基于不同血压参照标准的儿童高血压检出率比较
|
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。
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 Ma2017. The agreement of high SBP was higher between Mi 2017 and America 2017 than that between Ma2017 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 Mi2017 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.
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 Ma2017. The agreement of high SBP was higher between Mi 2017 and America 2017 than that between Ma2017 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 Mi2017 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.
引文
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(01):1-8.Chen WW,Gao RL,Liu LS,et al.China cardiovascular disease report(outline)[J].Chinese Circulation Journal,2018,33(01):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.
[2]Patel P,Ordunez P,Connell K,et al.Standardized hypertension management to reduce cardiovascular disease morbidity and mortality worldwide[J].South Med J,2018,111(3):133-136.DOI:10.14423/SMJ.0000000000000776
[3]赵地,张明明,陈芳芳,等.儿童期高血压对成年期罹患高血压的预测研究[J].北京医学,2008,30(11):657-660.Zhao D,Zhang MM,Chen FF,et al.The prediction of elevated blood pressure in childhood for adult hypertension[J].Beijing Medical Journal,2008,30(11):657-660.DOI:10.15932/j.0253-9713.2008.11.026
[4]刘力生.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.Liu LS.2010 Chinese guidelines for the management of hypertension[J].Chin J Hypertens,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.
[5]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.Mi J,Wang TY,Meng LH,et al.Development of blood pressure reference standards for Chinese children and adolescents[J].Chin J Evid Based Pediatr,2010,5(01):4-14.DOI:10.3969/j.issn.1673-5501.2010.01.002.
[6]范晖,闫银坤,米杰.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(05):428-435.Fan H,Yan YK,Mi J.Updating blood pressure references for Chinese children aged 3-17 years[J].Chin J Hypertens,2017,25(5):428-435.DOI:10.16439/j.cnki.1673-7245.2017.05.009.
[7]Dong Y,Ma J,Song Y,et al.National blood pressure reference for Chinese Han children and adolescents aged 7 to 17 years novelty and significance[J].Hypertension,2017,70(5):897-906.DOI:10.1161/HYPERTENSIONAHA.117.09983.
[8]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[J].Pediatrics,2004,114(suppl2):555-576.DOI:10.1542/peds.114.2.S2.555.
[9]Flynn JT,Kaelber DC,Baker-Smith CM,et al.Subcommittee on screening and management of high blood pressure in children.clinical practice guideline for screening and management of high blood pressure in children and adolescents[J].Pediatrics,2017,140(3):e20171904.DOI:10.1542/peds.2017-3035.
[10]Sharma AK,Metzger DL,Rodd CJ.Prevalence and severity of high blood pressure among children based on the 2017 American academy of pediatrics guidelines[J].JAMA Pediatrics,2018,172(6):557-565.DOI:10.1001/jamapediatrics.2018.0223.
[11]熊宗璠.配对计数资料的Kappa统计量[J].临床检验杂志,1992,10(2):101-102.Xiong ZF.Kappa statistics for paired count data[J].Journal of Clinical Laboratory Science,1992,10(2):101-102.DOI:10.13602/j.cnki.jcls.1992.02.038.
[12]Watson P F,Petrie A.Method agreement analysis:a review of correct methodology[J].Theriogenology,2010,73(9):1167-1179.DOI:10.1016/j.theriogenology.2010.01.003.
[13]陆慧,沈冲,赵启慧,等.儿童青少年血压偏高和高血压与心理行为因素关系的研究[J].中华疾病控制杂志,2014,18(8):736-739.Lu H,Shen C,Zhao QH,et al.Study on the relationship between psychological behavior factors and blood pressure elevation and hypertension in children and adolescents[J].Chin Dis Control Prev,2014,18(8):736-739.
[14]母昌垒,张艳,刘晓强,等.我国儿童青少年高血压流行病学及影响因素研究进展[J].中华高血压杂志,2018,26(1):20-24.Mu CL,Zhang Y,Liu XQ,et al.Research progress on epidemiology and influencing factors of hypertension in children and adolescents in China[J].Chin J Hypertens,2018,26(1):20-24.DOI:10.16439/j.cnki.1673-7245.2018.01.014.
[15]Mourato FA,Mattos SS,Lima Filho JL,et al.Height-based equations can improve the diagnosis of elevated blood pressure in children[J].Am J Hypertens,2018,31(9):1059-1065.DOI:10.1093/ajh/hpy028.
[16]Nerenberg KA,Zarnke KB,Leung AA,et al.Hypertension Canada’s 2018 guidelines for diagnosis,risk assessment,prevention,and treatment of hypertension in adults and children[J].Canadian Journal of Cardiology,2018,34(5):506-525.DOI:10.1016/j.cjca.2018.02.022.
[17]马玉霞.社会经济地位及膳食相关因素对我国九省区成年居民血压状况的影响研究(1991-2009)[D].北京:中国疾病预防控制中心,2011:105-108.Ma YX.The impact of socioeconomic status and dietary-related factors on blood pressure among adults in 9 provinces of China(1991-2009)[D].Beijing:Chinese center for disease control and prevention,2011:105-108.
