青少年血压评价以及血压身高指数对青少年高血压的识别与预测研究

发布时间：2018-03-28 00:01

本文选题：青少年　切入点：身高　出处：《华中科技大学》2015年博士论文

【摘要】：研究目的 (1)比较不同年龄、性别和身高别青少年血压水平的差异,探讨青少年身高、年龄和性别对青少年血压评价的作用。 (2)探讨2010年中国儿童青少年高血压诊断标准与2004年美国儿童青少年血压评判标准比较12-17岁长沙市青少年高血压患病率的差别。 (3)研究血压身高指数(BPHRI)对青少年高血压的识别和预测价值,探讨12-17岁青少年高血压评价BPHRI临界值,为青少年高血压的诊断和预防提供理论依据。对象与方法 1.研究对象采用整群随机抽样的方法抽取长沙市的49所中学(共80所中学,包括65所初中和15所高中)初一至高二的全部12-17岁的青少年中学生作为本次研究的对象,共66481人,包括33483名女生(50.4%)和32998名男生(49.6%)。其中第一部分研究中排除了7656名超体重和3285名肥胖的青少年青少年。 2.研究方法 (1)测量研究对象身高(cm)、体重(kg)和收缩压(Korotkoff第I音)舒张压(Korotkoff第V音)。 (2)通过分组匹配的方法,分别探讨青少年身高、性别和年龄在青少年青少年血压水平变化过程中的作用。 (3)按“中国学龄儿童青少年超体重、肥胖筛查BMI分类标准”进行超体重和肥胖判定。 (4)分别参照中国青少年标准身高和美国CDC2000发布的青少年身高标准将研究对象身高进行标准化转换； (5)分别参照“中国3-17岁儿童青少年血压参照标准”和"2004年美国儿童青少年高血压评价诊断标准”,按青少年收缩压(SBP)和(或)舒张压(DBP)平均值大于等于同年龄、同性别、同身高(采用美国标准时考虑)的第95百分位数血压临界值者定义为儿童青少年高血压。 (6)按如下公式计算收缩压身高指数(Systolic blood pressure to height ratio index, SBPHRI)和舒张压身高指数(Diastolic blood pressure to height ratio index, DBPHRI): SBPHRI=收缩压(mmHg)/身高(cm), DBPHRI=舒张压(mmHg)/身高(cm)。 3.统计分析方法采用SPSS19.0软件包对原始数据进行整理和统计分析。采用t检验、方差分析、χ2检验、Pearson相关分析、多元线性回归分析对数据进行统计推断分析。kappa值用于评价两种血压评价判定结果一致性；采用ROC曲线分析BPHRI对青少年高血压的预测效果。研究结果第一部分 (1)随着青少年年龄的增长,男女生身高、收缩压以及舒张压均逐渐增长；各年龄组男生的身高、收缩压和舒张压均显著高于同年龄段的女生(P0.001)。 (2)通过匹配控制年龄和身高后,青少年男生收缩压与舒张压仍然显著高于同年龄段同身高的青少年女生(P0.001); (3)进行身高匹配后,青少年男女生的收缩压和舒张压仍随年龄的增长而显著升高(相邻年龄组血压均值比较,P均0.001)； (4)对青少年男女生进行年龄和性别匹配后,各年龄组青少年男女生收缩压与舒张压水平均随身高的增长而显著上升(P0.001)； (5)多元线性回归模型分析结果表明,青少年的身高水平对青少年收缩压(β=0.24,P0.001)以及舒张压(β=0.18,P0.001)的影响明显大于其年龄(SBP,β=0.15; DBP, β=0.12, P0.001)和性别(SBP, β=021; DBP, β=0.13, P＜0.001)的影响,决定系数R2=0.56和0.62,P0.001. 第二部分 (1)参照中国标准时,青少年男生高血压总患病率为14.3%,女生为10.4%；显著高于美国标准下,男生高血压总患病率为2.6%,女生为6.0%；随着男女生年龄的增加,采用两种血压标准计算得出的高血压患病率均呈现显著上升的趋势(P0.001)。 (2)各年龄段男女生参照中美两种血压标准判定的高血压患病率随身高百分位数的上升呈现明显上升的趋势,且两种血压标准判定的高血压患病率间的差别随年龄增大及身高百分位数上升而显著增大(P0.001)； (3)两种高血压标准在判断女生收缩期以及男女生舒张期高血压的一致性均较微弱(Kappa值分别为0.145、0.208和0.198,一致性检验P均0.001)；而两种诊断标准在判断男生收缩期高血压的一致性为中度强度(Kappa值为0.529,一致性检验P0.001)。第三部分 (1)男生的SBPHRI/DBPHRI均值为0.648/0.413,女生SBPHRI/DBPHRI均值为0.638/0.416,男女性别及年龄之间的差距极其微小,但仍有显著性统计学意义(P0.001) (2)相关性分析结果显示,BPHRI与青少年身高呈显著负相关、与收缩压及舒张压呈极强的正相关,而与男生年龄呈弱相关(SBP, r=0.024; DBP, r=0.048; P均0.001),与女生年龄无相关性。 (3) SBPHRI和DBPHRI对高血压最佳诊断临界值为男生0.76/0.48,女生0.74/0.47。SBPHRI对男生收缩期高血压预测的AUC为0.996-0.997,灵敏度为0.982-0.985,特异度为0.967-0.978；对女生收缩期高血压预测的AUC为0.993-0.994,灵敏度为0.947-0.973,特异度为0.928-0.934; DBPHRI对男生舒张期高血压预测的AUC为0.987-0.995,灵敏度为0.969-0.987,特异度为0.925-0.974；对女生舒张期高血压预测的AUC为0.991-0.992,灵敏度为0.950-0.966,特异度为0.915-0.928。年龄段男女生BPHRI对高血压预测的阴性预测值NPV均接近于1.00,阳性预测值PPV也在0.30-0.60之间,也表明SBPHRI和DBPHRI对相应对青少年高血压具有较好的预测作用。研究结论性别、年龄和身高均对青少年的血压水平产生显著而又独立的影响,且身高对血压的影响最大,在制定青少年血压参照标准时应当综合考虑性别、年龄,尤其是身高等三个指标的影响。中美两种儿童青少年血压评价标准对本次青少年高血压诊断结果的一致性较差；中国评价标准下青少年高血压的患病率显著高于美国标准,且两种标准下高血压的患病率的差别随青少年年龄和身高增加而相应增大；美国标准考虑了儿童青少年身高因素,在高血压诊断上比中国标准更加精确；中国标准未考虑身高因素,容易造成对身高明显偏高青少年高血压的误诊和身高明显偏低青少年高血压的漏诊。 12-17岁青少年BPHRI水平受青少年性别和年龄的影响较小,对青少年高血压具有极好的识别和预测价值,是高血压简单而且准确的诊断指标。
[Abstract]:research objective
(1) to compare the difference of blood pressure in adolescents with different ages, sex and height, and to explore the effect of adolescent height, age and sex on the evaluation of young people's blood pressure.
