		52	0.70
3组	113	1.52		180	2.42		212	2.85
4组	600	8.08		855	11.51		1216	16.37
马军2017与米杰2010			0.733^*			0.800^*			0.775^*
1组	6677	89.99		6564	88.46		6108	82.32
2组	228	3.07		261	3.52		378	5.09
3组	65	0.88		1	0.01		46	0.62
4组	450	6.06		594	8.01		888	11.97
美国2004与米杰2010			0.752^*			0.580^*			0.671^*
1组	6724	90.55		6569	88.46		6139	82.67
2组	238	3.20		481	6.48		556	7.49
3组	24	0.32		0	0.00		19	0.26
4组	440	5.93		376	5.06		712	9.59
美国2017与米杰2010			0.748^*			0.912^*			0.870^*
1组	6462	87.44		6516	88.17		5979	80.91
2组	84	1.14		100	1.35		116	1.57
3组	259	3.50		27	0.37		158	2.14
4组	585	7.92		747	10.11		1137	15.39
米杰2017与美国2017			0.846^*			0.833^*			0.881^*
1组	6509	88.08		6358	86.04		5903	79.88
2组	177	2.40		6	0.08		72	0.97
3组	37	0.50		258	3.49		192	2.60
4组	667	9.03		768	10.39		1223	16.55
马军2017与美国2017			0.727^*			0.849^*			0.805^*
1组	6543	88.54		6614	89.50		6093	82.45
2组	335	4.53		185	2.50		368	4.98
3组	3	0.04		2	0.03		2	0.03
4组	509	6.89		588	7.97		927	12.54
美国2004与美国2017			0.681^*			0.626^*			0.679^*
1组	6546	88.58		6616	89.53		6095	82.48
2组	383	5.18		400	5.41		568	7.69
3组	0	0.00		0	0.00		0	0.00
4组	461	6.24		374	5.06		727	9.84
注：“1组”指两标准均未诊断为HBP；“2组”指前者未诊断而后者诊断为HBP；“3组”指前者诊断而后者未诊断为HBP；“4组”指两标准均诊断为HBP。“*”表示Kappa检验中P<0.05，表示假设检验中Kappa值与0的差异具有统计学意义。

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