血压身高比在吉林省延吉市青少年高血压筛查中的应用

Application of blood pressure-to-height ratio in screening adolescents' hypertension in Yanji city of Jilin province

目的:探讨采用血压身高比(BPHR)筛查吉林省延吉市青少年高血压的最佳截断值,为了解吉林省延吉市青少年高血压患病率提供依据。方法:2016年9—10月选取吉林省延吉市城镇23所中学和高中,采用整群抽样方法,选取12~17岁学生共18 244人(男生9 567人,女生8 677人),测量其血压(BP)、身高和体质量,计算收缩压身高比(SBPHR)和舒张压身高比(DBPHR),采用受试者工作特征(ROC)曲线确定BPHR预测青少年高血压的最佳截断值,并评估该截断值的敏感度、特异度、阴性预测值(NPV)和阳性预测值(PPV)。结果:12~17岁朝鲜族和汉族青少年高血压患病率男生分别为12.8%和13.0%,女生分别为5.9%和6.2%;不同性别的2个民族调查对象高血压患病率比较差异无统计学意义(χ~2=0.091,P>0.05;χ~2=0.295,P>0.05);总高血压患病率男生为12.9%,女生为6.1%,不同性别高血压患病率比较差异有统计学意义(χ~2=242.072,P<0.01)。男生在15岁时高血压患病率达到高峰,高血压患病率随年龄而变化的曲线呈突增突降趋势;随着年龄增长,女生高血压患病率变化较小。在12~17岁时,各年龄段男生高血压患病率均明显高于女生(P<0.05)。男生的年龄与SBPHR呈负相关关系(r=-0.085,P<0.01),女生的年龄与SBPHR无相关关系(r=-0.018,P>0.05)。男生的年龄与DBPHR呈负相关关系(r=-0.080,P<0.01),女生的年龄与DBPHR无相关关系(r=-0.017,P>0.05),但相关系数均小于0.1,判定为无关联。在12~17岁时,采用SBPHR筛查SBP的阈值,男生为0.73 mmHg·cm^(-1)(敏感度为92.2%,特异度为88.9%,PPV为52.6%,NPV为98.8%),女生为0.75mmHg·cm^(-1)(敏感度为95.6%,特异度为89.5%,PPV为33.6%,NPV为99.6%);采用DBPHR筛查DBP的阈值,男生为0.49 mmHg·cm^(-1)(敏感度为91.6%,特异度为93.9%,PPV为35.3%,NPV为99.6%),女生为0.51 mmHg·cm^(-1)(敏感度为89.8%,特异度为94.3%,PPV为26.7%,NPV为99.8%)。结论:吉林省延吉市12~17岁青少年高血压患病率低于全国平均水平,BPHR可作为筛查吉林省延吉市12~17岁青少年高血压的指标。

Objective：To explore the optimal cutoff values of blood pressure-to-height ratio（BPHR）for screening the hypertension of the adolescents,and to provide the basis for understanding the prevalence of hypertension in the adolescents in Yanji city of Jilin province.Methods：From September to October 2016,a total of 23 middle schools and high schools in Yanji city of Jilin province were selected,and a total of 18 244 adolescents（9 567 boys and 8 677 girls）aged from 12 to 17 years old in Yanji city of Jilin province were enrolled by means of whole population sampling.The blood pressure（BP）,heights and body weights of the adolescents were measured,and the systolic BP-to-height ratio（SBPHR）and diastolic BP-to-height ratio（DBPHR）were calculated.Receiver operating characteristic（ROC）curve analysis was performed to determine the optimal cutoff values and evaluate the sensitivity,specificity,negative predictive value（NPV）and positive predictive value（PPV）.Results：The prevalence of hypertension in the Korean and Han adolescents aged 12-17 years old were 12.8% and 13.0% for boys and 5.9% and 6.2% for girls,respectively;there was no significant difference in the prevalence of hypertension between different genders in two nationalities（χ-2=0.091,P〈0.05;χ-2=0.295,P〈0.05）.The total prevalence of hypertension was 12.9%for boys and 6.1%for girls,the difference was statistically significant（χ-2= 242.072,P〈0.01）.The prevalence of hypertension of the boys at the age of 15 years old reached its peak and the curve of hypertension prevalence changed with age showed as a sudden increasing and sudden decreasing trend;the changes of prevalence of hypertension with age were little in the girls.The prevalence of hypertension in the boys aged 12 to 17 years old was significantly higher than that in the girls（P〈0.05）.The correlation between age and SBPHR in the boys was negative（r=-0.085,P〈0.01）,and there was no correlation between age and SBPHR in the girls（r=0.018,P〈0.05）.The correlation between age and DBPHR in the boys aged 12-17 years old was negative（r=-0.080,P〈0.01）,and there was no correlation in the girls（r=-0.017,P〈0.05）;all the correlation coefficients were less than 0.1,so it was judged that there was no significant correlation between age and BPHR.The threshold values of SBP screened by SBPHR were 0.73 mmHg·cm-（-1） in the boys aged 12-17 years old（sensitivity：92.2%,specificity：88.9%, PPV：52.6%, NPV：98.8%） and0.75 mmHg·cm-（-1） in the girls（sensitivity：95.6%,specificity：89.5%,PPV：33.6%, NPV：99.6%）,respectively.The threshold values of DBP screened by DBPHR were 0.49 mmHg·cm-（-1） in the boys aged 12-17 years old（sensitivity：91.6%,specificity：93.9%,PPV：35.3%,NPV：99.6%）and 0.51 mmHg·cm-（-1） in the girls（sensitivity： 89.8%, specificity： 94.3%, PPV： 26.7%, NPV： 99.8%）, respectively.Conclusion：The prevalence of hypertension in the adolescents aged 12-17 years old in Yanji city of Jilin province is lower than the national average value,and BPHR can be used as an index to screen the hypertension of the adolescents aged 12-17 years old in Yanji city of Jilin province.