太原市青春期高血压流行病学调查与左心室肥厚关系研究
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摘要
目的:1.了解太原市城乡青春期血压水平以及高血压的发生状况,探索青春期原发性高血压的易患因素。2.了解青春期高血压患者的左心室肥厚的发生率及左心室构型,LVMI的危险因素,为开展成年期心血管疾病的预防提出理论依据。
方法:2006.9—2007.1采用分层整群随机抽样方法对太原市1749名13-18岁青春期少年进行身高、体重、收缩压、舒张压的测定,并计算BMI,以血压值在其年龄、性别第95百分位以上者为高血压,经进一步体检排除继发性高血压,筛选出原发性高血压者69例,将其作为研究对象。1.用随机抽样法在所有血压正常青少年中选择69例作为对照,进行1:1病例对照配对,抽取静脉血查空腹血糖、甘油三酯、胆固醇,并填写统一制定的调查表。计算原发性高血压及高血压前期的发生率,对可能影响高血压发生的因素进行logistic回归分析。2.选取同年龄血压正常、性别、身高、BMI相近者作为对照,行UCG检查,计算LVMI,RWT。3.采用SPSS13.0统计软件分析。
结果:1.太原市高血压发病率为3.9%,其中男5.0%,女2.1%。城乡间SBP、DBP均值无显著性差异,城乡原发性高血压发生率无显著性差异;高血压前期发病率7.4%,其中男性患病率7.9%,女性患病率6.8%,男、女性患病率无显著性差异(P>0.05)。
2.同性别、不同年龄组间SBP、DBP均值无显著性差异,男女之间SBP、DBP有显著性差异。3.单因素分析显示:体质指数升高、高脂血症是青春期原发性高血压的重要危险因素。将收缩压和舒张压分别进行分析,发现BMI、经常作恶梦、感到入睡困难、高血压家族史、经常吃西式快餐、高脂血症是收缩期高血压的危险因素;睡眠呼吸暂停、肥胖、高脂血症是舒张期高血压的危险因素。多因素logistic回归分析显示:BMI、高脂血症是青春期原发性高血压发病的危险因素。收缩期原发性高血压的危险因素有BMI、感到入睡困难、高脂血症、高血压家族史;舒张期原发性高血压的危险因素有BMI、睡眠呼吸暂停、高脂血症。4.与对照组相比,高血压组LVMI、IVST、LVPW均显著升高,LVMI与SBP呈显著正相关。发现向心性重构者15(21.4%)人,未发现有左心室肥厚患者。
结论:1.肥胖、高脂血症是青春期原发性高血压的重要危险因素,与收缩期及舒张期原发性高血压均有关系,感到入睡困难、经常作噩梦、高血压家族史是收缩期高血压的危险因素,睡眠呼吸暂停是舒张期高血压的危险因素。2.高血压组LVMI、IVST、LVPW均显著升高,发现向心性重构者15(21.4%)人,未发现有左心室肥厚患者。3.LVMI与SBP呈显著正相关。
Objective: To investigate the level of the blood pressure and the prevalence rate of essential arterial hypertension in adolescents in Taiyuan. To investigate the risk factors associated with primary hypertension in adolescents. To investigate the prevalence of left ventricular hypertrophy and left ventricular structure associated with primary hypertension in adolescents and the risk factors of LVMI.
Method A Stratified-clustered-random sampling study of 1,749 adolescents aged 13 to 18 years in Taiyuan were used and age,height, weight , systolic blood pressure and diastolic pressure were conducted from September 2006 to January 2007,then calculate the BMI..The standard of hypertension is that SBP or DBP is greater than or equal to 95th percentile by sex and age. Undergoing further medical examination to exclude the secondary hypertension ,69 cases of essential hypertension were screened. Conducted these cases as study objects.
1.Random Sampling were used to select 69 cases as control group from all the normotensive adolscents, the clinical case-control study was performed . Venous blood was taken suction to check fasting blood glucose, triglyceride and Cholesterol. And relative information about cases was filled in the unified questionnaires forms.
2. Selected 69 cases with normal blood pressure with similar age, sex, height, BMI, as control group, inspection trip UCG,then calculated LVMI and RWT. 3.The data were analyzed with the software of SPSS13.0 . logistic regression analysis for 13 influence factors of essential hypertension were made.
Results:1.the prevalence rate of hypertension in Taiyuan was 3.9%, 5.0% in boys and 2.1% in girls.There was no significant difference in SBP, DBP mean and the prevalence rate of hypertension between urban and rural areas. The prevalence rate of pre-Hypertension was 7.4%, with 7.9% in boys and 6.8% in girls. There was no significant difference in the prevalence rate between boys and girls.(P> 0.05).
2. There was no significant difference in SBP and DBP mean between different age groups of the same sex. There was a significant difference in SBP, DBP between boys and girls.
