中国3～17岁儿童性别、年龄别和身高别血压参照标准

Updating blood pressure references for Chinese children aged 3-17 years

目的对2010年发布的中国儿童性别和年龄别血压标准(2010年标准)进行更新,制定性别、年龄别和身高别的儿童血压参照标准(更新标准)。方法参照人群同2010年标准,共纳入儿童106 123人。血压测量采用水银血压计,以Korotkoff音第1音为收缩压,第5音为舒张压。采用位置、形状和范围的广义相加模型(GAMLSS),计算不同性别、年龄别及身高别对应的第50、90、95和99百分位(P_(50)、P_(90)、P_(95)和P_(99))血压值。采用一组独立的儿童血压现况调查数据(n=43 476,6~17岁,男性占51.2%)验证新旧标准的一致性。结果更新标准的血压切点值(P_(50)、P_(90)、P_(95)和P_(99))随年龄及身高增加而增加。与2010年标准相比,更新标准明显降低了身高P_5对应收缩压-P95值,其中男童降低3~7、女童降低0~6mm Hg;更新标准明显抬高了身高P_(95)对应收缩压-P_(95)值,其中,男童升高2~6、女童升高0~4mm Hg;更新标准只降低了3~13岁男女身高P_5对应舒张压-P_(95)值;更新标准身高P_(95)对应舒张压-P_(95)值与2010年标准无明显差异。2010年标准诊断的高血压儿童中,用更新标准确诊为高血压的比例为90.1%。结论更新标准同时考虑了性别、年龄和身高因素,可更准确评估儿童血压水平。

Objective To develop blood pressure （BP} references by age and height simultaneously for Chinese chil- dren aged 3--17 years（updating references）. Methods Based on a pooled sample of 106 123 children, BP values were obtained with certified mercury sphygmomanometers by trained examiners. Systolic BP { SBP） and diastolic BP （DBP） were defined by Korotkoff sounds phase 1 and phase 5, respectively. The sex-, age- and height-specific BP percentiles （P50, P90 , P95 and P99 ） were calculated by the generalized additive model for location scale and shape （GAMLSS）. Data on BP were available for a total of 43 476 children aged 6 to t7 years {male： 51.2%） from a separate survey and the difference in the discrimination ability of hypertension between updating references and BP references in 2010 was studied. Results The cut-off values（P50, P90, P95 and P99 ） of BP increased with height and age. Compared to BP references in 2010, SBP level of the 95th percentiles of updating references at the height of 5th percentiles was lower（lowered by 3--7 mm Hg in male and 0--6 mm Hg in female） ; SBP level of the 95th per- centiles of updating re[erences at the height of 95th percentiles was higher{increased by 2--6 mm Hg in male and 0--4 mm Hg in female） ; DBP level of the 95th percentiles of updating references at the height of 5th percentiles from 3 to 13 years was lower; DBP level of the 95th percentiles of updating references at the height of 95th percentiles was similar. Among hypertensive children defined by BP references in 2010, 90.1% remained hypertensive according to updating references. Conclusion The BP references by age and height are useful for identifying hypertensive children.