广西隆林县苗族2000人高血压前期Ⅰ级与Ⅱ级临床差异的对比分析
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摘要
目的对比分析苗族2 000人高血压前期Ⅰ级(PHT1)与Ⅱ级(PHT2)的临床差异。方法用分层随机抽样方法,抽取隆林县苗族成人2 000人,调查其性别、年龄、民族、病史、饮食、饮酒及吸烟信息;检测身高、体质量、腰围、臀围、血压、血脂、血糖和尿酸。高血压前期(PHT)者根据血压升高类型分为3个亚型:单纯收缩压(SBP)升高型PHT(ISP),单纯舒张压(DBP)升高型PHT(IDP),双期血压升高型PHT(SDP)。结果 1隆林苗族PHT检出率为30.0%,PHT1与PHT2检出率分别为18.7%和11.3%,差异有统计学意义(χ2=36.075,P<0.01)。PHT者中PHT1占62.3%,PHT2占37.7%,差异有统计学意义χ2=36.075,P<0.01)。2青年、中年及老年组人群的PHT1检出率分别为26.8%、14.9%和14.4%,差异有统计学意义(χ2=43.600,P<0.01),PHT2检出率分别为8.4%、11.0%和14.0%,差异有统计学意义(χ2=11.394,P<0.01)。3在PHT亚型中ISP占42.3%,IDP占18.5%,SDP占39.2%;ISP及IDP以PHT1者为主,而SDP以PHT2者为主,差异均有统计学意义(χ2=55.094、21.802,P<0.01)。4PHT2者年龄、血压、腰围、臀围、腰臀比(Waist to Hip ratio,WHR)、腰围身高比(Waist to Height ratio,WHtR)的暴露平均水平高于PHT1者(t=2.429~15.638,P<0.05);PHT2者危险年龄比例、阳性高血压家族史、饮酒、吸烟、高密度脂蛋白胆固醇(HDL-C)降低、腹型肥胖及代谢综合征(Metabolic syndrome,MS)者的流行率高于PHT1者(χ2=4.771~89.389,P<0.05)。5在10个心血管病危险因素中,PHT1及PHT2危险因素聚集人均个数分别为3.8、4.3,危险因素聚集数≥5个的聚集率分别为29.8%、54.4%,差异有统计学意义(χ2=27.940,P<0.01)。结论隆林苗族PHT的检出率低于全国水平,PHT1检出率高于PHT2者,PHT1与PHT2的临床表现存在明显差异。
Objective To compare the differences between grade Ⅰ Prehypertension( PHT1) and Grade Ⅱ Prehypertension( PHT2) among Miao ethnic group. Methods 2 000 adults of miao ethnic group in Longlin were selected to this study by stratified random sampling method. Then,a survey about their age,genders,ethnic group,history of illness,diet,drinking and smoking was collected by the questionnaire survey. Meanwhile their weights, heights, blood pressure, waist cicumferfence( WC),hip cicumferfence( HC),fasting plasma gloucose( FBG),blood lipid and uric acid( UA) were deteced. In prehypertension( PHT) group,the subjects were classified into three suptypes: Isolated systolic PHT( ISP),Isolated Diastolic PHT( IDP),combined systolic and diastolic PHT( SDP). Results 1The prevalence of PHT in Miao minority was 30. 0%,18. 6% in PHT1 and 11. 3% in PHT2,and the difference was statistically significant( χ2= 36. 075,P < 0. 01). Proportion of PHT1 and PHT2 in PHT group were 62. 3% and 37. 7%( χ2= 36. 075,P < 0. 01). 2The prevalence of PHT1 of people who aged from 18 to 44,45~ 59 and 60 or above were 26. 8%,14. 9% and 14. 4%,respectively,so difference was statistically significant( χ2= 43. 600,P < 0. 01),and those in the PHT2 were 8. 4%,11. 0% and 14. 0%,respectively( χ2= 11. 394,P < 0. 01). 3In three suptypes of PHT,proportion of ISP,IDP and SDP were 42. 3%,18. 5% and 39. 2%,respectively. Percentages of PHT1 and PHT2 in SDP were 56. 6% and 43. 4%, and those in ISP were 76. 3% and 24. 7%, and those in IDP were 70. 3% and29. 7%,respectively,significant difference were observed among the three suptypes( χ2= 55. 094,21. 802,P < 0. 01). 4The mean levels of age,SBP,DBP,WC,HC,WHR,WHtR in PHT2 group were higher than those in PHT1 group( t = 2. 429 ~15. 638,P < 0. 05). The prevalence of dangerous age,with positive family history of EH,drinking,smoking,low HDL- C( high density lipoprotein cholesterol),abdominal obesity and MS in PHT2 group were higher than those in PHT1 group( χ2=4. 