3. Single factor analysis approved that increased body mass index and hyperlipidemia are important risk factors for adolescent primary hypertension. Will systolic and diastolic blood pressure were analyzed and found that increased BMI, regular nightmares, sleep difficulty, family history of hypertension, Western-style fast food eating often, hyperlipidemia are isolated risk factors of systolic hypertension, and sleep apnea, obesity, Hyperlipidemia are risk factors of diastolic hypertension. Multivariate logistic regression analysis showed that increased BMI during adolescence essential hypertension risk factors. Risk factors of systolic hypertension were sleep difficulties, hyperlipidemia, and family history of hypertension; diastolic hypertension risk factors sleep opnea, hyperlipidemia.
4. Compared with the control group, LVMI, IVST, LVPW were significantly increased in the hypertensive group, LVMI was significantly correlated with the SBP. Concentric remodeling was present in 15 of 69 (21.4%) in the study object. No patient was found with left ventricular hypertrophy.
Conclusion: Obesity and hyperlipidemia are the risk factors for primary hypertension in adolescence. Sleep difficulties and often a nightmare, family history of hypertension are the isolated risk factors of systolic hypertension, sleep apnea is the risk factor of diastolic hypertension. Concentric remodeling was present in 15 of 69 (21.4%) in the study object. No patient was found with left ventricular hypertrophy.
方法:2006.9—2007.1采用分层整群随机抽样方法对太原市1749名13-18岁青春期少年进行身高、体重、收缩压、舒张压的测定,并计算BMI,以血压值在其年龄、性别第95百分位以上者为高血压,经进一步体检排除继发性高血压,筛选出原发性高血压者69例,将其作为研究对象。1.用随机抽样法在所有血压正常青少年中选择69例作为对照,进行1:1病例对照配对,抽取静脉血查空腹血糖、甘油三酯、胆固醇,并填写统一制定的调查表。计算原发性高血压及高血压前期的发生率,对可能影响高血压发生的因素进行logistic回归分析。2.选取同年龄血压正常、性别、身高、BMI相近者作为对照,行UCG检查,计算LVMI,RWT。3.采用SPSS13.0统计软件分析。
结果:1.太原市高血压发病率为3.9%,其中男5.0%,女2.1%。城乡间SBP、DBP均值无显著性差异,城乡原发性高血压发生率无显著性差异;高血压前期发病率7.4%,其中男性患病率7.9%,女性患病率6.8%,男、女性患病率无显著性差异(P>0.05)。
2.同性别、不同年龄组间SBP、DBP均值无显著性差异,男女之间SBP、DBP有显著性差异。3.单因素分析显示:体质指数升高、高脂血症是青春期原发性高血压的重要危险因素。将收缩压和舒张压分别进行分析,发现BMI、经常作恶梦、感到入睡困难、高血压家族史、经常吃西式快餐、高脂血症是收缩期高血压的危险因素;睡眠呼吸暂停、肥胖、高脂血症是舒张期高血压的危险因素。多因素logistic回归分析显示:BMI、高脂血症是青春期原发性高血压发病的危险因素。收缩期原发性高血压的危险因素有BMI、感到入睡困难、高脂血症、高血压家族史;舒张期原发性高血压的危险因素有BMI、睡眠呼吸暂停、高脂血症。4.与对照组相比,高血压组LVMI、IVST、LVPW均显著升高,LVMI与SBP呈显著正相关。发现向心性重构者15(21.4%)人,未发现有左心室肥厚患者。
结论:1.肥胖、高脂血症是青春期原发性高血压的重要危险因素,与收缩期及舒张期原发性高血压均有关系,感到入睡困难、经常作噩梦、高血压家族史是收缩期高血压的危险因素,睡眠呼吸暂停是舒张期高血压的危险因素。2.高血压组LVMI、IVST、LVPW均显著升高,发现向心性重构者15(21.4%)人,未发现有左心室肥厚患者。3.LVMI与SBP呈显著正相关。
Objective: To investigate the level of the blood pressure and the prevalence rate of essential arterial hypertension in adolescents in Taiyuan. To investigate the risk factors associated with primary hypertension in adolescents. To investigate the prevalence of left ventricular hypertrophy and left ventricular structure associated with primary hypertension in adolescents and the risk factors of LVMI.
Method A Stratified-clustered-random sampling study of 1,749 adolescents aged 13 to 18 years in Taiyuan were used and age,height, weight , systolic blood pressure and diastolic pressure were conducted from September 2006 to January 2007,then calculate the BMI..The standard of hypertension is that SBP or DBP is greater than or equal to 95th percentile by sex and age. Undergoing further medical examination to exclude the secondary hypertension ,69 cases of essential hypertension were screened. Conducted these cases as study objects.
1.Random Sampling were used to select 69 cases as control group from all the normotensive adolscents, the clinical case-control study was performed . Venous blood was taken suction to check fasting blood glucose, triglyceride and Cholesterol. And relative information about cases was filled in the unified questionnaires forms.
2. Selected 69 cases with normal blood pressure with similar age, sex, height, BMI, as control group, inspection trip UCG,then calculated LVMI and RWT. 3.The data were analyzed with the software of SPSS13.0 . logistic regression analysis for 13 influence factors of essential hypertension were made.
