基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

胡佳; 韩迪; 海波; 丁子尧; 尹洁云; 杨海兵; 沈蕙

doi:10.16462/j.cnki.zhjbkz.2021.06.021

基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

doi: 10.16462/j.cnki.zhjbkz.2021.06.021

胡佳,
韩迪¹,
海波¹,
丁子尧¹,
尹洁云²,
杨海兵^1, ,,
沈蕙^1, ,

1.
215004 苏州，苏州市疾病预防控制中心
2.
215006 苏州，苏州大学医学部公共卫生学院流行病与卫生统计学系

基金项目:

国家自然科学基金 81602911

苏州市科技发展计划(民生科技)项目 SYS2019115

苏州市姑苏卫生人才计划培养项目 GSWS2020100

详细信息

通讯作者:
沈蕙，E-mail: 791675633@qq.com

杨海兵，E-mail：yhbing111@163.com

中图分类号: R179;R544
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出版历程
- 收稿日期: 2020-12-16
- 修回日期: 2021-02-08
- 刊出日期: 2021-06-10

Evaluation of simplified methods based on 2018 Chinese guidelines for the management of hypertension for screening high blood pressure among children and adolescents in Suzhou

HU Jia,
HAN Di¹,
HAI Bo¹,
DING Zi-yao¹,
YIN Jie-yun²,
YANG Hai-bing^{1
, ,},
SHEN Hui^{1
, ,}

1.
Suzhou Center for Disease Prevention and Control, Suzhou 215004, China
2.
Department of Epidemiology and Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215006, China

Funds:

National Natural Science Foundation of China 81602911

Program of Science and Technology for People's Livelihood in Suzhou, China SYS2019115

Gusu Health Talents Program Training Project in Suzhou, China GSWS2020100

More Information

Corresponding author: YANG Hai-bing, E-mail: yhbing111@163.com; SHEN Hui, E-mail: 791675633@qq.com

摘要

摘要: 目的评价不同简化方法筛查苏州市儿童青少年血压偏高的效果。方法采用分层整群随机抽样方法，招募7 340名6~17岁儿童青少年，测量身高、体重和血压。以中国高血压防治指南为金标准，评价公式法、身高别法、年龄组别表格法和性别年龄别表格法的筛查效果。结果根据金标准和4种简化方法，血压偏高检出率分别为17.3%、17.9%、17.5%、18.5%、17.1%。身高别法和性别年龄别表格法与金标准筛查结果差异均无统计学意义(χ² =0.593，P=0.477; χ² =0.865，P=0.383)。与金标准相比，公式法、身高别法、性别年龄别表格法的Kappa值分别为0.818、0.865、0.858，高于年龄组别表格法(0.670)。身高别法和性别年龄别表格法曲线下面积最高，分别为0.934(95% CI: 0.924~0.944)、0.927(95% CI: 0.916~0.938)，高于公式法(0.915, 95% CI: 0.904~0.926)，年龄组别表格法最低，为0.844(95% CI: 0.829~0.858)。分性别、年龄、身高比较时，4种简化标准的筛查效果与总体基本一致，身高别法、性别年龄别表格法在不同分组呈现各自筛查优势。结论 4种简化方法筛查效果均较好，考虑身高别法简便易行，更适合用于早期筛查。
- 儿童 /
- 青少年 /
- 简化方法 /
- 标准 /
- 血压偏高
Abstract: Objective To evaluate the validation of various simplified methods for screening high blood pressure (HBP) among children and adolescents in Suzhou. Methods 7 340 children and adolescents aged 6 to 17 years were enrolled by stratified cluster random sampling method. Height, weight and blood pressure were measured. Considering 2018 Chinese guidelines for the management of hypertension as gold standard, the validation of 4 simplified methods (formula method, height-specific method, age group-specific method, sex- and age-specific method) for screening HBP were assessed. Results According to gold standard and 4 simplified methods, the prevalence of HBP were 17.3%, 17.9%, 17.5%, 18.5%, 17.1%, respectively. There was no significant difference between the prevalence of HBP identified by height-specific method (χ² =0.593, P=0.477), sex- and age-specific method (χ² =0.865, P=0.383) and gold standard method. Kappa values of formula method, height-specific method, sex- and age-specific method were 0.818, 0.865, 0.858, respectively, higher than that of age group-specific method (0.670). Area under the curve (95% confidence interval) of height-specific method and sex- and age-specific method were 0.934 (95% CI: 0.924-0.944) and 0.927 (95% CI: 0.916-0.938), respectively, higher than that of formula method [0.915 (95% CI: 0.904-0.926)]. The age group-specific method had the lowest area under the curve[0.844 (95% CI: 0.829-0.858)] was the lowest. When stratified by age, sex and height, screening effects of 4 simplified methods among different subgroups were similar with total population. Height-specific method and sex-and age-specific method had different screening strengthens among different groups. Conclusion All 4 simplified methods performed well for screening HBP. Considering the convenience of using, height-specific method would be proper for early HBP screening.
- Child /
- Adolescent /
- Simplified method /
- Standard /
- High blood

