基于新版人体测量学指标的老年高血压发病风险预测模型

A model for predicting onset risk of senile hypertension based on new version of anthropometric indicators

目的分析新版人体测量学指标与老年高血压发病风险的相关性,构建初级模型及基于新版人体测量学指标的高级模型,比较各模型的预测效能。方法于2014年起建立一个前瞻性的动态序列,基线人群包括西安新城区的老年人群22508例,于2019年1月行首次随访,至同年12月完成随访,利用纳入及排除标准选取研究对象5398例。对基线及人体测量学指标与高血压相关性行单因素分析,依据高血压的诊断标准,将患者分为高血压组及非高血压组,并对人体测量学指标与高血压相关性行多因素Logistic回归分析;利用基础因素构建高血压发病风险初级模型,纳入新版人体测量学指标构建高级模型,分析各模型的预测效能。结果①高血压组的年龄、性别、学历、基线收缩压、基线舒张压、血脂、空腹血糖等基线指标及体质指数(BMI)、腰围(WC)、腰高比(WHtR)、内脏脂肪指数(VAI)、身体形态指数(ABSI)及身体圆度指数(BRI)等6种人体测量学指标均明显高于非高血压组(P<0.05)。②调整各混杂因素后,BMI、WC、WHtR、VAI、BRI等5种人体测量学指标的水平增加可提升高血压的发病风险(P<0.05),而ABSI与高血压发病风险无相关性(P>0.05)。③年龄、基线收缩压、基线舒张压、空腹血糖等因素与高血压的发病风险有相关性(P<0.05),纳入初级模型的构建。④男性中纳入BMI和BRI时的预测效能明显优于初级模型,女性中纳入BMI时的预测效能明显优于初级模型(P均<0.05)。结论在老年人群中,BMI、WC、WHtR、VAI、BRI等5种人体测量学指标的水平提升可增加高血压发病风险,其中BMI具有最佳的预测效能。本次研究基于新版人体测量学指标构建老年高血压发病风险的预测模型,存在精确、清晰、高效的应用优势,患者接受程度高,利于更大程度降低诊治压力、优化医疗资源配置,具有较好的公共卫生意义。

Objective To analyze the correlation between new version of anthropometric indicators and onset risk of senile hypertension,establish a primary model and an advanced model based on new version of anthropometric indicators and compare the predictive efficacy between 2 models.Methods A prospective dynamic sequence was established in 2014 and baseline population included 22508 aged population from Xincheng District of Xi`an City.The population was followed up from Jan.2019 to Dec.2019,and 5398 cases were chosen as subjects according to inclusion and exclusion criteria.The correlation among baseline indexes,anthropometric indicators and hypertension was given a single-factor analysis,and the cases were divided,according to hypertension diagnosis standard,into hypertension group and non-hypertension group.The correlation between anthropometric indicators and hypertension was given a multi-factor Logistic regression analysis.A primary model for onset risk of hypertension was established by applying basic factors,and an advanced model was established after included new version of anthropometric indicators.The predictive efficacy of these models was analyzed.Results①The baseline indexes including age,sex,educational history,baseline systolic blood pressure(SBP),baseline diastolic blood pressure(DBP),blood fat and fasting plasma glucose(FPG),and 6 anthropometric indicators including body mass index(BMI),waist circumference(WC),waist to height ratio(WHtR),visceral adiposity index(VAI),a body shape index(ABSI)and body roundness index(BRI)were all significantly higher in hypertension group than those in non-hypertension group(P<0.05).②After adjusted confounding factors,the increases of BMI,WC,WHtR,VAI and BRI promoted hypertension onset risk(P<0.05),and ABSI was not correlated to hypertension onset risk(P>0.05).③Age,baseline SBP,baseline DBP and FPG were correlated to hypertension onset risk(P<0.05)and they were enclosed into the establishment of primary model.④The predictive efficacy of BMI and BRI was significantly superior in advanced model to that in primary model in the male,and predictive efficacy of BMI was significantly superior in advanced model to that in primary model in the female(all P<0.05).Conclusion In anthropometric indicators,the increases of BMI,WC,WHtR,VAI and BRI will promote hypertension onset risk,and BMI has the highest predictive efficacy.A predictive model for onset risk of senile hypertension is established based on new version of anthropometric indicators,which is accurate,distinct and efficient and has higher patient’s acceptance.It is conducive for reducing diagnostic and therapeutic pressure and optimizing medical resource allocation,and has higher public health significance.