771 ~ 89. 389,P < 0. 05). 5In the ten risk factors for CVD,the mean of risk factors under clustering in PHT1 and PHT2 were3. 8 and 4. 3,respectively. The prevalence of PHT1 and PHT2 with 5 and above risk factors were 29. 8% and 54. 4% respectively( χ2= 27. 940,P < 0. 01). Conclusion The prevalence of PHT in Miao ethnic group in Longlin County is lower then that of in China,the prevalence of PHT1 was higher than that of PHT2,and they have many obvious difference in clinical manifestation.
Objective To compare the differences between grade Ⅰ Prehypertension( PHT1) and Grade Ⅱ Prehypertension( PHT2) among Miao ethnic group. Methods 2 000 adults of miao ethnic group in Longlin were selected to this study by stratified random sampling method. Then,a survey about their age,genders,ethnic group,history of illness,diet,drinking and smoking was collected by the questionnaire survey. Meanwhile their weights, heights, blood pressure, waist cicumferfence( WC),hip cicumferfence( HC),fasting plasma gloucose( FBG),blood lipid and uric acid( UA) were deteced. In prehypertension( PHT) group,the subjects were classified into three suptypes: Isolated systolic PHT( ISP),Isolated Diastolic PHT( IDP),combined systolic and diastolic PHT( SDP). Results 1The prevalence of PHT in Miao minority was 30. 0%,18. 6% in PHT1 and 11. 3% in PHT2,and the difference was statistically significant( χ2= 36. 075,P < 0. 01). Proportion of PHT1 and PHT2 in PHT group were 62. 3% and 37. 7%( χ2= 36. 075,P < 0. 01). 2The prevalence of PHT1 of people who aged from 18 to 44,45~ 59 and 60 or above were 26. 8%,14. 9% and 14. 4%,respectively,so difference was statistically significant( χ2= 43. 600,P < 0. 01),and those in the PHT2 were 8. 4%,11. 0% and 14. 0%,respectively( χ2= 11. 394,P < 0. 01). 3In three suptypes of PHT,proportion of ISP,IDP and SDP were 42. 3%,18. 5% and 39. 2%,respectively. Percentages of PHT1 and PHT2 in SDP were 56. 6% and 43. 4%, and those in ISP were 76. 3% and 24. 7%, and those in IDP were 70. 3% and29. 7%,respectively,significant difference were observed among the three suptypes( χ2= 55. 094,21. 802,P < 0. 01). 4The mean levels of age,SBP,DBP,WC,HC,WHR,WHtR in PHT2 group were higher than those in PHT1 group( t = 2. 429 ~15. 638,P < 0. 05). The prevalence of dangerous age,with positive family history of EH,drinking,smoking,low HDL- C( high density lipoprotein cholesterol),abdominal obesity and MS in PHT2 group were higher than those in PHT1 group( χ2=4. 771 ~ 89. 389,P < 0. 05). 5In the ten risk factors for CVD,the mean of risk factors under clustering in PHT1 and PHT2 were3. 8 and 4. 3,respectively. The prevalence of PHT1 and PHT2 with 5 and above risk factors were 29. 8% and 54. 4% respectively( χ2= 27. 940,P < 0. 01). Conclusion The prevalence of PHT in Miao ethnic group in Longlin County is lower then that of in China,the prevalence of PHT1 was higher than that of PHT2,and they have many obvious difference in clinical manifestation.
