用LMS法构建2～6岁儿童电子血压计血压百分位数曲线

Establishment of oscillometrically measured blood pressure reference percentile curves in 2-6 years old children by LMS method

目的利用妇幼保健院常规体检数据,构建儿童血压百分位数,为儿童血压监测提供参考依据。方法选择在上海闵行区妇幼保健院产科出生,于2006年3月至2010年11月期间接受常规体检的2～6岁儿童4619名,截取体检中的年龄、性别、身高、体重和血压(电子血压计测量)数据,身高、体重和血压测量严格按照医院常规要求。应用LMS方法分别拟合男女童收缩压(SBP)、舒张压(DBP)随年龄变化的百分位曲线,采用SBP、DBP的P5、P50、P90、P95、P99作为参考曲线,并与日本学龄前儿童正常血压(电子血压计测量)和高血压参考值进行比较。结果男、女儿童的SBP、DBP各百分位曲线均随年龄增长呈逐渐上升趋势,平均SBP水平增长高于DBP(男:6.62mmHgvs4.62mmHg;女:5.55mmHgvs2.05mmHg)。日本男、女童SBP水平在2～6岁明显高于本研究人群(差值为6～11mmHg);日本男、女童DBP水平在5岁后与本研究人群吻合度好。比较本研究人群与日本人群身高发现,日本男、女童2～6岁身高均高于本研究人群(差值分别为:男1.16,3.16,6.06,7.54和6.3cm;女1.15,2.27,6.68,8.23和7.33cm)。结论本研究提供了单中心、大样本资料的基于电子血压计测量的2～6岁儿童SBP、DBP的P50、P90和P95参考值,对儿童高血压预防保健具有较好的应用价值。

Objective The aim of this study was to develop a reference percentile curves of BP measured by automated device from a representative sample of preschool children in shanghai. Methods 4 619 healthy preschool children from 2 to 6 years of age were consecutive enrolled from March 2006 to November 2010 and all these children were born and received regular physical examination in Shanghai Minhang Maternal and Child Health Hospital. BP and heart rate were measured on the right arm at the level of the heart after each child had rested in the sitting position for 5 min, using automated BP recorder （Model 45NEO-E6, Welch Allyn,USA）. All measurements were performed in the clinic room of the hospital with the temperature between 20~C and 25~C. Children were kept natural posture when BP was measured by trained pediatricians. Centile curves for SBP and DBP were drawn by sex using LMS method, the 5＇h ,50＇h ,90th ,95th ,99＇h percentiles of SBP and DBP were compared with those from Japanese preschool children with the same age. Results BP increased linearly with age for both boys and girls. Generally, the means of SBP and DBP for girls showed slightly lower than the boys （ female ： 5.55 mmHg vs 2.05 mmHg ; male ： 6.62 mmHg vs 4.62 mmHg）, respectively. The percentiles of BP from the current study were significantly different from the Japanese references. The SBP 95th percentile of current study was significantly lower than Japanese references for boys and girls by 6 - 11 mmHg. The DBP 95＇h percentiles of boys aged 2 were slightly lower than Japanese reference, however, they remained the same levels from 3 - 6 years old. The percentiles of girls at 2 - 3 years old were lower than the Japanese reference, and exceeded at 3 - 4 years old and kept slightly higher to age of 6 years. Compared with the data from the Japanese, children in our study were found to have a lower height during the age range for both sexes （ male ： 1.16 cm, 3.16 cm,, 6.06 cm,7.54cm and 6.3 cm ; female ： 1.15, 2.27, 6.68, 8.23, and 7.33 cm, respectively）. Conclusions This study provides the median, 90th and 95th percentile reference values of SBP and DBP based on a single-center large sample of children aged 2 - 6 years. These reference percentiles may be useful to primary child care providers for the early screening and prevention of hypertension in Chinese preschool.