[18]娄东辉,陆强,史文宗,等.秦皇岛市儿童应用中国和美国儿童高血压诊断标准的比较[J].中华高血压杂志,2012,20(8):733-737.Lou DH,Lu Q,Shi WZ,et al.Chinese and American diagnostic criterions for hypertension applied in children of qinhuang dao city:a comparative study[J].Chin J Hypertens,2012,20(08):733-737.DOI:10.16439/j.cnki.1673-7245.2012.08.037.
[2]Patel P,Ordunez P,Connell K,et al.Standardized hypertension management to reduce cardiovascular disease morbidity and mortality worldwide[J].South Med J,2018,111(3):133-136.DOI:10.14423/SMJ.0000000000000776
[3]赵地,张明明,陈芳芳,等.儿童期高血压对成年期罹患高血压的预测研究[J].北京医学,2008,30(11):657-660.Zhao D,Zhang MM,Chen FF,et al.The prediction of elevated blood pressure in childhood for adult hypertension[J].Beijing Medical Journal,2008,30(11):657-660.DOI:10.15932/j.0253-9713.2008.11.026
[4]刘力生.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.Liu LS.2010 Chinese guidelines for the management of hypertension[J].Chin J Hypertens,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.
[5]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.Mi J,Wang TY,Meng LH,et al.Development of blood pressure reference standards for Chinese children and adolescents[J].Chin J Evid Based Pediatr,2010,5(01):4-14.DOI:10.3969/j.issn.1673-5501.2010.01.002.
[6]范晖,闫银坤,米杰.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(05):428-435.Fan H,Yan YK,Mi J.Updating blood pressure references for Chinese children aged 3-17 years[J].Chin J Hypertens,2017,25(5):428-435.DOI:10.16439/j.cnki.1673-7245.2017.05.009.
[7]Dong Y,Ma J,Song Y,et al.National blood pressure reference for Chinese Han children and adolescents aged 7 to 17 years novelty and significance[J].Hypertension,2017,70(5):897-906.DOI:10.1161/HYPERTENSIONAHA.117.09983.
[8]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[J].Pediatrics,2004,114(suppl2):555-576.DOI:10.1542/peds.114.2.S2.555.
[9]Flynn JT,Kaelber DC,Baker-Smith CM,et al.Subcommittee on screening and management of high blood pressure in children.clinical practice guideline for screening and management of high blood pressure in children and adolescents[J].Pediatrics,2017,140(3):e20171904.DOI:10.1542/peds.2017-3035.
[10]Sharma AK,Metzger DL,Rodd CJ.Prevalence and severity of high blood pressure among children based on the 2017 American academy of pediatrics guidelines[J].JAMA Pediatrics,2018,172(6):557-565.DOI:10.1001/jamapediatrics.2018.0223.
[11]熊宗璠.配对计数资料的Kappa统计量[J].临床检验杂志,1992,10(2):101-102.Xiong ZF.Kappa statistics for paired count data[J].Journal of Clinical Laboratory Science,1992,10(2):101-102.DOI:10.13602/j.cnki.jcls.1992.02.038.
[12]Watson P F,Petrie A.Method agreement analysis:a review of correct methodology[J].Theriogenology,2010,73(9):1167-1179.DOI:10.1016/j.theriogenology.2010.01.003.
[13]陆慧,沈冲,赵启慧,等.儿童青少年血压偏高和高血压与心理行为因素关系的研究[J].中华疾病控制杂志,2014,18(8):736-739.Lu H,Shen C,Zhao QH,et al.Study on the relationship between psychological behavior factors and blood pressure elevation and hypertension in children and adolescents[J].Chin Dis Control Prev,2014,18(8):736-739.
[14]母昌垒,张艳,刘晓强,等.我国儿童青少年高血压流行病学及影响因素研究进展[J].中华高血压杂志,2018,26(1):20-24.Mu CL,Zhang Y,Liu XQ,et al.Research progress on epidemiology and influencing factors of hypertension in children and adolescents in China[J].Chin J Hypertens,2018,26(1):20-24.DOI:10.16439/j.cnki.1673-7245.2018.01.014.
[15]Mourato FA,Mattos SS,Lima Filho JL,et al.Height-based equations can improve the diagnosis of elevated blood pressure in children[J].Am J Hypertens,2018,31(9):1059-1065.DOI:10.1093/ajh/hpy028.
[16]Nerenberg KA,Zarnke KB,Leung AA,et al.Hypertension Canada’s 2018 guidelines for diagnosis,risk assessment,prevention,and treatment of hypertension in adults and children[J].Canadian Journal of Cardiology,2018,34(5):506-525.DOI:10.1016/j.cjca.2018.02.022.
[17]马玉霞.社会经济地位及膳食相关因素对我国九省区成年居民血压状况的影响研究(1991-2009)[D].北京:中国疾病预防控制中心,2011:105-108.Ma YX.The impact of socioeconomic status and dietary-related factors on blood pressure among adults in 9 provinces of China(1991-2009)[D].Beijing:Chinese center for disease control and prevention,2011:105-108.
[18]娄东辉,陆强,史文宗,等.秦皇岛市儿童应用中国和美国儿童高血压诊断标准的比较[J].中华高血压杂志,2012,20(8):733-737.Lou DH,Lu Q,Shi WZ,et al.Chinese and American diagnostic criterions for hypertension applied in children of qinhuang dao city:a comparative study[J].Chin J Hypertens,2012,20(08):733-737.DOI:10.16439/j.cnki.1673-7245.2012.08.037.