肥胖指标及血压身高比对城市学龄儿童高血压的预测作用研究

发布时间：2018-04-13 02:30

本文选题：儿童青少年 + 肥胖　；参考：《山东大学》2014年硕士论文

【摘要】：研究目的： 1比较不同肥胖指标,包括体质指数(BMI)、腰围(WC)和腰围身高比(WHtR)对儿童高血压的预测效果。 2探讨血压身高比(BPHR)对儿童高血压的预测效果。对象与方法： 1.研究对象选取济南市市区中等水平中小学校学生作为研究对象,要求本市户籍或一年以上常住人口,年龄为6-17岁。采用方便整群抽样的方法,共抽取了济南市4所学校,其中小学2所,初中1所,高中1所。共获得有效样本8378人,男生4245人,女生4133人,男女比接近1：1。 2.研究方法对研究对象进行问卷调查和体格检查。问卷内容主要包括调查对象的基本情况、出生信息、膳食习惯及疾病家族史等,体格检查主要包括身高、体重、WC、收缩压(SBP)、舒张压(DBP)、心率等,并计算BMI、WHtR、收缩压身高比(SBPHR)和舒张压身高比(DBPHR)。分别参照“2-18岁儿童超重、肥胖筛查BMI界值点标准”、“7-18岁中国学龄儿童青少年腰围界值点标准”和‘'WHtR国际标准(以0.5为临界值)”,来划分肥胖类型,根据“中国儿童高血压的诊断标准”划分儿童高血压。所有仪器在使用前进行校正,调查员在调查前进行统一培训,在整个调查中有专门的质控员进行质控,从而保证测量结果的准确性。 3.统计分析采用Epidata软件进行数据双录入,采用SPSS13.0软件和MedCalc软件进行统计学分析。性别间各个测量指标均数的比较采用t检验,组间率的比较采用χ2检验,指标间的相关性采用Pearson相关分析,各肥胖指标与血压关系采用偏相关分析和多元线性回归分析,各肥胖指标对高血压的预测效果采用多因素Logistic回归分析和ROC曲线分析。BPHR对儿童高血压的预测效果采用ROC曲线分析。研究结果 1儿童不同类型肥胖患病率 (1)参照“2-18岁儿童超重、肥胖筛查BMI界值点标准”,总体的超重患病率为19.1%,其中男生为20.0%,女生为18.2%,总体的肥胖患病率为18.9%,男生为23.9%,女生为13.8%,超重和肥胖患病率均为男生高于女生(P0.05)。 (2)参照“7-18岁中国学龄儿童青少年腰围界值点标准”,总体的腹型肥胖患病率为28.3%,其中男生为32.5%,女生为24.1%,男生高于女生(P0.001)。 (3)参照“WHtR国际标准”,总体的腹型肥胖患病率为19.1%,其中男生为26.2%,女生为11.9%。男生高于女生(P0.001)。 2.儿童高血压患病率参照“中国儿童高血压的诊断标准”,总体的患病率为16.7%,其中男生高血压患病率为20.1%,女生为13.1%,男生高于女生(P0.001)。 3各肥胖指标对高血压的预测作用 (1)偏相关分析结果显示,控制年龄后,SBP和DBP与各肥胖指标均存在相关性(P0.001)。各肥胖指标与SBP或DBP的偏相关系数由大到小依次为BMI、WC和WHtR。按男女进行亚组分析,趋势保持不变。 (2)多元线性回归分析显示,控制年龄后,SBP和DBP与各肥胖指标密切相关(P0.001),各肥胖指标对SBP或DBP的回归系数由大到小依次为BMI、WC、 WHtR。按男女进行亚组分析,趋势保持不变。 (3)Logistic回归分析显示,控制年龄后,高血压、收缩期高血压和舒张期高血压的发病风险均随着各肥胖指标的增高而增加,各肥胖指标预测高血压的比值比(OR)由大到小依次为BMI、WC、WHtR。按男女进行亚组分析,趋势保持不变。 (4)各肥胖指标预测高血压、收缩期高血压和舒张期高血压的ROC曲线下的面积(AUC)均高于0.7(对舒张期高血压的预测除外),提示各肥胖指标对高血压的预测效果较好,且BMI的预测效果略优于WC和WHtR。按男女进行亚组分析,趋势保持不变。 4. BPHR对儿童高血压的预测作用 (1) SBPHR与SBP, DBPHR与DBP存在着密切相关性。 (2)以SBPHR对收缩期高血压进行预测,男生各年龄组AUC为0.943-0.995,灵敏度为0.818-0.976,特异度为0.828-0.930；女生各年龄组AUC为0.941-0.982,灵敏度为0.886-1,特异度为0.761-0.930。以DBPHR对舒张期高血压进行预测,男生各年龄组AUC为0.979-0.995,灵敏度为0.957-1,特异度为0.873-0.989；女生各年龄组AUC为0.975-0.998,灵敏度为0.875-1,特异度为0.919-0.992。 (3)联合运用SBPHR和DBPHR预测总体高血压,其灵敏度为0.956,特异度为0.848,提示BPHR对高血压有很好的预测效果。研究结论 1.济南市6～17岁学龄儿童的各种类型肥胖患病率和高血压患病率均处于国内较高的水平。 2.BMI、WC和WHtR均对高血压有较好的预测作用,BMI略优于WC和WHtR,可用于高血压的早期预警。 3. SBPHR和DBPHR对高血压有很好的预测效果,是预测儿童高血压的简单而且准确的指标。
[Abstract]:The purpose of the study is:
1 the effects of different obesity indicators, including body mass index (BMI), waist circumference (WC) and waist height ratio (WHtR), were compared to predict the effect of hypertension in children.
2 to investigate the predictive effect of blood pressure and height ratio (BPHR) on hypertension in children.
Objects and methods:
1. research objects
Selecting Ji'nan city middle level in primary and middle school students as the research object, requirements for household registration in the city for more than one year or the resident population, age 6-17. By convenient cluster sampling, a total sample of 4 schools in Ji'nan City, the 2 primary school, 1 junior middle schools, 1 high school received a total of 8378 valid samples. People, 4245 boys and 4133 girls, male and female ratio close to 1:1.
2. research methods
A questionnaire survey and physical examination of the object of study. The main contents of the questionnaire include the basic situation of the survey of birth information, dietary habits and family history of the disease, physical examination including height, weight, WC, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and calculate the BMI, WHtR, systolic blood pressure height ratio (SBPHR) and diastolic blood pressure (DBPHR) were taller than. Refer to "overweight children 2-18 years of age, obesity screening BMI value standard", "the 7-18 year old Chinese school-age children and adolescents WC cut-off point standard and the international standard"'WHtR "(0.5 of the critical value), divided according to the type of obesity." hypertension diagnosis standard of hypertension in children "Chinese divided children. All the instruments calibrated before use, investigators were trained in the investigation, in the investigation of the quality control staff special quality control, so as to ensure the accuracy of the measurement results.
3. statistical analysis
Epidata software is used to record data, and SPSS13.0 software and MedCalc software are used for statistical analysis.
