4岁儿童体重状态与早期血压、心脏结构功能改变的研究

Weight status related early changes in blood pressure,cardiac structure and function in 4-year-old children

目的探讨4岁儿童体重状态与早期血压、心脏结构功能改变的相关性。方法在队列研究平台上,通过横断面分析儿童体重状态和心血管指标的关系,于2017至2020年在由上海新华医院牵头的“上海优生儿童队列”平台中,对1477名4岁儿童进行身高、体重、血压测量和心脏超声检查。根据不同体质指数(BMI)进行分类,将研究对象分为5组(消瘦、体重过轻、正常、超重及肥胖),利用单因素方差分析比较不同组间血压水平及心脏结构功能指标,通过多因素线性回归模型分析儿童血压及心脏结构功能与体重状态之间的关联,并采用多因素Logistic回归模型分析不同体重状态是否为儿童早期血压升高和左心室肥厚的独立危险因素。结果纳入的1477名儿童中男772名、女705名。男童超重及肥胖115例(14.9%),女童超重及肥胖68例(9.6%)。正常体重儿童916名(62.0%),消瘦75例(5.1%),体重过轻303例(20.5%),超重130例(8.8%),肥胖53例(3.6%)。各组对比发现,BMI越高,4岁儿童的收缩压、舒张压、左心室质量指数、左心室后壁收缩期厚度、左心室后壁舒张期厚度、左心室收缩末期内径、左心室舒张末期内径、室间隔收缩期厚度及左心室射血分数均越高,组间差异均有统计学意义(F=31.73、6.59、14.22、4.96、3.01、31.50、39.79、5.91、3.09,均P<0.05)。多因素线性回归结果提示,超重及肥胖儿童与收缩压(β=5.2,95%CI 3.6~6.8)、左心室质量指数(β=1.9,95%CI 0.8~3.1)、左心室收缩末期内径(β=1.3,95%CI 0.9~1.8)、左心室舒张末期内径(β=1.6,95%CI 1.0~2.2)均呈显著正相关。在Logistic回归模型中,与正常体重4岁儿童相比,超重(OR=2.37,95%CI 1.27~4.41)及肥胖儿童(OR=10.90,95%CI 4.47~26.60)血压升高的风险均显著更高,但其左心室肥厚的风险均未出现显著增高(均P>0.05)。结论4岁儿童超重及肥胖与血压升高、心腔内径及左心室质量指数增大存在关联。超重及肥胖是4岁儿童血压升高的独立危险因素。

Objective To explore the association between weight status and early changes in blood pressure,cardiac structure and function in children at 4 years of age.Methods A cross-sectional study of the relationship between weight status and cardiovascular parameters was performed on the platform of"Shanghai Birth Cohort"in Shanghai Xinhua Hospital between 2017 and 2020.Height,weight,blood pressure and echocardiography were measured in 1477 children at 4 years of age.According to body mass index(BMI),participants were classified into five groups:underweight,lean,normal weight,overweight and obese.Blood pressure,cardiac structure and function indexes were compared among different groups using one-way ANOVA.The associations between blood pressure,cardiac structure and function and weight status in children were analyzed by linear regression models.Multivariate logistic regression models were used to analyze whether weight status was an independent risk factor for elevated blood pressure or left ventricular hypertrophy(LVH)in children.Results A total of 1477 children including 772 boys and 705 girls were included in this study.There were 115 overweight and obese boys(14.9%)and 68 overweight and obese girls(9.6%).The majority of children had normal weight(916 cases,62.0%),followed by underweight(303 cases,20.5%),overweight(130 cases,8.8%),lean(75 cases,5.1%),and obese(53 cases,3.6%).With the increase of BMI,systolic blood pressure,diastolic blood pressure,left ventricular mass index(LVMI),left ventricular posterior wall thickness in systole,left ventricular posterior wall thickness in diastole,left ventricular diameter in end-systole,left ventricular diameter in end-diastole,interventricular septum thickness in systole and left ventricular ejection fraction showed significantly positive trend,and the differences among the groups were significant(F=31.73,6.59,14.22,4.96,3.01,31.50,39.79,5.91,3.09,all P<0.05).Multiple linear regression showed that overweight and obese were all positively associated with systolic blood pressure(β=5.2,95%CI 3.6-6.8),LVMI(β=1.9,95%CI 0.8-3.1),left ventricular diameter in end-systole(β=1.3,95%CI 0.9-1.8),and left ventricular diameter in end-diastole(β=1.6,95%CI 1.0-2.2).In the Logistic regression model,compared with normal weight children,overweight(OR=2.37,95%CI 1.37-4.41)and obese children(OR=10.90,95%CI 4.47-26.60)both had significantly increased risk of elevated blood pressure.However,the risk of LVH did not significantly increased.Conclusions Overweight and obesity in 4-year-old children are associated with increased blood pressure,increased left ventricle diameter and LVMI.Overweight and obesity are independent risk factors for elevated blood pressure in children at 4 years of age.