Results:1.the prevalence rate of hypertension in Taiyuan was 3.9%, 5.0% in boys and 2.1% in girls.There was no significant difference in SBP, DBP mean and the prevalence rate of hypertension between urban and rural areas. The prevalence rate of pre-Hypertension was 7.4%, with 7.9% in boys and 6.8% in girls. There was no significant difference in the prevalence rate between boys and girls.(P> 0.05).
2. There was no significant difference in SBP and DBP mean between different age groups of the same sex. There was a significant difference in SBP, DBP between boys and girls.
3. Single factor analysis approved that increased body mass index and hyperlipidemia are important risk factors for adolescent primary hypertension. Will systolic and diastolic blood pressure were analyzed and found that increased BMI, regular nightmares, sleep difficulty, family history of hypertension, Western-style fast food eating often, hyperlipidemia are isolated risk factors of systolic hypertension, and sleep apnea, obesity, Hyperlipidemia are risk factors of diastolic hypertension. Multivariate logistic regression analysis showed that increased BMI during adolescence essential hypertension risk factors. Risk factors of systolic hypertension were sleep difficulties, hyperlipidemia, and family history of hypertension; diastolic hypertension risk factors sleep opnea, hyperlipidemia.
4. Compared with the control group, LVMI, IVST, LVPW were significantly increased in the hypertensive group, LVMI was significantly correlated with the SBP. Concentric remodeling was present in 15 of 69 (21.4%) in the study object. No patient was found with left ventricular hypertrophy.
Conclusion: Obesity and hyperlipidemia are the risk factors for primary hypertension in adolescence. Sleep difficulties and often a nightmare, family history of hypertension are the isolated risk factors of systolic hypertension, sleep apnea is the risk factor of diastolic hypertension. Concentric remodeling was present in 15 of 69 (21.4%) in the study object. No patient was found with left ventricular hypertrophy.
引文
[1]中国居民营养与健康状况调查报告之一:2002综合报告.中国居民营养与健康状况调查报告.
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[3]McNIece KL , Poffenbarger TS , Turner JL et al prevalence of hypertension and pre-hypertension among adolescents J Pediatrics 2007 Jun;150(6);640-4,644.
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[8] Kelishadi R, Ardalan G, Gheiratmand R et al Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):956-63.
[9]Moura AA, Silva MA, Ferraz MR Prevalence of high blood pressure in children and adolescents from the city of Maceió, Brazil J Pediatr (Rio J). 2004 Jan-Feb;80(1):35-40
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[1]中国居民营养与健康状况调查报告之一:2002综合报告.中国居民营养与健康状况调查报告
[2] Luma GB, Spiotta RT .Hypertension in children and adolescents. Am Fam Physician. 2006 May 1;73(9):1558-68
[3] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004 554:555 -- 577.
[4] McNIece KL,Poffenbarger TS ,Turner JL et al prevalence of hypertension and pre-hypertension among adolescents J Pediatrics 2007 Jun;150(6);640-4,644.
[5] Pileggi C,Carbone V, Nobile CG et al Blood pressure and related cardiovascular disease risk factors in 6-18 year-old students in Italy. J Paediatr Child Health. 2005 Jul;41(7):347-52.
[6] Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004) Hypertens Res. 2006 Aug;29 Suppl:S1-105.
[7] Tak YR, Yun EH, An JY,et al Prevalence of cardiovascular risk factors in school-aged children J Prev Med Pub Health. 2005 Aug;38(3):366-72.
[8] Jafar TH, Islam M, Poulter N, et al Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: a comparative study. Circulation. 2005 Mar 15;111(10):1291-7.
[9] Kelishadi R, Ardalan G, Gheiratmand R et al Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):956-63.
[10] Moura AA, Silva MA, Ferraz MR Prevalence of high blood pressure in children and adolescents from the city of Maceió, Brazil J Pediatr (Rio J). 2004 Jan-Feb;80(1):35-40
[11]刘忠仁近十年我国高血压患病率概况心脑血管病防治, 2003年06期
[12]徐宛玲,王建国,王丽青春期血压调查研究<<医学理论与实践>>2002年08期
[13]王天有梁璐米杰等北京地区儿童及青少年血压分布特征《中华儿科杂志》2007,45(5)
[14]杨琳,郭丛芳,赵群等4132名少年儿童血压状况调查分析中国心血管病研究杂志2006年2月第4卷第2期
[15]祖淑玉;刘伟;徐成丽2001年河北省儿童青少年血压及相关因素分析基础医学与临床, 2007年05期
[16]宋文辉江文胜高进等铜陵市城区3 146名儿童高血压患病率调查安徽医科大学学报2006, 41(6)
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[8] Jafar TH, Islam M, Poulter N, et al Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: a comparative study. Circulation. 2005 Mar 15;111(10):1291-7.
[9] Kelishadi R, Ardalan G, Gheiratmand R et al Blood pressure and its influencing factors in a national representative sample of Iranian children and adolescents: the CASPIAN Study.Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):956-63.
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[11]刘忠仁近十年我国高血压患病率概况心脑血管病防治, 2003年06期
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