血压身高比筛查青春期儿童青少年血压偏高效果评价

Detection of high blood pressure on adolescent children and adolescents by using blood pressure to height ratio

目的分析血压身高比性别分类法、年龄分类法和年龄性别分类法筛查青春期血压偏高的效果,为预防儿童青少年高血压提供依据。方法对参与黑龙江省佳木斯市中小学常规体检的10~17岁汉族学生26 068名进行生长发育指标测量,采用受试者工作特征曲线确定3种方法筛查血压偏高的最佳临界值,计算曲线下面积(AUC)、灵敏度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、阳性预测值(PPV)、阴性预测值(NPV)、Kappa值用于评价。结果儿童青少年血压偏高检出率为22.7%。筛查青春期血压偏高时,性别分类法的AUC、灵敏度、特异度、+LR、-LR、PPV、NPV、Kappa值分别为0.87,95.0%,79.1%,4.56,0.06,57.2%,98.2%,0.60;年龄分类法分别为0.89,93.3%,84.5%,6.04,0.08,64.0%,97.7%,0.67;年龄性别分类法分别为0.90,94.3%,85.5%,6.52,0.07,65.7%,98.1%,0.69。3种方法灵敏度、特异度及阴性预测值较高,但阳性预测值较低。年龄性别分类法的AUC和Kappa值最高,性别分类法最低。结论年龄性别分类法筛查效果最好,但相对复杂;年龄分类法筛查效果良好且更加简便。推荐采用2种方法筛查青春期血压偏高。

Objective To investigate the prevalence of high blood pressure in adolescent children and adolescents in Jiamusi, Heilongjiang Province, China. To analyze age-, gender-and age*gender-spectific classification of blood pressure to height ratio for screening high blood pressure in adolescence. Methods Anthropometric parameters were measured in 26 068 Han students aged 10 to 17 participating in the routine physical examination in Jiamusi, Heilongjiang Province. Using the receive operating characteristic curve to determine the cut-offs for screening high blood pressure by three classification methods. The area under curve( AUC), sensitivity, specificity, positive likelihood ratio( + LR), negative likelihood ratio(-LR), positive predictive value( PPV), negative predictive value( NPV), and Kappa value were used for evaluation. Results The detection rate of high blood pressure in children and adolescents was 22.7%. When screening high blood pressure in adolescence, the AUC, sensitivity, specificity, +LR,-LR, PPV, NPV, and Kappa values of the gender classification were 0.87, 95.0%, 79.1%, 4.56, 0.06, 57.2%,98.2%, 0.60, respectively;the age classification were 0.89, 93.3%, 84.5%, 6.04, 0.08, 64.0%, 97.7%, 0.67, respectively;the age-gender classification were 0.90, 94.3%, 85.5%, 6.52, 0.07, 65.7%, 98.1%, 0.69, respectively. The sensitivity, specificity and negative predictive values of the three methods were higher, but the positive predictive value was lower. The age-gender classification had the highest AUC and Kappa value and the lowest were gender classification. Conclusion The age-gender classification has the best screening effect, but it is relatively complicated. The age classification has a good screening effect and it is more convenient. Both methods are recommended for screening for high blood pressure during puberty.