引文
[1]李天资,梁烨,潘兴寿,等.广西百色市不同民族高血压患病率及其与代谢综合征的关系[J].中华内分泌代谢杂志,2011,27(3):234-236.
[2]黄裕立,邱文克,刘长华,等.中国广东省顺德地区高血压前期的流行情况及其危险因素调查[J].英国医学杂志(中文版),2015,18(1):29-33.
[3]陶国高,刘桂岚.高血压前期分级与心脑血管疾病的关系及干预方法的研究进展[J].实用心脑肺血管病杂志,2016,24(4):1-4.
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[5]陶国高,陆海平,黄胜立,等.广西百色市隆林县苗族高血压流行特征与防控对策的研究[J].右江医学,2015,43(4):409-414.
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[7]陈灏珠,林果为,王吉耀.实用内科学(上册)[M].14版.北京:人民卫生出版社,2013:1023-1027.
[8]温潇潇,麦劲壮,高向民,等.成人中心性肥胖的腰围切点分析[J].中华心血管病杂志,2015,43(9):822-826.
[9]赵润栓,平昭,郭晔炳,等.成年人腰臀比与人体反应速度的相关性分析[J].现代医学,2014,42(2):125-127.
[10]ASHWELL M,GUNN P,GIBSON S.Waist-to-height ratio is a better screeing toll than waist Circumference and BMI for adult cardiometabolic risk factors:systematic review and meta-analysis[J].Obes Rev,2012,13(3):275-286.
[11]王天星,王明慧,赵薇,等.承德市成人居民高血压患病水平及危险因素调查[J].医学动物防制,2016,32(1):78-80.
[12]张秀云,孙晓华,贾潜龙,等.北京市平谷区2015年全民健康生活方式行动现况调查分析[J].医学动物防制,2016,32(6):610-613.
[13]王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408-412.
[14]金楠,李革,李会,等.中国大陆地区成年人高血压前期发生率及危险因素的meta分析[J].南方医科大学学报,2013,33(12):1738-1743.
[15]张小飞,蔡乐,崔文龙,等.云南少数民族正常高值血压、高血压患病与体重指数和腰围关系的对比分析[J].现代预防医学,2015,42(17):3218-3221.
[16]HUANG Y,SU L,CAI X,et al.Association of all-cause and cardiovascular mortality with prehypertension:a mata-analysis[J].Am Heart J,2014,167(2):160-168.
[17]李颖.高血压前期的防治研究进展[J].实用心脑肺血管病杂志,2012,20(8):125-126.
[18]郭琳,聂连涛,李中健.高血压前期与自主神经功能改变关系分析[J].中国全科医学,2014,17(34):4087-4089.
[19]周慧,胡晓抒,郭志荣,等.高血压前期的血压水平与多代谢异常的关系[J].中华流行病学杂志,2005,26(11):892-896.
[20]GUPTA P,NAGARAJU SP,GUPTA A,et al.Prehypertension-time to act[J].Saudi J Kideny Dis Transpl,2012,23(2):223-233.
[21]孙玉萍,张晓进,荣卫,等.哈萨克族受检人群代谢综合征检出率及性别差异的研究[J].国际检验医学杂志,2016,37(10):1305-1307.
[22]吴寿岭,阮春雨,李冬青,等.高血压前期人群中代谢综合征发生情况[J].中华高血压杂志,2010,18(4):335-338.
[23]吴寿岭,张颖,阮春雨,等.代谢综合征对高血压前期人群心脑血管事件的影响[J].中华心血管病杂志,2012,40(5):397-401.
[24]叶晓平,伍悦蕾,张廷杰,等.成都市社区居民高血压前期流行病学研究—7288例人群分析[J].四川医学,2013,34(6):909-911.
[25]赵欢欢,孙跃民,姚薇,等.天津市社区正常高值血压居民合并已知高血压危险因素分析[J].中国慢性病预防与控制,2015,23(4):275-278.
