基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

Evaluation of simplified methods based on 2018 Chinese guidelines for the management of hypertension for screening high blood pressure among children and adolescents in Suzhou

目的评价不同简化方法筛查苏州市儿童青少年血压偏高的效果。方法采用分层整群随机抽样方法,招募7340名6~17岁儿童青少年,测量身高、体重和血压。以中国高血压防治指南为金标准,评价公式法、身高别法、年龄组别表格法和性别年龄别表格法的筛查效果。结果根据金标准和4种简化方法,血压偏高检出率分别为17.3%、17.9%、17.5%、18.5%、17.1%。身高别法和性别年龄别表格法与金标准筛查结果差异均无统计学意义(χ^(2)=0.593,P=0.477;χ^(2)=0.865,P=0.383)。与金标准相比,公式法、身高别法、性别年龄别表格法的Kappa值分别为0.818、0.865、0.858,高于年龄组别表格法(0.670)。身高别法和性别年龄别表格法曲线下面积最高,分别为0.934(95%CI:0.924~0.944)、0.927(95%CI:0.916~0.938),高于公式法(0.915,95%CI:0.904~0.926),年龄组别表格法最低,为0.844(95%CI:0.829~0.858)。分性别、年龄、身高比较时,4种简化标准的筛查效果与总体基本一致,身高别法、性别年龄别表格法在不同分组呈现各自筛查优势。结论4种简化方法筛查效果均较好,考虑身高别法简便易行,更适合用于早期筛查。

Objective To evaluate the validation of various simplified methods for screening high blood pressure(HBP)among children and adolescents in Suzhou.Methods 7340 children and adolescents aged 6 to 17 years were enrolled by stratified cluster random sampling method.Height,weight and blood pressure were measured.Considering 2018 Chinese guidelines for the management of hypertension as gold standard,the validation of 4 simplified methods(formula method,height-specific method,age group-specific method,sex-and age-specific method)for screening HBP were assessed.Results According to gold standard and 4 simplified methods,the prevalence of HBP were 17.3%,17.9%,17.5%,18.5%,17.1%,respectively.There was no significant difference between the prevalence of HBP identified by height-specific method(χ^(2)=0.593,P=0.477),sex-and age-specific method(χ^(2)=0.865,P=0.383)and gold standard method.Kappa values of formula method,height-specific method,sex-and age-specific method were 0.818,0.865,0.858,respectively,higher than that of age groupspecific method(0.670).Area under the curve(95%confidence interval)of height-specific method and sex-and age-specific method were 0.934(95%CI:0.924-0.944)and 0.927(95%CI:0.916-0.938),respectively,higher than that of formula method[0.915(95%CI:0.904-0.926)].The age group-specific method had the lowest area under the curve[0.844(95%CI:0.829-0.858)]was the lowest.When stratified by age,sex and height,screening effects of 4 simplified methods among different subgroups were similar with total population.Height-specific method and sex-and age-specific method had different screening strengthens among different groups.Conclusion All 4 simplified methods performed well for screening HBP.Considering the convenience of using,height-specific method would be proper for early HBP screening.