本文選題：青少年　切入點：身高　出處：《華中科技大學(xué)》2015年博士論文

【摘要】：研究目的 (1)比較不同年齡、性別和身高別青少年血壓水平的差異,探討青少年身高、年齡和性別對青少年血壓評價的作用。 (2)探討2010年中國兒童青少年高血壓診斷標(biāo)準(zhǔn)與2004年美國兒童青少年血壓評判標(biāo)準(zhǔn)比較12-17歲長沙市青少年高血壓患病率的差別。 (3)研究血壓身高指數(shù)(BPHRI)對青少年高血壓的識別和預(yù)測價值,探討12-17歲青少年高血壓評價BPHRI臨界值,為青少年高血壓的診斷和預(yù)防提供理論依據(jù)。 對象與方法 1.研究對象 采用整群隨機(jī)抽樣的方法抽取長沙市的49所中學(xué)(共80所中學(xué),包括65所初中和15所高中)初一至高二的全部12-17歲的青少年中學(xué)生作為本次研究的對象,共66481人,包括33483名女生(50.4%)和32998名男生(49.6%)。其中第一部分研究中排除了7656名超體重和3285名肥胖的青少年青少年。 2.研究方法 (1)測量研究對象身高(cm)、體重(kg)和收縮壓(Korotkoff第I音)舒張壓(Korotkoff第V音)。 (2)通過分組匹配的方法,分別探討青少年身高、性別和年齡在青少年青少年血壓水平變化過程中的作用。 (3)按“中國學(xué)齡兒童青少年超體重、肥胖篩查BMI分類標(biāo)準(zhǔn)”進(jìn)行超體重和肥胖判定。 (4)分別參照中國青少年標(biāo)準(zhǔn)身高和美國CDC2000發(fā)布的青少年身高標(biāo)準(zhǔn)將研究對象身高進(jìn)行標(biāo)準(zhǔn)化轉(zhuǎn)換； (5)分別參照“中國3-17歲兒童青少年血壓參照標(biāo)準(zhǔn)”和"2004年美國兒童青少年高血壓評價診斷標(biāo)準(zhǔn)”,按青少年收縮壓(SBP)和(或)舒張壓(DBP)平均值大于等于同年齡、同性別、同身高(采用美國標(biāo)準(zhǔn)時考慮)的第95百分位數(shù)血壓臨界值者定義為兒童青少年高血壓。 (6)按如下公式計算收縮壓身高指數(shù)(Systolic blood pressure to height ratio index, SBPHRI)和舒張壓身高指數(shù)(Diastolic blood pressure to height ratio index, DBPHRI): SBPHRI=收縮壓(mmHg)/身高(cm), DBPHRI=舒張壓(mmHg)/身高(cm)。 3.統(tǒng)計分析方法 采用SPSS19.0軟件包對原始數(shù)據(jù)進(jìn)行整理和統(tǒng)計分析。采用t檢驗、方差分析、χ2檢驗、Pearson相關(guān)分析、多元線性回歸分析對數(shù)據(jù)進(jìn)行統(tǒng)計推斷分析。kappa值用于評價兩種血壓評價判定結(jié)果一致性；采用ROC曲線分析BPHRI對青少年高血壓的預(yù)測效果。 研究結(jié)果 第一部分 (1)隨著青少年年齡的增長,男女生身高、收縮壓以及舒張壓均逐漸增長；各年齡組男生的身高、收縮壓和舒張壓均顯著高于同年齡段的女生(P0.001)。 (2)通過匹配控制年齡和身高后,青少年男生收縮壓與舒張壓仍然顯著高于同年齡段同身高的青少年女生(P0.001); (3)進(jìn)行身高匹配后,青少年男女生的收縮壓和舒張壓仍隨年齡的增長而顯著升高(相鄰年齡組血壓均值比較,P均0.001)； (4)對青少年男女生進(jìn)行年齡和性別匹配后,各年齡組青少年男女生收縮壓與舒張壓水平均隨身高的增長而顯著上升(P0.001)； (5)多元線性回歸模型分析結(jié)果表明,青少年的身高水平對青少年收縮壓(β=0.24,P0.001)以及舒張壓(β=0.18,P0.001)的影響明顯大于其年齡(SBP,β=0.15; DBP, β=0.12, P0.001)和性別(SBP, β=021; DBP, β=0.13, P＜0.001)的影響,決定系數(shù)R2=0.56和0.62,P0.001. 