[2]黄裕立,邱文克,刘长华,等.中国广东省顺德地区高血压前期的流行情况及其危险因素调查[J].英国医学杂志(中文版),2015,18(1):29-33.
[3]陶国高,刘桂岚.高血压前期分级与心脑血管疾病的关系及干预方法的研究进展[J].实用心脑肺血管病杂志,2016,24(4):1-4.
[4]XU T,LIN J,ZHU G,et al.Prevaence of prehypertension and associated risk factors among Chinese aduts from a large-scale population survey[J].BMC Public Health,2016,16(1):775-782.
[5]陶国高,陆海平,黄胜立,等.广西百色市隆林县苗族高血压流行特征与防控对策的研究[J].右江医学,2015,43(4):409-414.
[6]王文.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):18-40.
[7]陈灏珠,林果为,王吉耀.实用内科学(上册)[M].14版.北京:人民卫生出版社,2013:1023-1027.
[8]温潇潇,麦劲壮,高向民,等.成人中心性肥胖的腰围切点分析[J].中华心血管病杂志,2015,43(9):822-826.
[9]赵润栓,平昭,郭晔炳,等.成年人腰臀比与人体反应速度的相关性分析[J].现代医学,2014,42(2):125-127.
[10]ASHWELL M,GUNN P,GIBSON S.Waist-to-height ratio is a better screeing toll than waist Circumference and BMI for adult cardiometabolic risk factors:systematic review and meta-analysis[J].Obes Rev,2012,13(3):275-286.
[11]王天星,王明慧,赵薇,等.承德市成人居民高血压患病水平及危险因素调查[J].医学动物防制,2016,32(1):78-80.
[12]张秀云,孙晓华,贾潜龙,等.北京市平谷区2015年全民健康生活方式行动现况调查分析[J].医学动物防制,2016,32(6):610-613.
[13]王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408-412.
[14]金楠,李革,李会,等.中国大陆地区成年人高血压前期发生率及危险因素的meta分析[J].南方医科大学学报,2013,33(12):1738-1743.
[15]张小飞,蔡乐,崔文龙,等.云南少数民族正常高值血压、高血压患病与体重指数和腰围关系的对比分析[J].现代预防医学,2015,42(17):3218-3221.
[16]HUANG Y,SU L,CAI X,et al.Association of all-cause and cardiovascular mortality with prehypertension:a mata-analysis[J].Am Heart J,2014,167(2):160-168.
[17]李颖.高血压前期的防治研究进展[J].实用心脑肺血管病杂志,2012,20(8):125-126.
[18]郭琳,聂连涛,李中健.高血压前期与自主神经功能改变关系分析[J].中国全科医学,2014,17(34):4087-4089.
[19]周慧,胡晓抒,郭志荣,等.高血压前期的血压水平与多代谢异常的关系[J].中华流行病学杂志,2005,26(11):892-896.
[20]GUPTA P,NAGARAJU SP,GUPTA A,et al.Prehypertension-time to act[J].Saudi J Kideny Dis Transpl,2012,23(2):223-233.
[21]孙玉萍,张晓进,荣卫,等.哈萨克族受检人群代谢综合征检出率及性别差异的研究[J].国际检验医学杂志,2016,37(10):1305-1307.
[22]吴寿岭,阮春雨,李冬青,等.高血压前期人群中代谢综合征发生情况[J].中华高血压杂志,2010,18(4):335-338.
[23]吴寿岭,张颖,阮春雨,等.代谢综合征对高血压前期人群心脑血管事件的影响[J].中华心血管病杂志,2012,40(5):397-401.
[24]叶晓平,伍悦蕾,张廷杰,等.成都市社区居民高血压前期流行病学研究—7288例人群分析[J].四川医学,2013,34(6):909-911.
[25]赵欢欢,孙跃民,姚薇,等.天津市社区正常高值血压居民合并已知高血压危险因素分析[J].中国慢性病预防与控制,2015,23(4):275-278.