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图 1 4种简化方法预测血压偏高的ROC曲线

Figure 1. The ROC curve of prediction for high blood pressure of 4 simplified rmethods

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表 1 研究对象的基本特征(x±s)

Table 1. Characteristics of participants (x±s)

变量	男生	女生	总计	t/χ²值	P值
年龄[n(%), 岁]				2.182	0.140
6~＜12	1729(45.2)	1532(43.5)	3261(44.4)
12~17	2092(54.8)	1987(56.5)	4079(55.6)
身高(cm)	154.1±18.6	149.8±14.6	152.0±16.9	10.962	< 0.001
体重(kg)	49.6±18.3	44.8±14.0	47.3±16.6	12.826	< 0.001
BMI (kg/m²)	20.2±4.2	19.4±3.7	19.8±4.0	8.335	< 0.001
SBP (mm Hg)	111.9±14.3	106.7±12.0	109.4±13.5	16.815	< 0.001
DBP (mm Hg)	63.9±8.5	64.5±8.3	64.2±8.4	-3.237	0.001
身高分组^a [n(%), cm]				-1.967	0.049
＜P_17.5	396(10.4)	278(7.9)	674(9.2)
P_17.5~＜P_82.5	2437(63.8)	2315(65.8)	4752(64.7)
≥P_82.5	988(25.9)	926(26.3)	1914(26.1)
BMI分组^a [n(%), kg/m²]				-12.596	< 0.001
正常	2369(62.0)	2655(75.4)	5024(68.4)
超重	775(20.3)	505(14.4)	1280(17.4)
肥胖	677(17.7)	359(10.2)	1036(14.1)
血压偏高 [n(%), mm Hg]	720(18.8)	550(15.6)	1270(17.3)	13.223	< 0.001
注：^a统计分析方法为秩和检验。

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表 2 4种简化方法判定儿童青少年血压偏高情况[n(%)]

Table 2. Prevalence of high blood pressure among children and adolescents based on 4 simplified methods [n(%)]

标准	男生	女生	总计	χ²值^a	P值
指南标准	720(18.8)	550(15.6)	1 270(17.3)
公式法	686(18.0)	631(17.9)	1 317(17.9)	5.708	0.019
身高别法	832(21.8)	451(12.8)	1 283(17.5)	0.593	0.477
年龄组别表格法	886(23.2)	471(13.4)	1 357(18.5)	10.616	0.001
性别年龄别表格法	706(18.5)	548(15.6)	1 254(17.1)	0.865	0.383
注：^a此统计检验值为总体人群不同简化方法与指南标准比较。

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表 3 4种简化方法筛查儿童青少年血压偏高的效果评价

Table 3. Performance of 4 simplified methods for screening high blood pressure among children and adolescents