第二部分 (1)參照中國標(biāo)準(zhǔn)時,青少年男生高血壓總患病率為14.3%,女生為10.4%；顯著高于美國標(biāo)準(zhǔn)下,男生高血壓總患病率為2.6%,女生為6.0%；隨著男女生年齡的增加,采用兩種血壓標(biāo)準(zhǔn)計算得出的高血壓患病率均呈現(xiàn)顯著上升的趨勢(P0.001)。 (2)各年齡段男女生參照中美兩種血壓標(biāo)準(zhǔn)判定的高血壓患病率隨身高百分位數(shù)的上升呈現(xiàn)明顯上升的趨勢,且兩種血壓標(biāo)準(zhǔn)判定的高血壓患病率間的差別隨年齡增大及身高百分位數(shù)上升而顯著增大(P0.001)； (3)兩種高血壓標(biāo)準(zhǔn)在判斷女生收縮期以及男女生舒張期高血壓的一致性均較微弱(Kappa值分別為0.145、0.208和0.198,一致性檢驗P均0.001)；而兩種診斷標(biāo)準(zhǔn)在判斷男生收縮期高血壓的一致性為中度強(qiáng)度(Kappa值為0.529,一致性檢驗P0.001)。 第三部分 (1)男生的SBPHRI/DBPHRI均值為0.648/0.413,女生SBPHRI/DBPHRI均值為0.638/0.416,男女性別及年齡之間的差距極其微小,但仍有顯著性統(tǒng)計學(xué)意義(P0.001) (2)相關(guān)性分析結(jié)果顯示,BPHRI與青少年身高呈顯著負(fù)相關(guān)、與收縮壓及舒張壓呈極強(qiáng)的正相關(guān),而與男生年齡呈弱相關(guān)(SBP, r=0.024; DBP, r=0.048; P均0.001),與女生年齡無相關(guān)性。 (3) SBPHRI和DBPHRI對高血壓最佳診斷臨界值為男生0.76/0.48,女生0.74/0.47。SBPHRI對男生收縮期高血壓預(yù)測的AUC為0.996-0.997,靈敏度為0.982-0.985,特異度為0.967-0.978；對女生收縮期高血壓預(yù)測的AUC為0.993-0.994,靈敏度為0.947-0.973,特異度為0.928-0.934; DBPHRI對男生舒張期高血壓預(yù)測的AUC為0.987-0.995,靈敏度為0.969-0.987,特異度為0.925-0.974；對女生舒張期高血壓預(yù)測的AUC為0.991-0.992,靈敏度為0.950-0.966,特異度為0.915-0.928。年齡段男女生BPHRI對高血壓預(yù)測的陰性預(yù)測值NPV均接近于1.00,陽性預(yù)測值PPV也在0.30-0.60之間,也表明SBPHRI和DBPHRI對相應(yīng)對青少年高血壓具有較好的預(yù)測作用。 研究結(jié)論 性別、年齡和身高均對青少年的血壓水平產(chǎn)生顯著而又獨立的影響,且身高對血壓的影響最大,在制定青少年血壓參照標(biāo)準(zhǔn)時應(yīng)當(dāng)綜合考慮性別、年齡,尤其是身高等三個指標(biāo)的影響。 中美兩種兒童青少年血壓評價標(biāo)準(zhǔn)對本次青少年高血壓診斷結(jié)果的一致性較差；中國評價標(biāo)準(zhǔn)下青少年高血壓的患病率顯著高于美國標(biāo)準(zhǔn),且兩種標(biāo)準(zhǔn)下高血壓的患病率的差別隨青少年年齡和身高增加而相應(yīng)增大；美國標(biāo)準(zhǔn)考慮了兒童青少年身高因素,在高血壓診斷上比中國標(biāo)準(zhǔn)更加精確；中國標(biāo)準(zhǔn)未考慮身高因素,容易造成對身高明顯偏高青少年高血壓的誤診和身高明顯偏低青少年高血壓的漏診。 12-17歲青少年BPHRI水平受青少年性別和年齡的影響較小,對青少年高血壓具有極好的識別和預(yù)測價值,是高血壓簡單而且準(zhǔn)確的診斷指標(biāo)。
[Abstract]:research objective
(1) to compare the difference of blood pressure in adolescents with different ages, sex and height, and to explore the effect of adolescent height, age and sex on the evaluation of young people's blood pressure.
