我国6～11岁儿童血压升高与出生体重的关系

Relationship between birth weight and elevated blood pressure among children aged 6 - 11 years in China

目的分析我国8省（自治区、直辖市）6～11岁儿童出生体重与儿童期血压升高的关系。方法采用分层系统随机整群抽样方法，2010年9至11月中国疾病预防控制中心以我国8省为抽样框，抽取18920名6—11岁儿童作为研究对象，测量其身高、体重、腰围和血压。血压值以Korotkoff音开始（K1）出现时为收缩压，Korotkoff音消失（K5）为舒张压。血压升高定义为收缩压或舒张压大于等于同年龄、同性别和身高者血压的第95百分位数。通过父母自填问卷获得儿童出生体重和高血压家族史等信息。采用方差分析比较低、正常和高出生体重三组儿童身体测量指标和血压水平的差异，采用多因素Logistic回归逐步法分析出生体重、目前体重指数对儿童期血压升高的影响。结果6～8岁和9～11岁组男童可见身高、体重、腰围、体重指数、收缩压和舒张压水平随出生体重分组的升高呈上升趋势，仅6—8岁组男童的腰围在不同出生体重组问差异无统计学意义（P=0．112），其余各指标在不同出生体重组间差异均有统计学意义（P〈0．05）。6—8岁和9～11岁组女童可见身高、体重、腰围、体重指数和舒张压水平随m生体重分组的升高呈上升趋势，差异有统计学意义（P〈0．05），但收缩压在不同出生体重组间差异无统计学意义（P＝0．099）。在调整年龄、高血压患病家族史后，与正常出生体重儿童相比，高出生体重男童和女童发生儿童期血压升高相对风险OR值分别为1．23（1．06—1．43）和0．89（0．71～1．10）；增加调整儿童当前体重指数后，与正常出生体重儿童相比，高出生体重男童和女童发生儿童期血压升高的OR值分别为1．06（0．90～1．24）和0．73（0．58～0．91）。低出生体重组与正常儿童相比，发生儿童期血压升高的相对风险无统计学意义。6—11岁男童和女童当前体重指数每增加1个单位，发生血压升高的相对风险分别为1．16和1．20倍。结论6-11岁儿童血压升高与其当前体重指数密切相关，而与出生体重无明显关系。

Objective To analyze the relationship between birth weight and elevated blood pressure among schoolchildren aged 6 - 11 years in 8 provinces of China. Method A stratified random cluster sampling was used from sampling frame of eight provinces in the mainland of China. A total of 18 920 students aged 6 - 11 years eventually participated in this study. Height, weight, waist circumference （WC） and blood pressure of all the subjects were measured. Korotkoff Ⅰand Ⅴ were recorded as systolic blood pressure （SBP） and diastolic blood pressure （DBP）. Elevated blood pressure was considered for SBP and/ or DBP equal to or above the reference sex-, age- and height-specific 95th percentile. Birth weight and family history of hypertension were collected by self-administered questionnaire. Analysis of variance was used to compare body measure indicators among 3 birth weight groups. Multivariate Logistic regression analysis was performed to identify the relationship between birth weight, current BMI and elevated blood pressure among children. Result The level of height, weight, WC, BMI, SBP and DBP were on the rise with the increase of the birth weight groups among boys （ P 〈 0.05 ） , except for WC among boys aged 6 -8 years. The level of height, weight, WC, BMI and DBP showed a trend of escalation among girls （P 〈 0. 05）. But, SBP among 3 birth weight groups in girls was not significantly different （P = 0. 099）. After adjusting for age and family history of hypertension, compared with the normal birth weight group, the odds ratio and 95% CI of having elevated blood pressure among boys and gMs in high birth weight group were 1.23 （1. 06 - 1. 43） and 0. 89 （0. 71 - 1. 10）, respectively; and the ORs（95% CI） were 1. 06 （0.90 - 1.24） for boys and 0. 73 （0. 58 - 0. 91 ） for girls after adjusting for age, family history of hypertension and current BMI of students. The relative risk of elevated blood pressure for boys and girls in low birth weight group were not significantly difterent as compared with normal birth weight group. Conclusion Current BMI but not birth weight was found to be a strong determinant of elevated blood pressure among children aged 6 - 11 years in China.