中国学生首次遗精、月经初潮与肥胖联合作用对血压偏高的影响

The combined effect of spermarche, menarche and obesity on elevated blood pressure among Chinese students

目的 分析中国学生首次遗精、月经初潮与肥胖联合作用对血压的影响.方法 从2014年全国学生体质与健康调研资料中（涵盖内地31个省份,不包括中国香港、台湾和澳门）选取身高、体重、血压和青春期发育资料完整的11-17岁男生（55614名）和9-14岁女生（50395名）作为研究对象,共计106009名.将研究对象分为未出现首次遗精/月经初潮非肥胖组、未出现首次遗精/月经初潮肥胖组、已出现首次遗精/月经初潮非肥胖组和已出现首次遗精/月经初潮肥胖组,采用多水平logistic回归模型分析研究对象首次遗精和月经初潮与肥胖联合作用对血压的影响.结果 55614名11-17岁男生出现首次遗精率为62.1%（34512/55614）,肥胖率为7.5%（4166/55614）,平均SBP/DBP为110.7/68.2 mmHg（1 mm Hg=0.133 kPa）.50395名9-14岁女生出现月经初潮率为48.2%（24301/50395）,肥胖率为5.8%（2942/50395）,平均SBP/DBP为102.9/64.8 mmHg.未出现首次遗精非肥胖组、未出现首次遗精肥胖组、已出现首次遗精非肥胖组和已出现首次遗精肥胖组血压偏高检出率分别为5.2%（1003/19274）、17.9%（328/1828）、6.6%（2132/32174）和23.9%（558/2338）;未出现月经初潮非肥胖组、未出现月经初潮肥胖组、已出现月经初潮非肥胖组和已出现月经初潮肥胖组血压偏高检出率分别为5.9%（1439/24570）、17.2%（262/1524）、5.0%（1147/22883）和17.0%（241/1418）.多水平logistic回归模型分析显示,在调整了不同省份、年龄、身高和城乡因素后,已出现首次遗精/月经初潮肥胖组血压偏高的风险高于未出现首次遗精/月经初潮非肥胖组[男生：OR（95%CI）=4.93（4.30-5.66）;女生：OR（95%CI）=3.77（3.16-4.50）].结论 中国学生中首次遗精/月经初潮和肥胖与血压关联密切,无论男、女学生,进入青春期较早并肥胖者更易出现血压偏高.因此,在出现首次遗精/月经初潮前对学生进行肥胖预防和干预可能有益于降低其未来高血压的发生.

Objective To investigate the association between the combined effect of spermarche/menarche and obesity with elevated blood pressure among Chinese students. Methods A total of 106009 primary and secondary school students （55614 boys and 50395 girls） were selected from＆quot;2014 National Physical Fitness and Health Surveillance＆quot;（including 31 provinces, with the exception of Hong Kong, Macao, and Taiwan） with full record of height, weight, blood pressure, puberty development data of spermarche/menarche. The level of blood pressure, as well as the prevalence of high blood pressure（HBP）, were compared between different subgroups （pre-spermarche/menarche and non-obesity group, pre-spermarche/menarche and obesity group, pro-spermarche/menarche and non-obesity group, pro-spermarche/menarche and obesity group）, and mulilevel logistic model was used to investigate the relationship between puberty development, obesity and blood pressure. Results Among 55614 boys aged 11 to 17 years old, the prevalence of spermarche was 62.1% （34512/55614）, the prevalence of obesity was 7.5% （4166/55614）, and the mean values of systolic pressure and diastolic pressure were 110.7/68.2 mmHg （1 mmHg=0.133 kPa）. While among 50395 girls aged 9-14 years, the prevalence of menarche was 48.2% （24301/50395）, theprevalence of obesity was 5.8% （2942/50395）, and the mean values of systolic pressure and diastolic pressure was 102.9/64.8 mmHg. The prevalence of high blood pressure was 5.2% （1003/19274）, 17.9%（328/1828）, 6.6% （2132/32174）, and 23.9% （558/2338） in pre-spermarche and non-obesity boys, pre-spermarche and obesity boys, pro-spermarche and non-obesity boys and pro-spermarche and obesity boys, respectively. The prevalence of high blood pressure was 5.9% （1439/24570）, 17.2% （262/1524）, 5.0% （1147/22883）, and 17.0% （241/1418） in pre-menarche and non-obesity girls, pre-menarche and obesity girls, pro-menarche and non-obesity girls and pro-menarche and obesity girls, respectively. After adjustment of region, age, height and urban/rural area by multilevel model, the students in pro-spermarche/menarche and obesity group were more likely to have high blood pressure （boys： OR（95%CI）=4.93 （4.30-5.66）; girls： OR（95%CI）=3.77（3.16-4.50）） Conclusion Puberty development and obesity were closed associated with blood pressure. Both boys and girls who enter puberty earlier and were in obesity status were more likely to have high blood pressure. Therefore, interventions focused on obesity prevetion and intervention among prepuberty students may be beneficial to reduce their prevalence of high blood pressure in the future.