(2) to explore the difference between the diagnostic criteria of hypertension in Chinese children and adolescents in 2010 and the standard of blood pressure assessment for children and adolescents in the United States in 2004. The prevalence of hypertension among adolescents aged 12-17 years old in Changsha is different.
(3) to study the value of blood pressure and height index (BPHRI) in identifying and predicting hypertension in adolescents, and to explore the critical value of BPHRI in 12-17 year old adolescents, so as to provide a theoretical basis for diagnosis and prevention of hypertension in adolescents.
Object and method
1. research objects
49 middle schools by using cluster random sampling method to extract Changsha city (a total of 80 schools, including 65 junior high schools and 15 high schools) middle school all 12-17 years old young high school students as the research object, a total of 66481 people, including 33483 girls and 32998 boys (50.4%) (49.6%) the first part of the study. The exclusion of 7656 overweight and 3285 obese adolescents.
2. research methods
(1) measure the subjects' height (CM), body weight (kg) and systolic pressure (Korotkoff I sound) diastolic pressure (Korotkoff V sound).
(2) the role of height, sex and age of adolescents in the change of blood pressure in adolescents was investigated by group matching.
(3) super weight and obesity were determined according to the "BMI classification standard for overweight and obesity screening in Chinese school-age children and adolescents."
(4) according to the standard height of Chinese teenagers and the height standards of young people in the United States CDC2000, the height of the study was standardized.
(5) respectively according to "blood pressure of children aged 3-17 China youth reference standard" and "American children and adolescents 2004 hypertension diagnostic evaluation standard", according to the systolic blood pressure (SBP) and adolescents (or) diastolic blood pressure (DBP) the average value is greater than or equal to the same age, same sex, same height (the American Standard) ninety-fifth percentile of blood pressure is defined as the critical value of hypertension in children and adolescents.
(6) according to the following formula to calculate the systolic blood pressure height index (Systolic blood pressure to height ratio index, SBPHRI) and diastolic blood pressure height index (Diastolic blood pressure to height ratio index, DBPHRI SBPHRI=): systolic blood pressure (mmHg) / height (CM), DBPHRI= Shu Zhang Ya (mmHg) / height (CM).
3. statistical analysis method
Packet sorting and statistical analysis of the original data by SPSS19.0 software. Using t test, variance analysis, 2 test, Pearson correlation analysis, multiple linear regression analysis of data for statistical inference analysis.Kappa value used for the evaluation of two blood pressure evaluation results consistency; mining analysis and forecast effect of BPHRI on hypertension in adolescents with ROC curve.
Research results
Part one
(1) with the growth of adolescent age, the height, systolic blood pressure and diastolic blood pressure of boys and girls increased. The height, systolic blood pressure and diastolic blood pressure of boys in all age groups were significantly higher than those of girls of the same age group (P0.001).
(2) after matching the control age and height, the systolic and diastolic pressure of young boys was still significantly higher than that of young girls with the same age as the same height (P0.001).
3. After height matching, the systolic blood pressure and diastolic blood pressure of young boys and girls still increased with age. (the mean value of blood pressure in adjacent age group was 0.001, P).