(2) to explore the difference between the diagnostic criteria of hypertension in Chinese children and adolescents in 2010 and the standard of blood pressure assessment for children and adolescents in the United States in 2004. The prevalence of hypertension among adolescents aged 12-17 years old in Changsha is different.
(3) to study the value of blood pressure and height index (BPHRI) in identifying and predicting hypertension in adolescents, and to explore the critical value of BPHRI in 12-17 year old adolescents, so as to provide a theoretical basis for diagnosis and prevention of hypertension in adolescents.
Object and method
1. research objects
49 middle schools by using cluster random sampling method to extract Changsha city (a total of 80 schools, including 65 junior high schools and 15 high schools) middle school all 12-17 years old young high school students as the research object, a total of 66481 people, including 33483 girls and 32998 boys (50.4%) (49.6%) the first part of the study. The exclusion of 7656 overweight and 3285 obese adolescents.
2. research methods
(1) measure the subjects' height (CM), body weight (kg) and systolic pressure (Korotkoff I sound) diastolic pressure (Korotkoff V sound).
(2) the role of height, sex and age of adolescents in the change of blood pressure in adolescents was investigated by group matching.
(3) super weight and obesity were determined according to the "BMI classification standard for overweight and obesity screening in Chinese school-age children and adolescents."
(4) according to the standard height of Chinese teenagers and the height standards of young people in the United States CDC2000, the height of the study was standardized.
(5) respectively according to "blood pressure of children aged 3-17 China youth reference standard" and "American children and adolescents 2004 hypertension diagnostic evaluation standard", according to the systolic blood pressure (SBP) and adolescents (or) diastolic blood pressure (DBP) the average value is greater than or equal to the same age, same sex, same height (the American Standard) ninety-fifth percentile of blood pressure is defined as the critical value of hypertension in children and adolescents.
(6) according to the following formula to calculate the systolic blood pressure height index (Systolic blood pressure to height ratio index, SBPHRI) and diastolic blood pressure height index (Diastolic blood pressure to height ratio index, DBPHRI SBPHRI=): systolic blood pressure (mmHg) / height (CM), DBPHRI= Shu Zhang Ya (mmHg) / height (CM).
3. statistical analysis method
Packet sorting and statistical analysis of the original data by SPSS19.0 software. Using t test, variance analysis, 2 test, Pearson correlation analysis, multiple linear regression analysis of data for statistical inference analysis.Kappa value used for the evaluation of two blood pressure evaluation results consistency; mining analysis and forecast effect of BPHRI on hypertension in adolescents with ROC curve.
