身高别血压值简化方法筛检济南市城区儿童青少年血压偏高的效果
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摘要
目的评价身高别血压值简化方法筛检济南市城区儿童青少年血压偏高的准确性。方法利用"十二五"国家科技支撑计划项目"儿童心血管疾病预警、诊治技术研究"济南调查点数据,共纳入济南市城区年龄6~17岁儿童青少年7840人。以2004年美国第4次儿童血压报告为"金标准",计算身高别血压值简化筛检方法的灵敏度、特异度、阳性预测值、阴性预测值、受试者工作特征(ROC)曲线下面积和Kappa系数,评价该简化方法的筛检效果。结果依据美国第4次儿童血压报告标准,济南市城区年龄6~17岁儿童青少年血压偏高前期检出率为14.4%,血压偏高检出率为9.4%;依据身高别血压值简化方法,检出率分别为13.4%和8.5%。与"金标准"相比,身高别血压值简化方法筛检儿童青少年血压偏高效果较好,两者一致性较高(Kappa系数为0.84);同时,该简化方法具有较高灵敏度(0.82)、特异度(0.99)、阳性预测值(0.90)、阴性预测值(0.98)和ROC曲线下面积(0.90)。简化方法在不同性别、年龄组和体质量指数分组均表现较好的筛检能力。结论身高别血压值简化方法具有较好的筛检效果,可用于儿童青少年血压偏高的早期筛查。
Objective To evaluate the performance of absolute height-specific thresholds for identifying elevated blood pressure(BP)among children and adolescents in urban region of Jinan. Methods Data was from the National Science and Technology Support Program during the Twelfth Five-year Plan Period named "early warning,diagnosis and treatment of childhood cardiovascular disease" conducted in Jinan. A total of 7840 children and adolescents aged 6-17 years were included in this study. According to the golden standard of the fourth report on the diagnosis,evaluation and treatment of high blood pressure in children and adolescents of American in 2004,the sensitivity,specificity,positive predictive values,negative predictive values,area under the receiver operating characteristic(ROC)curve of the absolute height-specific simplified method and Kappa were calculated to assess its performance.Results According to the golden standard,the prevalence of pre-elevated BP and elevated BP in urban region of Jinan was 14.4% and 9.4%,respectively. Based on the absolute height-specific method,the corresponding prevalence was 13.4%and 8.5%,respectively. The two approaches showed almost perfect agreement,with high Kappa coefficient(0.84).Compared with the the golden standard,the absolute height-specific simplified method performed well in our study,with high sensitivity(0.82),high specificity(0.99),high positive predictive values(0.90),high negative predictive values(0.98)and large area under the ROC curve(AUC,0.90). It also performed well among subgroups of different gender,age or body mass index(BMI). Conclusion The absolute height-specific simplified method performs well,and it can be used for early screening of hypertension in children and adolescents.
Objective To evaluate the performance of absolute height-specific thresholds for identifying elevated blood pressure(BP)among children and adolescents in urban region of Jinan. Methods Data was from the National Science and Technology Support Program during the Twelfth Five-year Plan Period named "early warning,diagnosis and treatment of childhood cardiovascular disease" conducted in Jinan. A total of 7840 children and adolescents aged 6-17 years were included in this study. According to the golden standard of the fourth report on the diagnosis,evaluation and treatment of high blood pressure in children and adolescents of American in 2004,the sensitivity,specificity,positive predictive values,negative predictive values,area under the receiver operating characteristic(ROC)curve of the absolute height-specific simplified method and Kappa were calculated to assess its performance.Results According to the golden standard,the prevalence of pre-elevated BP and elevated BP in urban region of Jinan was 14.4% and 9.4%,respectively. Based on the absolute height-specific method,the corresponding prevalence was 13.4%and 8.5%,respectively. The two approaches showed almost perfect agreement,with high Kappa coefficient(0.84).Compared with the the golden standard,the absolute height-specific simplified method performed well in our study,with high sensitivity(0.82),high specificity(0.99),high positive predictive values(0.90),high negative predictive values(0.98)and large area under the ROC curve(AUC,0.90). It also performed well among subgroups of different gender,age or body mass index(BMI). Conclusion The absolute height-specific simplified method performs well,and it can be used for early screening of hypertension in children and adolescents.
引文
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[15]Chiolero A,Paradis G.User-friendly tools to identify elevated blood pressure in children[J].Paediatr Child Health,2013,18(2):63-64.