组别	AUC(95% CI)	灵敏度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)	Kappa值
总体
公式法	0.915(0.904~0.926)	86.6	96.4	83.5	97.2	0.818
身高别法	0.934(0.924~0.944) ^a	89.3	97.5	88.4	97.8	0.865
年龄组别表格法	0.844(0.829~0.858) ^{a, b}	75.4	93.4	70.5	94.8	0.670
性别年龄别表格法	0.927(0.916~0.938) ^c	87.7	97.7	88.8	97.4	0.858
男
公式法	0.899(0.882~0.915)	82.6	97.1	86.7	96.0	0.812
身高别法	0.963(0.955~0.971) ^{a, b}	96.9	95.7	83.9	99.3	0.874
年龄组别表格法	0.847(0.828~0.865) ^{a, b}	79.4	89.9	64.6	95.0	0.637
性别年龄别表格法	0.912(0.896~0.927) ^{a, b, c}	85.3	97.0	87.0	96.6	0.829
女
公式法	0.938(0.924~0.952)	91.8	95.8	80.0	98.4	0.826
身高别法	0.894(0.874~0.914) ^a	79.3	99.5	96.7	96.3	0.850
年龄组别表格法	0.836(0.812~0.859) ^{a, b}	70.0	97.1	81.7	94.6	0.713
性别年龄别表格法	0.946(0.932~0.961) ^{b, c}	90.9	98.4	91.2	98.3	0.894
年龄(6~＜12岁)
公式法	0.928(0.911~0.945)	89.3	96.4	79.7	98.3	0.815
身高别法	0.937(0.919~0.954)	88.6	98.7	91.7	98.2	0.886
年龄组别表格法	0.886(0.866~0.905) ^{a, b}	85.5	91.6	61.9	97.5	0.664
性别年龄别表格法	0.892(0.870~0.915) ^{a, b}	79.5	99.0	92.5	96.8	0.834
年龄(12~17岁)
公式法	0.908(0.893~0.923)	85.2	96.5	85.9	96.3	0.819
身高别法	0.931(0.918~0.944) ^a	89.7	96.5	86.7	97.4	0.851
年龄组别表格法	0.824(0.918~0.944) ^{a, b}	69.8	95.0	77.8	92.6	0.674
性别年龄别表格法	0.944(0.933~0.955) ^{a, c}	92.2	96.6	87.2	98.0	0.869
身高(＜P_17.5)
公式法	0.799(0.737~0.861)	59.8	100.0	100.0	93.7	0.718
身高别法	0.943(0.909~0.978) ^a	90.7	97.9	88.0	98.4	0.875
年龄组别表格法	0.757(0.692~0.822) ^b	51.5	99.8	92.5	98.0	0.640
性别年龄别表格法	0.780(0.717~0.843) ^b	56.7	99.3	93.2	93.2	0.669
身高(P_17.5~＜P_82.5)
公式法	0.913(0.898~0.928)	84.7	97.9	89.3	96.9	0.843
身高别法	0.942(0.930~0.954) ^a	90.6	97.7	89.2	98.1	0.878
年龄组别表格法	0.845(0.827~0.864) ^{a, b}	74.0	95.0	75.2	94.7	0.695
性别年龄别表格法	0.927(0.913~0.941) ^c	86.3	99.1	95.3	97.2	0.888
身高(≥P_82.5)
公式法	0.947(0.935~0.959)	98.1	91.3	72.6	99.5	0.788
身高别法	0.915(0.893~0.936) ^a	86.0	96.9	86.7	67.0	0.832
年龄组别表格法	0.858(0.835~0.882) ^{a, b}	84.7	87.0	60.5	96.0	0.621
性别年龄别表格法	0.963(0.954~0.972) ^{a, b, c}	99.2	93.4	78.0	99.8	0.839
注：^a与公式法比较P < 0.05;^b与身高别法比较P < 0.05;^c与年龄组别表格法比较P < 0.05。

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基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

doi: 10.16462/j.cnki.zhjbkz.2021.06.021

通讯作者:
沈蕙，E-mail: 791675633@qq.com

杨海兵，E-mail：yhbing111@163.com

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Evaluation of simplified methods based on 2018 Chinese guidelines for the management of hypertension for screening high blood pressure among children and adolescents in Suzhou

Corresponding author: YANG Hai-bing, E-mail: yhbing111@163.com; SHEN Hui, E-mail: 791675633@qq.com

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基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

doi: 10.16462/j.cnki.zhjbkz.2021.06.021

通讯作者: 沈蕙，E-mail: 791675633@qq.com 杨海兵，E-mail：yhbing111@163.com

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出版历程

Evaluation of simplified methods based on 2018 Chinese guidelines for the management of hypertension for screening high blood pressure among children and adolescents in Suzhou

Corresponding author: YANG Hai-bing, E-mail: yhbing111@163.com; SHEN Hui, E-mail: 791675633@qq.com

计量

出版历程

目录

通讯作者:
沈蕙，E-mail: 791675633@qq.com

杨海兵，E-mail：yhbing111@163.com