基于非同日三时点筛查的儿童高血压率及其与肥胖的关系

Detection of hypertension based on measurements at three occasions in different days and its relationship with obesity in children

目的 探讨基于非同日三时点测量的血压值和血压偏高检出率的变化趋势及其与肥胖的关系,为儿童高血压的识别和防控提供科学依据。方法 采用方便整群抽样的方法,选取山东省淄博市桓台县某所小学作为调查点,于2017年11月至2018年1月进行“儿童心血管健康队列”的基线调查,将该小学所有知情同意并自愿参加的学生均纳入,有效样本量共计1 505名儿童(年龄6~11岁)。第1时点血压偏高儿童在2周后进行第2时点血压测量,若第2时点仍为血压偏高,则再间隔2周后进行第3时点血压测量。连续非同日三时点均为血压偏高者判定为高血压。采用多元线性回归模型检验非同日三时点血压的变化趋势,采用Cochran-Armitage趋势分析检验非同日三时点血压偏高率的变化趋势,采用logistic回归模型分析肥胖与血压偏高在三时点的关系。结果 随着随访次数的增加,人群平均血压水平逐渐升高(趋势检验P<0.05),非同日三时点的血压偏高率分别为15.5%、4.0%和1.9%,呈显著下降趋势(趋势检验P<0.05)。与体重和腰围均正常儿童相比,混合型肥胖与血压偏高的关联强度在三时点增加(第1时点:OR=3.62,95% CI:2.65~4.96;第2时点:OR=9.50,95% CI:4.95~18.22;第3时点:OR=8.94,95% CI:3.48~22.96;均P<0.05)。按性别进行分层分析,结果与合计相似。结论 基于非同日三时点测量的6~11岁儿童血压偏高率明显降低。随着随访次数的增加,不同类型肥胖(尤其是混合型肥胖)与血压偏高的关系逐渐增强。

Objective To analyze the trends in blood pressure (BP) values and the elevated BP based on the measurements at three occasions in different days and its relationship with obesity in children and provide scientific evidence for the identification and prevention of hypertension in children. Methods A public primary school in Huantai county of Zibo, Shandong province, was selected as the investigation field by using a convenient cluster sampling method. The baseline survey of “Children's Cardiovascular Health Cohort” was carried out from November 2017 to January 2018. All the students with willingness and informed consent in this school were included in the survey, and the valid sample size was 1 505 children (aged 6-11 years). Children with elevated BP at the measurement of the first occasion should had a second measurement 2 weeks later, and a third measurement was given 2 weeks later if BP was still high at the measurement of the second occasion. Hypertension was confirmed if elevated BP was detected in the measurements at all the three occasions in different days. Multivariate linear regression model was used to assess the trend in BP values in children in the measurements at three occasions in different days, Cochran-Armitage trend analysis was used to evaluate the trend of elevated BP, and logistic regression model was used to analyze the relationship of elevated BP with obesity at three occasions in different days. Results In this study, with the increase of follow-up visits, the BP levels continued to rise (trend P<0.05). The elevated BP rates at three occasions were 15.5%, 4.0% and 1.9%, respectively, showing a significantly downward trend (trend P<0.05). Compared with both normal weight and normal waist circumference, the association between obesity types (general obesity only, abdominal obesity only, and mixed obesity) and elevated BP at three occasions increased (the first occasion: OR=3.62, 95% CI: 2.65-4.96;the second occasion: OR=9.50, 95% CI: 4.95-18.22;and the third occasion: OR=8.94, 95% CI: 3.48-22.96;all P<0.05). Stratified analysis by gender showed similar results. Conclusions The elevated BP rates based on the measurements at three occasions in different days in children aged 6-11 years showed a significant decrease trend. The association between different types of obesity (especially mixed obesity) and elevated BP in children became stronger gradually with the progress of the follow up.