[16]Ma C,Kelishadi R,Hong YM,et al.Performance of eleven simplified methods for the identification of elevated blood pressure in children and adolescents[J].Hypertension,2016,68(3):614-620.
[17]米杰,闫银坤.如何制定科学及实用的儿童血压参照标准[J].中华高血压杂志,2017,25(5):404-406.
[18]米杰,王天有,孟玲慧,等.中国儿童青少年血压参照标准的研究制定[J].中国循证儿科杂志,2010,5(1):4-14.
[19]范晖,闫银坤,米杰,等.中国3~17岁儿童性别、年龄别和身高别血压参照标准[J].中华高血压杂志,2017,25(5):428-435.
[20]范晖,闫银坤,米杰,等.中国3~17岁儿童血压简化标准的研制[J].中华高血压杂志,2017,25(5):436-440.
[2]任杰,张迎修,郭晓雷,等.2011年山东省青少年人群盐与高血压相关知识,态度和行为分析[J].中华高血压杂志,2014,22(2):146-150.
[3]Lande MB,Carson NL,Roy J,et al.Effects of childhood primary hypertension on carotid intima media thickness:a matched controlled study[J].Hypertension,2006,48(1):40-44.
[4]Hanevold C,Waller J,Daniels S,et al.The effects of obesity,gender,and ethnic group on left ventricular hypertrophy and geometry in hypertensive children:a collaborative study of the International Pediatric Hypertension Association[J].Pediatrics,2004,113(2):328-333.
[5]Chen X,Wang Y.Tracking of blood pressure from childhood to adulthood:a systematic review and meta-regression analysis[J].Circulation,2008,117(25):3171-3180.
[6]Juhola J,Magnussen CG,Viikari JS,et al.Tracking of serum lipid levels,blood pressure,and body mass index from childhood to adulthood:the cardiovascular risk in young Finns study[J].J Pediatr,2011,159(4):584-590.
[7]Hartz J,Li JS,Akintoye OO,et al.Clinicians'adherence to guidelines on evaluation of hypertension in children and adolescents[J].World J Pediatr Congenit Heart Surg,2016,7(4):440-445.
[8]The fourth report on the diagnosis,evaluation,and treatment of high blood pressure in children and adolescents[J].Pediatrics,2004,114(2suppl 4th report):555-576.
[9]Chiolero A,Paradis G,Simonetti GD,et al.Absolute heightspecific thresholds to identify elevated blood pressure in children[J].J Hypertens,2013,31(6):1170-1174.
[10]张媛媛,杨丽丽,席波.济南市城区年龄6~17岁儿童青少年血压偏高现状[J].中华高血压杂志,2018,26(1):72-77.
[11]孟玲慧,侯冬青,单馨影,等.OMRONHEM-7012电子血压计测量儿童青少年血压的准确性评价[J].中华高血压杂志,2013,21(2):158-162.
[12]李辉,宗心南,季成叶.中国2~18岁儿童青少年超重和肥胖筛查体重指数界值点的研究[J].中华流行病学杂志,2010,31(6):616-620.
[13]Cohen J.Weighted kappa:nominal scale agreement with provision for scaled disagreement or partial credit[J].Psychol Bull,1968,70(4):213-220.
[14]Landis JR,Koch GG.The measurement of observer agreement for categorical data[J].Biometrics,1977,33(1):159-174.
[15]Chiolero A,Paradis G.User-friendly tools to identify elevated blood pressure in children[J].Paediatr Child Health,2013,18(2):63-64.
[16]Ma C,Kelishadi R,Hong YM,et al.Performance of eleven simplified methods for the identification of elevated blood pressure in children and adolescents[J].Hypertension,2016,68(3):614-620.
[17]米杰,闫银坤.如何制定科学及实用的儿童血压参照标准[J].中华高血压杂志,2017,25(5):404-406.
[18]米杰,王天有,孟玲慧,等.中国儿童青少年血压参照标准的研究制定[J].中国循证儿科杂志,2010,5(1):4-14.
[19]范晖,闫银坤,米杰,等.中国3~17岁儿童性别、年龄别和身高别血压参照标准[J].中华高血压杂志,2017,25(5):428-435.
[20]范晖,闫银坤,米杰,等.中国3~17岁儿童血压简化标准的研制[J].中华高血压杂志,2017,25(5):436-440.