Compared with the gender of each measurement indicators are the number of t test between groups was compared using the 2 test, correlation analysis using Pearson correlation between blood pressure and obesity indices by partial correlation analysis and multivariate linear regression analysis, the prediction effect of the obesity index on hypertension by multi factor analysis and prediction effect of.BPHR children with hypertension by ROC curve analysis Logistic regression analysis and ROC curve.
Research results
Prevalence of different types of obesity in 1 children
(1) refer to "overweight children 2-18 years of age, obesity screening BMI value standard, the overall prevalence of overweight was 19.1%, and 20% for boys and 18.2% for girls, the overall prevalence rate of obesity was 18.9%, 23.9% for boys and 13.8% for girls, the prevalence of overweight and obesity were higher in boys than girls (P0.05).
(2) referring to the "7-18 year old Chinese school age children's waist circumference boundary value standard", the overall prevalence of abdominal obesity is 28.3%, of which boys are 32.5%, girls are 24.1%, boys are higher than girls (P0.001).
(3) referring to the "WHtR international standard", the overall prevalence rate of abdominal obesity was 19.1%, among which boys were 26.2% and girls were higher than girls (P0.001) for 11.9%..
2. children's prevalence of hypertension
According to the diagnostic criteria of Chinese children's hypertension, the overall prevalence rate is 16.7%. The prevalence rate of hypertension among boys is 20.1%, girls are 13.1%, boys are higher than girls (P0.001).
The predictive effect of 3 obesity indexes on hypertension
(1) partial correlation analysis showed that after controlling age, there was a correlation between SBP and DBP and obesity indexes (P0.001). The partial correlation coefficients between obesity index and SBP or DBP were BMI from large to small, and WC and WHtR. were subdivided by men and women, and the trend remained unchanged.
(2) multiple linear regression analysis showed that after controlling age, SBP and DBP were closely related to each obesity index (P0.001). The regression coefficients of obesity indicators for SBP or DBP ranged from large to small in order of BMI, WC and WHtR. according to the subgroup analysis of men and women, and the trend remained unchanged.
(3) Logistic regression analysis showed that after controlling for age, hypertension, risk of systolic hypertension and diastolic hypertension were increased with the increase of the obesity index and predict hypertension ratio of the obesity index (OR) followed by BMI, WC, WHtR. subgroup analysis was carried out by the men and women, the trend remains unchanged.
(4) prediction of hypertension obesity indices, the ROC curve of systolic hypertension and diastolic hypertension under the area (AUC) were higher than 0.7 (except for the prediction of diastolic blood pressure), suggesting that the prediction effect of the obesity index on hypertension is better, while the predicted effect of BMI on WC and WHtR. slightly better by the men and women of subgroup analyses the trend remains unchanged.
Predictive effect of 4. BPHR on hypertension in children
(1) there is a close correlation between SBPHR and SBP, DBPHR and DBP.
(2) the systolic hypertension to predict SBPHR, male AUC of each age group is 0.943-0.995, sensitivity is 0.818-0.976, the specificity was 0.828-0.930; the girls in each age group AUC is 0.941-0.982, sensitivity is 0.886-1, the specificity of 0.761-0.930. to DBPHR on diastolic hypertension predict boys in each age group was 0.979-0.995 AUC, the sensitivity was 0.957-1. The specificity of 0.873-0.989; girls in each age group AUC is 0.975-0.998, sensitivity is 0.875-1, the specificity was 0.919-0.992.
(3) combined use of SBPHR and DBPHR to predict overall hypertension with a sensitivity of 0.956 and a specificity of 0.848, suggesting that BPHR has a good predictive effect on hypertension.
research conclusion
1. the prevalence rate of various types of obesity and the prevalence rate of hypertension at 6~17 year old school age children in Ji'nan are all at a higher level in China.
2.BMI, WC and WHtR have a good predictive effect on hypertension. BMI is slightly better than WC and WHtR, which can be used for early warning of hypertension.
3. SBPHR and DBPHR have a good predictive effect on hypertension. It is a simple and accurate indicator for predicting high blood pressure in children.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4;R723.14

【参考文献】