(4) after matching age and sex between boys and girls, systolic blood pressure and diastolic blood pressure of boys and girls in different age groups increased significantly with height growth (P0.001).
(5) the results of multiple linear regression model showed that adolescent height level of adolescent systolic blood pressure (beta =0.24, P0.001) and diastolic pressure (beta =0.18, P0.001) was significantly greater than the impact of age (SBP, =0.15, DBP, beta; beta =0.12, P0.001) and gender (SBP, P = 021; DBP. Beta =0.13, P < 0.001) the influence of the coefficient of determination R2=0.56 and 0.62, P0.001.
The second part
(1) China reference standard, the total prevalence rate of hypertension in young boys 14.3%, girls 10.4%; boys was significantly higher than the American Standard, the total prevalence rate of hypertension was 2.6%, female was 6%; male and female students increased with age, the prevalence rate of high blood pressure with two blood pressure standard calculated showed a significant upward trend (P0.001).
(2) boys and girls of all ages to Sino US two blood pressure criteria the prevalence rate of hypertension increased with the increase of height percentile, and the two kinds of blood pressure standard to determine the prevalence of hypertension increases with age and the difference between the height percentile increased significantly (P0.001);
(3) two kinds of hypertension in judging the standard of girls and boys systolic diastolic hypertension were relatively weak consistency (Kappa = 0.145,0.208 and 0.198 respectively, the consistency test P 0.001); and two diagnostic criteria in judging the consistency of boys for systolic hypertension intensity (Kappa = 0.529, consistency test P0.001).
The third part
(1) the average SBPHRI/DBPHRI of boys is 0.648/0.413, and the average SBPHRI/DBPHRI of girls is 0.638/0.416. The difference between men and women is very small, but there is a significant statistical difference (P0.001).
(2) correlation analysis showed that BPHRI had a significant negative correlation with adolescent height, a strong positive correlation with systolic blood pressure and diastolic blood pressure, but weakly correlated with male age (SBP, r=0.024, DBP, r=0.048, P all 0.001), and had no correlation with girls' age.
(3) SBPHRI and DBPHRI on hypertension optimal diagnostic critical value of male 0.76/0.48, female 0.74/0.47.SBPHRI male systolic hypertension predicted AUC 0.996-0.997, sensitivity is 0.982-0.985, the specificity was 0.967-0.978; the female systolic hypertension predicted AUC 0.993-0.994, sensitivity is 0.947-0.973, the specificity was 0.928-0.934; DBPHRI of male diastolic hypertension predicted AUC for 0.987-0.995, the sensitivity is 0.969-0.987, the specificity was 0.925-0.974; the girls diastolic hypertension predicted AUC 0.991-0.992, sensitivity is 0.950-0.966, the specificity of 0.915-0.928. age of male and female students of BPHRI negative predictive value NPV of hypertension are close to 1, the positive predictive value of PPV is between 0.30-0.60, SBPHRI and DBPHRI also showed the corresponding the blood pressure has good prediction effect.
research conclusion
Gender, age and height all have significant and independent effects on blood pressure level of adolescents, and height has the greatest impact on blood pressure. When making the reference standard of adolescent blood pressure, we should take into consideration the influence of three indicators, such as gender, age, especially height.
The two children's blood pressure evaluation standard for the poor consistency of adolescent hypertension diagnosis results; the prevalence rate of hypertension Chinese evaluation standard of adolescents was significantly higher than that of American Standard, and the two kinds of differences in the rate of prevalence of hypertension in adolescents with standard age and body height increased; the standard considers height factors in children and adolescents in the diagnosis of hypertension, than the standard Chinese more accurate; China standard does not consider the height factor, easily lead to significantly higher height of adolescent hypertension is significantly lower misdiagnosis and missed diagnosis of height of adolescent hypertension.
The BPHRI level of 12-17 year olds is less affected by the sex and age of adolescents. It has excellent identification and predictive value for adolescent hypertension, and is a simple and accurate diagnostic index for hypertension.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R544.1

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本文編號：1673829