本文選題：兒童青少年 + 肥胖　； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：研究目的： 1比較不同肥胖指標(biāo),包括體質(zhì)指數(shù)(BMI)、腰圍(WC)和腰圍身高比(WHtR)對(duì)兒童高血壓的預(yù)測(cè)效果。 2探討血壓身高比(BPHR)對(duì)兒童高血壓的預(yù)測(cè)效果。 對(duì)象與方法： 1.研究對(duì)象 選取濟(jì)南市市區(qū)中等水平中小學(xué)校學(xué)生作為研究對(duì)象,要求本市戶籍或一年以上常住人口,年齡為6-17歲。采用方便整群抽樣的方法,共抽取了濟(jì)南市4所學(xué)校,其中小學(xué)2所,初中1所,高中1所。共獲得有效樣本8378人,男生4245人,女生4133人,男女比接近1：1。 2.研究方法 對(duì)研究對(duì)象進(jìn)行問(wèn)卷調(diào)查和體格檢查。問(wèn)卷內(nèi)容主要包括調(diào)查對(duì)象的基本情況、出生信息、膳食習(xí)慣及疾病家族史等,體格檢查主要包括身高、體重、WC、收縮壓(SBP)、舒張壓(DBP)、心率等,并計(jì)算BMI、WHtR、收縮壓身高比(SBPHR)和舒張壓身高比(DBPHR)。分別參照“2-18歲兒童超重、肥胖篩查BMI界值點(diǎn)標(biāo)準(zhǔn)”、“7-18歲中國(guó)學(xué)齡兒童青少年腰圍界值點(diǎn)標(biāo)準(zhǔn)”和‘'WHtR國(guó)際標(biāo)準(zhǔn)(以0.5為臨界值)”,來(lái)劃分肥胖類型,根據(jù)“中國(guó)兒童高血壓的診斷標(biāo)準(zhǔn)”劃分兒童高血壓。所有儀器在使用前進(jìn)行校正,調(diào)查員在調(diào)查前進(jìn)行統(tǒng)一培訓(xùn),在整個(gè)調(diào)查中有專門的質(zhì)控員進(jìn)行質(zhì)控,從而保證測(cè)量結(jié)果的準(zhǔn)確性。 3.統(tǒng)計(jì)分析 采用Epidata軟件進(jìn)行數(shù)據(jù)雙錄入,采用SPSS13.0軟件和MedCalc軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 性別間各個(gè)測(cè)量指標(biāo)均數(shù)的比較采用t檢驗(yàn),組間率的比較采用χ2檢驗(yàn),指標(biāo)間的相關(guān)性采用Pearson相關(guān)分析,各肥胖指標(biāo)與血壓關(guān)系采用偏相關(guān)分析和多元線性回歸分析,各肥胖指標(biāo)對(duì)高血壓的預(yù)測(cè)效果采用多因素Logistic回歸分析和ROC曲線分析。BPHR對(duì)兒童高血壓的預(yù)測(cè)效果采用ROC曲線分析。 研究結(jié)果 1兒童不同類型肥胖患病率 (1)參照“2-18歲兒童超重、肥胖篩查BMI界值點(diǎn)標(biāo)準(zhǔn)”,總體的超重患病率為19.1%,其中男生為20.0%,女生為18.2%,總體的肥胖患病率為18.9%,男生為23.9%,女生為13.8%,超重和肥胖患病率均為男生高于女生(P0.05)。 (2)參照“7-18歲中國(guó)學(xué)齡兒童青少年腰圍界值點(diǎn)標(biāo)準(zhǔn)”,總體的腹型肥胖患病率為28.3%,其中男生為32.5%,女生為24.1%,男生高于女生(P0.001)。 (3)參照“WHtR國(guó)際標(biāo)準(zhǔn)”,總體的腹型肥胖患病率為19.1%,其中男生為26.2%,女生為11.9%。男生高于女生(P0.001)。 2.兒童高血壓患病率 參照“中國(guó)兒童高血壓的診斷標(biāo)準(zhǔn)”,總體的患病率為16.7%,其中男生高血壓患病率為20.1%,女生為13.1%,男生高于女生(P0.001)。 3各肥胖指標(biāo)對(duì)高血壓的預(yù)測(cè)作用 (1)偏相關(guān)分析結(jié)果顯示,控制年齡后,SBP和DBP與各肥胖指標(biāo)均存在相關(guān)性(P0.001)。各肥胖指標(biāo)與SBP或DBP的偏相關(guān)系數(shù)由大到小依次為BMI、WC和WHtR。按男女進(jìn)行亞組分析,趨勢(shì)保持不變。 (2)多元線性回歸分析顯示,控制年齡后,SBP和DBP與各肥胖指標(biāo)密切相關(guān)(P0.001),各肥胖指標(biāo)對(duì)SBP或DBP的回歸系數(shù)由大到小依次為BMI、WC、 WHtR。按男女進(jìn)行亞組分析,趨勢(shì)保持不變。 (3)Logistic回歸分析顯示,控制年齡后,高血壓、收縮期高血壓和舒張期高血壓的發(fā)病風(fēng)險(xiǎn)均隨著各肥胖指標(biāo)的增高而增加,各肥胖指標(biāo)預(yù)測(cè)高血壓的比值比(OR)由大到小依次為BMI、WC、WHtR。按男女進(jìn)行亞組分析,趨勢(shì)保持不變。 (4)各肥胖指標(biāo)預(yù)測(cè)高血壓、收縮期高血壓和舒張期高血壓的ROC曲線下的面積(AUC)均高于0.7(對(duì)舒張期高血壓的預(yù)測(cè)除外),提示各肥胖指標(biāo)對(duì)高血壓的預(yù)測(cè)效果較好,且BMI的預(yù)測(cè)效果略優(yōu)于WC和WHtR。按男女進(jìn)行亞組分析,趨勢(shì)保持不變。 4. BPHR對(duì)兒童高血壓的預(yù)測(cè)作用 (1) SBPHR與SBP, DBPHR與DBP存在著密切相關(guān)性。 (2)以SBPHR對(duì)收縮期高血壓進(jìn)行預(yù)測(cè),男生各年齡組AUC為0.943-0.995,靈敏度為0.818-0.976,特異度為0.828-0.930；女生各年齡組AUC為0.941-0.982,靈敏度為0.886-1,特異度為0.761-0.930。以DBPHR對(duì)舒張期高血壓進(jìn)行預(yù)測(cè),男生各年齡組AUC為0.979-0.995,靈敏度為0.957-1,特異度為0.873-0.989；女生各年齡組AUC為0.975-0.998,靈敏度為0.875-1,特異度為0.919-0.992。 (3)聯(lián)合運(yùn)用SBPHR和DBPHR預(yù)測(cè)總體高血壓,其靈敏度為0.956,特異度為0.848,提示BPHR對(duì)高血壓有很好的預(yù)測(cè)效果。 研究結(jié)論 1.濟(jì)南市6～17歲學(xué)齡兒童的各種類型肥胖患病率和高血壓患病率均處于國(guó)內(nèi)較高的水平。 2.BMI、WC和WHtR均對(duì)高血壓有較好的預(yù)測(cè)作用,BMI略優(yōu)于WC和WHtR,可用于高血壓的早期預(yù)警。 3. SBPHR和DBPHR對(duì)高血壓有很好的預(yù)測(cè)效果,是預(yù)測(cè)兒童高血壓的簡(jiǎn)單而且準(zhǔn)確的指標(biāo)。
[Abstract]:The purpose of the study is:
1 the effects of different obesity indicators, including body mass index (BMI), waist circumference (WC) and waist height ratio (WHtR), were compared to predict the effect of hypertension in children.
2 to investigate the predictive effect of blood pressure and height ratio (BPHR) on hypertension in children.
Objects and methods:
1. research objects
Selecting Ji'nan city middle level in primary and middle school students as the research object, requirements for household registration in the city for more than one year or the resident population, age 6-17. By convenient cluster sampling, a total sample of 4 schools in Ji'nan City, the 2 primary school, 1 junior middle schools, 1 high school received a total of 8378 valid samples. People, 4245 boys and 4133 girls, male and female ratio close to 1:1.
2. research methods
A questionnaire survey and physical examination of the object of study. The main contents of the questionnaire include the basic situation of the survey of birth information, dietary habits and family history of the disease, physical examination including height, weight, WC, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and calculate the BMI, WHtR, systolic blood pressure height ratio (SBPHR) and diastolic blood pressure (DBPHR) were taller than. Refer to "overweight children 2-18 years of age, obesity screening BMI value standard", "the 7-18 year old Chinese school-age children and adolescents WC cut-off point standard and the international standard"'WHtR "(0.5 of the critical value), divided according to the type of obesity." hypertension diagnosis standard of hypertension in children "Chinese divided children. All the instruments calibrated before use, investigators were trained in the investigation, in the investigation of the quality control staff special quality control, so as to ensure the accuracy of the measurement results.
