应用不同参考标准评估2010年上海市7—17岁儿童青少年高血压患病率

Evaluation of different diagnostic criteria for hypertension prevalence among children and adolescents aged 7-17 years in Shanghai in 2010

目的分别应用基于年龄和性别的中国儿童青少年血压参考标准（NBPR）和基于年龄、性别和身高百分位数的儿童青少年血压参考标准（BPCH），评估上海市儿童青少年人群的高血压患病率。方法样本人群来自上海市学生体质健康监测中心2010年的常规数据，包含7—17岁男女生各3300名。NBPR是我国儿童青少年基于性别和年龄的血压参考标准（2010），BPCH是应用GAMLSS技术参考中国家庭营养健康调查1991至2009年的数据构建的基于性别、年龄和身高百分位数的儿童血压参考标准。收缩压（SBP）或舒张压（DBP）≥其性别、年龄和身高相应的％界值定义为高血压。对两种标准下结果不一致的研究对象进行特征分析，计算身高的z值并进行比较。结果应用NBPR，男生、女生的高血压患病率分别为11．3％、10．0％，患病率随着年龄的增长而增长。应用BPCH，男生、女生高血压患病率分别为6．9％、6．0％，发病率在各年龄段大致稳定。187名（5．6％）男生和190名（5．7％）女生应用NBPR和BPCH均被诊断为高血压，42名男生（1．3％）、8名女生（0．2％）仅被BPCH诊断为高血压，其平均身高[男：（138．1±2．1）cm，女：（139．4±9．8）cm]分别低于总体样本的平均身高[男：17cm（Z=-0．78，P〈0．0001）；女：11cm（Z=-1．29，P=0．0159）]。188名男生（5．7％）、141名女生（4．3％）仅被NBPR诊断为高血压，平均身高[男生：（169．0±17．6）cm，女生：（160．6±6．5）cm]分别高于总体样本的平均身高[男生：13．9em（Z=0．31，P〈0．0001）；女生：10．2cm（Z=0．39，P〈0．0001）]。结论通过对NBPR和BPCH的比较结果显示，血压标准考虑身高与否直接影响着男生4．42％和女生4．03％血压的判定，建议我国须建立与国际接轨的同时考虑性别、年龄和身高的血压参考值。

Objective To investigate the prevalence of hypertension in representative sample of children and adolescents aged 7 - 17 years in Shanghai, by using the current national age- and gender-specific cutoffs（NBPR） and using a new cutoffs including height percentiles （BPCH）. Methods The data were from the 2010 routine survey of Shanghai Municipal Center for Students Physical Fitness and Heahh Surveillance involving 3 300 boys and girls respectively. Hypertension was defined as average SBP/ DBP equal to or above the 95th percentile. BPCH was constructed by using GAMISS program, for gender, age and height percentiles, based on non-overweight study subjects from 1991 -2009 Chinese Health and Nutrition Survey. Children and adolescents＇with inconsist results dignosed by BPCH and NBPR were analyzed, heights of them were compared by Z-score. Results The prevalence rate of hypertension diagnosed by NBPR was 11.3% for males and 10% for females. The rate was 6. 9% for males and 6% for females by using NBPR. The prevalence rate increased with age by NBPR whereas it kept approximately stable by BPCH. The Kappa index of hypertension was 0. 583 in male and 0. 695 in female using the two references, and the consistent rate was 93% ,95% respectively. 377 samples （5.7% in total） were diagnosed as hypertensive by both cutoffs. 50 （boys：42, girls：8 ） hypertensive children were in BPCH who were missed by NBPR, with mean height lower than mean height of total samples by 17 cm in boys （ Z = - 0. 78, P 〈 0. 000 1 ） and 11 cm in girls （ Z = - 1.29, P = 0. 015 9 ） respectively. There were 329 students （5 % in total） diagnosed by NBPR but missed by BPCI-I, with mean height being higher than average levels, 13.9 cm in boys（Z = 0. 31, P 〈 0. 000 1 ）and 10. 2 cm in girls （Z = 0. 39, P 〈 0. 000 1 ）. Conclusion It is suggested that height should be considered in diagnosis of hypertension and included in cutoffs for accurate estimation of blood pressure in children and adolescents.