Research results
Part one
(1) with the growth of adolescent age, the height, systolic blood pressure and diastolic blood pressure of boys and girls increased. The height, systolic blood pressure and diastolic blood pressure of boys in all age groups were significantly higher than those of girls of the same age group (P0.001).
(2) after matching the control age and height, the systolic and diastolic pressure of young boys was still significantly higher than that of young girls with the same age as the same height (P0.001).
3. After height matching, the systolic blood pressure and diastolic blood pressure of young boys and girls still increased with age. (the mean value of blood pressure in adjacent age group was 0.001, P).
(4) after matching age and sex between boys and girls, systolic blood pressure and diastolic blood pressure of boys and girls in different age groups increased significantly with height growth (P0.001).
(5) the results of multiple linear regression model showed that adolescent height level of adolescent systolic blood pressure (beta =0.24, P0.001) and diastolic pressure (beta =0.18, P0.001) was significantly greater than the impact of age (SBP, =0.15, DBP, beta; beta =0.12, P0.001) and gender (SBP, P = 021; DBP. Beta =0.13, P < 0.001) the influence of the coefficient of determination R2=0.56 and 0.62, P0.001.
The second part
(1) China reference standard, the total prevalence rate of hypertension in young boys 14.3%, girls 10.4%; boys was significantly higher than the American Standard, the total prevalence rate of hypertension was 2.6%, female was 6%; male and female students increased with age, the prevalence rate of high blood pressure with two blood pressure standard calculated showed a significant upward trend (P0.001).
(2) boys and girls of all ages to Sino US two blood pressure criteria the prevalence rate of hypertension increased with the increase of height percentile, and the two kinds of blood pressure standard to determine the prevalence of hypertension increases with age and the difference between the height percentile increased significantly (P0.001);
(3) two kinds of hypertension in judging the standard of girls and boys systolic diastolic hypertension were relatively weak consistency (Kappa = 0.145,0.208 and 0.198 respectively, the consistency test P 0.001); and two diagnostic criteria in judging the consistency of boys for systolic hypertension intensity (Kappa = 0.529, consistency test P0.001).
The third part
(1) the average SBPHRI/DBPHRI of boys is 0.648/0.413, and the average SBPHRI/DBPHRI of girls is 0.638/0.416. The difference between men and women is very small, but there is a significant statistical difference (P0.001).
(2) correlation analysis showed that BPHRI had a significant negative correlation with adolescent height, a strong positive correlation with systolic blood pressure and diastolic blood pressure, but weakly correlated with male age (SBP, r=0.024, DBP, r=0.048, P all 0.001), and had no correlation with girls' age.
(3) SBPHRI and DBPHRI on hypertension optimal diagnostic critical value of male 0.76/0.48, female 0.74/0.47.SBPHRI male systolic hypertension predicted AUC 0.996-0.997, sensitivity is 0.982-0.985, the specificity was 0.967-0.978; the female systolic hypertension predicted AUC 0.993-0.994, sensitivity is 0.947-0.973, the specificity was 0.928-0.934; DBPHRI of male diastolic hypertension predicted AUC for 0.987-0.995, the sensitivity is 0.969-0.987, the specificity was 0.925-0.974; the girls diastolic hypertension predicted AUC 0.991-0.992, sensitivity is 0.950-0.966, the specificity of 0.915-0.928. age of male and female students of BPHRI negative predictive value NPV of hypertension are close to 1, the positive predictive value of PPV is between 0.30-0.60, SBPHRI and DBPHRI also showed the corresponding the blood pressure has good prediction effect.
research conclusion
Gender, age and height all have significant and independent effects on blood pressure level of adolescents, and height has the greatest impact on blood pressure. When making the reference standard of adolescent blood pressure, we should take into consideration the influence of three indicators, such as gender, age, especially height.
The two children's blood pressure evaluation standard for the poor consistency of adolescent hypertension diagnosis results; the prevalence rate of hypertension Chinese evaluation standard of adolescents was significantly higher than that of American Standard, and the two kinds of differences in the rate of prevalence of hypertension in adolescents with standard age and body height increased; the standard considers height factors in children and adolescents in the diagnosis of hypertension, than the standard Chinese more accurate; China standard does not consider the height factor, easily lead to significantly higher height of adolescent hypertension is significantly lower misdiagnosis and missed diagnosis of height of adolescent hypertension.
The BPHRI level of 12-17 year olds is less affected by the sex and age of adolescents. It has excellent identification and predictive value for adolescent hypertension, and is a simple and accurate diagnostic index for hypertension.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R544.1

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