3. statistical analysis
Epidata software is used to record data, and SPSS13.0 software and MedCalc software are used for statistical analysis.
Compared with the gender of each measurement indicators are the number of t test between groups was compared using the 2 test, correlation analysis using Pearson correlation between blood pressure and obesity indices by partial correlation analysis and multivariate linear regression analysis, the prediction effect of the obesity index on hypertension by multi factor analysis and prediction effect of.BPHR children with hypertension by ROC curve analysis Logistic regression analysis and ROC curve.
Research results
Prevalence of different types of obesity in 1 children
(1) refer to "overweight children 2-18 years of age, obesity screening BMI value standard, the overall prevalence of overweight was 19.1%, and 20% for boys and 18.2% for girls, the overall prevalence rate of obesity was 18.9%, 23.9% for boys and 13.8% for girls, the prevalence of overweight and obesity were higher in boys than girls (P0.05).
(2) referring to the "7-18 year old Chinese school age children's waist circumference boundary value standard", the overall prevalence of abdominal obesity is 28.3%, of which boys are 32.5%, girls are 24.1%, boys are higher than girls (P0.001).
(3) referring to the "WHtR international standard", the overall prevalence rate of abdominal obesity was 19.1%, among which boys were 26.2% and girls were higher than girls (P0.001) for 11.9%..
2. children's prevalence of hypertension
According to the diagnostic criteria of Chinese children's hypertension, the overall prevalence rate is 16.7%. The prevalence rate of hypertension among boys is 20.1%, girls are 13.1%, boys are higher than girls (P0.001).
The predictive effect of 3 obesity indexes on hypertension
(1) partial correlation analysis showed that after controlling age, there was a correlation between SBP and DBP and obesity indexes (P0.001). The partial correlation coefficients between obesity index and SBP or DBP were BMI from large to small, and WC and WHtR. were subdivided by men and women, and the trend remained unchanged.
(2) multiple linear regression analysis showed that after controlling age, SBP and DBP were closely related to each obesity index (P0.001). The regression coefficients of obesity indicators for SBP or DBP ranged from large to small in order of BMI, WC and WHtR. according to the subgroup analysis of men and women, and the trend remained unchanged.
(3) Logistic regression analysis showed that after controlling for age, hypertension, risk of systolic hypertension and diastolic hypertension were increased with the increase of the obesity index and predict hypertension ratio of the obesity index (OR) followed by BMI, WC, WHtR. subgroup analysis was carried out by the men and women, the trend remains unchanged.
(4) prediction of hypertension obesity indices, the ROC curve of systolic hypertension and diastolic hypertension under the area (AUC) were higher than 0.7 (except for the prediction of diastolic blood pressure), suggesting that the prediction effect of the obesity index on hypertension is better, while the predicted effect of BMI on WC and WHtR. slightly better by the men and women of subgroup analyses the trend remains unchanged.
Predictive effect of 4. BPHR on hypertension in children
(1) there is a close correlation between SBPHR and SBP, DBPHR and DBP.
(2) the systolic hypertension to predict SBPHR, male AUC of each age group is 0.943-0.995, sensitivity is 0.818-0.976, the specificity was 0.828-0.930; the girls in each age group AUC is 0.941-0.982, sensitivity is 0.886-1, the specificity of 0.761-0.930. to DBPHR on diastolic hypertension predict boys in each age group was 0.979-0.995 AUC, the sensitivity was 0.957-1. The specificity of 0.873-0.989; girls in each age group AUC is 0.975-0.998, sensitivity is 0.875-1, the specificity was 0.919-0.992.
(3) combined use of SBPHR and DBPHR to predict overall hypertension with a sensitivity of 0.956 and a specificity of 0.848, suggesting that BPHR has a good predictive effect on hypertension.
research conclusion
1. the prevalence rate of various types of obesity and the prevalence rate of hypertension at 6~17 year old school age children in Ji'nan are all at a higher level in China.
2.BMI, WC and WHtR have a good predictive effect on hypertension. BMI is slightly better than WC and WHtR, which can be used for early warning of hypertension.
3. SBPHR and DBPHR have a good predictive effect on hypertension. It is a simple and accurate indicator for predicting high blood pressure in children.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725.4;R723.14

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 丁宗一;中國(guó)兒童期單純肥胖癥[J];中華兒童保健雜志;1998年02期

2 康如彤;鐘燕;蔣耀輝;;長(zhǎng)沙市12～17歲兒童青少年血壓水平的調(diào)查分析[J];中國(guó)兒童保健雜志;2011年07期

3 劉Z，

本文編號(hào)：1742558