大庆市学龄儿童血压分布、影响因素及其变化趋势研究

Study on the distribution and risk factors of hypertension among children:a cohort study

目的了解大庆市学龄儿童血压水平的特点和变化趋势并探讨影响儿童血压水平的危险因素。方法以大庆市小学新人学儿童为研究对象,进行为期五年的前瞻性研究;研究对象每年进行身高、体重和血压的测量,隔年进行三酰甘油、血糖和胰岛素的测定。统计分析采用SPSS 10.0软件。结果447例研究对象中。基线调查高血压患病率为2.01%、血压偏高者15.44%,至第五年患病率增至5.37%、血压偏高者19.46%。5年间,收缩压由(100.65±11.62)mm Hg(1 mm Hg= 0.133 kPa)增至(106.67±9.29)mm Hg,舒张压由(66.27±11.31)mm Hg增至(70.28±7.98) mm Hg,第五年男、女生差异显著。高血压家族史、体重指数(BMI)、三酰甘油、胰岛素、胰岛素抵抗指数和胰岛素敏感指数与血压水平有关联;其中家族史、BMI和胰岛素敏感指数对血压的变异解释最有意义,家族史与收缩压和胰岛素的差异与肥胖有关,胰岛素敏感性降低有独立作用。结论大庆市学龄期儿童高血压的患病率高于全国平均水平,肥胖、遗传和胰岛素抵抗是高血压发生的主要危险因素,这三者可独立作用,亦可相互协同。

Objective To explore the association between hypertension and the tendency of change among children,so as to lay a foundation for the prevention and control of hypertension. Methods Based on findings from the prevalence survey that carried out in September 1999 in Daqing of Heilongjiang provlnce. New admission children were selected as subjects to conduct a five-year cohort study. All the subjects were interviewed with questionnaires and their blood specimens were collected for biochemical analysis. All data were analyzed using SPSS 10.0 software. Results The prevalence of hypertension among 447 children was found 2.01% at the baseline study but increased to 5.37 % in the fifth year. During a five year period, the systolic pressure level among children increased from （100.65±11.62）mm Hg （ 1 mm Hg = 0.133 kPa） to （ 106.67 ± 9.29）mm Hg, while the diastolic pressure level was from （66.27 ± 11.31 ）mm Hg to （70.28 ± 7.98）mm Hg and showed significant difference between boys and girls. There were association between hypertension and family history, body mass index （BMI）, triglyceride, insulin, insulin resistance index while insulin sensitivity index and family history, BMI and insulin sensitivity index appeared to be the important factors. Children under this study were divided to ＇with family history or without＇ and then every group was divided to ＇ with over weight-obesity or normal＇. Obesity and insulin sensitivity seemed the key risk factors on hypertension. Descent of insulin sensitivity was an independent risk factor. Conclusion The level of blood tension among children in Daqing city was higher than that from the national data. The present study confirmed that over-weight, obesity, heredity and insulin resistance were the risk factors of hypertension while insulin resistance was related to hypertension. The interaction of these risk factors was independent or correlated to each other.