中国3～17岁儿童血压简化标准的研制

Establishing the user-friendly screening criteria for elevated blood pressure in Chinese children aged 3-17 years

目的对中国3~17岁儿童的性别、年龄别及身高别的血压参照标准(金标准)进行简化以建立使用方便的简化标准。方法依据金标准分别采用表格法和公式法制定2种简化标准。首先基于一个横断面研究,评价两种简化标准与金标准诊断儿童高血压的一致性及筛查效果;其次基于一个队列研究(1987年对年龄6~18岁的儿童开展基线调查,并在2011年进行了随访;儿童期及成年期均测量血压,且成年期对高血压靶器官进行检测评估),评价两种简化标准诊断的儿童期"高血压"对成年后高血压和心脏以及动脉血管的亚临床损害的预测价值。结果在6~17岁的儿童中以筛查儿童高血压的效度判定,公式法简化标准的灵敏度、特异度、阳性预测值和一致率均优于表格法简化标准(90.0%比87.6%,95.7%比93.6%,81.7%比74.5%,94.7%比92.6%),两简化标准的阴性预测值接近(97.8%比97.3%);公式法与表格法诊断的高血压儿童,成年期发生高血压、左心室质量指数(LVMI)偏高、颈股动脉脉搏波传导速度(cfPWV)偏高,颈动脉内膜中层厚度(CIMT)偏高和任一上述亚临床靶器官损害的风险比分别为2.68比2.98,1.38比1.47,1.36比1.28,1.51比1.41,1.30比1.26,两种简化标准的预测能力接近。结论公式法简化标准可用于中国6~17岁儿童高血压的快速筛查。

Objective To simplify blood pressure （BP） references of Chinese children aged 3--17 years by gender, age and height （gold standard） and to establish a user-friendly screening criteria for elevating BP. Methods Based on gold standard, we developed a simplified BP table and a formula for BP references. Based on a cross-sec- tional survey, the levels of BP were classified as normotensive or hypertensive based on gold standard and two simpli- fied BP references respectively. Sensitivity, specificity, positive predictive value, negative predictive value and a- greement rate were calculated. In addition, based on a cohort study （baseline survey and baseline blood measure- ments for children aged 6--18 years in 1987 and assessment of target organ damage at follow-up in 2011 }, we studied whether elevated BP in childhood could predict hypertension and subclinical target organ damage later in adulthood and if there were any differences in the predictive abilities between two simplified BP references. Results The for- mula for BP references had higher sensitivities, specificity, positive predictive values and agreement rates than the simplified BP table （90.0% vs 87.6%, 95.7% vs 93.6%, 81.70% vs 74.5%, 94.7% vs 92.6%）, while the nega- tive predictive values were similar between two simplified BP references {97.8 % vs 97.3 %） among children aged 6-- 17 years. Relative risks of adult hypertension, high left ventricular mass index （LVMI）, high carotid-femoral pulse wave velocity （cfPWV} ,high carotid artery intima media thickness （ CIMT） and any subclinical target organ damage were similar between formula for BP references and simplified BP table （2.68 vs 2.98, 1.38 vs 1.47, 1.36 vs 1.28, 1.51 vs 1.41, 1.30 vs 1.26）. Conclusion The user-friendly BP references based on the formula is simple and ac- curate for screening for elevated BP among children aged 6--17 years.