青少年营养转型期体重指数与血压、血脂、血糖、心脏结构及功能相关关系的队列研究

A cohort study on the relationship between body mass index and blood pressure, blood lipid, blood glucose, left ventricular structure and function in adolescents during transition period

目的应用队列研究方法探讨超重／肥胖学龄儿童在青少年期体重指数(BMI)与血压、血脂、血糖、心脏结构及功能的相关关系。方法采用整群抽样横断面调查与追踪调查的流行病学方法调查北京市健康学龄儿童(7-11岁)与9年后同一观察对象(16-20岁)共193名,于基线时(9年前)及随访时(9年后)对每名学生均测量身高、体重、血压,并均应用生化法于空腹12小时后抽血检查血清总胆固醇、血糖和甘油三酯水平。应用超声心动图方法检测随访时16-20岁学生的心脏结构、血流及功能。根据儿童期BMI值分为儿童期肥胖组、超重组、正常体重组,比较同一观察对象儿童期与青少年期各项指标的变化。结果同一人群青少年期较儿童期血脂、血糖水平无明显差异。儿童期肥胖组较正常体重组于9年后随访时(青少年期)的BMI(24．71 kg／m2±4．57 kg/m2和20．54 kg／m2±2．84 kg／m2)及收缩压(117．22 mm Hg±17．44 mm Hg和102．20 mm Hg±11．68 mm Hg,1 mm Hg=0．133 kPa)明显增高(P<0．001和P<0 05),室间隔增厚(0．87 cm±0.12 cm和0．77 cm±0．12 cm)及左室后壁增厚(0．91 cm±0．13 cm和0．79 cm±0．31 cm)(P<0．01和P<0．05)、左室心肌质量(167．84 g±16．29 g和128．95 g±63．00 g)及左室心肌质量指数(88．12 g／m2±17．19 g／m2和79．35 g／m2±39．01g/m2)明显增加(P值均<0．05),差异有统计学意义;左室舒张末期容积及心输出量增加,射血分数及左室短轴缩短率下降(P值均<0．05),心脏舒张功能各项指标体重正常组与肥胖组及超重组间差异均无统计学意义。结论学龄肥胖儿童较学龄体重正常儿童在成长为青少年后,BMI及血压明显增高,左室壁增厚,左室心肌质量增加,提示儿童期单纯肥胖症是成年后心血管疾病的重要危险因素。

Objective To investigate the relationship between body mass index（BMl） and blood pressure, blood lipid level, blood glucose, left ventricular structure and function in adolescents during transition period. Methods A vertical sectional survey on 193 pupils aged 7-11 years in primary school in 1996 was performed. 9 years later, the same research subjects aged 16-20 years were studied again in 2005. The subjects were divided into obesity, overweight and normal weight groups according to their BMI in 1996. Height, body weight, blood pressure, total cholesterol, triglyceride and blood glucose were collected and analyzed, and left ventricular structure and function were examined by echocardiography. Results Body mass index （ 24.71 kg/m^2±4.57 kg/m^2, 20.54 kg/m^ ±2.84 kg/m^2 ）, systolic blood pressure （117.22 mm Hg±17.44 mm Hg vs. 102.20 mm Hg±11.68 mm Hg）, thickness of inter-ventricular septum and posterior wall （0.87 cm± 0.12 cm vs. 0.77 cm±0.12 era, and 0.91 cm± 0.13 cm vs. 0.79 cm±0.31 cm）,left ventricular mass and mass index （167.84 g±16.29 g vs. 128.95 g± 63.00 g, and 88.12 g/m^2±17.19 g/m^2 vs. 79.35 g/m^2±39.01 g/m^2 ） were found significantly higher in obesity group than in normal weight group 9 years later （P 〈 0.05, P 〈 0.01 or P 〈 0. 001 ）. End diastolic volume and cardiac output were increased（ P〈 0.05） and ejection fraction and fractional shortening decreased（P〈 0.05）. There were no differences found in cardiac diastolic function between the studied groups. Conclusion The results suggested that simple obesity in childhood was an important cardiovascular risk factor when they grew into adolescents and adults.