家族史及体重指数在儿童血脂紊乱筛查中的意义

目的:探讨将家族史联合肥胖用于筛查儿童血脂紊乱的意义.方法:通过整群抽样方法对北京地区6～18岁儿童青少年进行横断面流行病学调查.有效调查对象19 037例,其中男童9 495人,女童9 542人,根据年龄及性别分为学龄期男童、青春期男童、学龄期女童和青春期女童.检测受试儿童空腹末梢血总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)以及身高、体重并计算体重指数.结果:在总受试儿童中,有家族史儿童占38%,肥胖儿童占4.9%,有家族史并肥胖儿童占2.5%,有家族史或肥胖儿童占40.4%.无肥胖且无家族史儿童、无肥胖但有家族史儿童、肥胖但无家族史儿童及肥胖且有家族史儿童各种血脂异常发生率分别为:高脂血症[7.9%]、9.6%、30.1%及31.5%;高胆固醇血症0.9%、1.5%、 3.3%及2.9%;高甘油三酯血症7.1%、8.6%、29.2%及31.3%;混合型高脂血症0.2%、0.5%、0.4%及2.7%.肥胖儿童发生血脂紊乱的危险性与非肥胖儿童相比各性别年龄分组OR值(95%可信区间)分别为:学龄期男童6.439 (4.178～9.925)、青春期男童6.287 (4.153～[9.518)、]学龄期女童5.063 (3.041～8.427)、青春期女童3.665 (2.536～5.296) (P均=0.000).有家族史儿童发生血脂紊乱的危险性与无家族史儿童相比各性别年龄分组OR值(95%可信区间)分别为:学龄期男童1.204[ (0.952～1.522)] (P =0.121)、青春期男童1.331 (1.047～1.692) (P=0.020)、学龄期女童1.095 (0.847～[1.416)] (P=0.490)、青春期女童1.260 (1.070～1.483)(P=0.005).在血脂紊乱儿童中,有家族史儿童占[43.8%,]肥胖儿童占15.8%,有家族史并肥胖儿童占8.2%,有家族史或肥胖儿童占51.3%.结论:家族史联合肥胖对于筛查儿童血脂紊乱有重要意义.

Screening for dyslipidemia based on family history combined with obesity in children

Objective:To explore the significance of family history combined with obesity in screening dyslipidemia in children. Methods: Cluster-randomized samplings in a transecting epidemiological survey for children aged 6 to 18 years in Beijing area were used. A total of 9 495 boys and 9 542 girls were virtually included in the study. They were divided into four groups as school boys, adolescent boys, school girls and adolescent girls. Their fasting capillary blood total cholesterol (TC) levels, triglyceride (TG) levels, body height and body weight were detected. Results: Of the detected children, 38% were with family history, 4.9% obese, 2.5% both obese and positive family history and 40.4% with positive family history or obese. The percentages of dyslipidemia in non-obese children without family history, non-obese children with family history, obese children without family history, and obese children with family history were as follows: hyperlipidemia: 7.9%, 9.6%, 30.1% and 31.5%, respectively; hypercholesterolemia: 0.9%, 1.5%, 3.3% and 2.9%, respectively; hypertriglyceridemia: 7.1%, 8.6%, 29.2% and 31.3% respectively. Odds Ratios (95%CI) of dyslipidemia in obese children including school boys, adolescent boys, school girls and adolescent girls were 6.439(4.178-9.925),6.287 (4.153-9.518),5.063 (3.041-8.427) and 3.665 (2.536-5.296),respectively. Odds Ratios (95%CI) of dyslipidemia in children with family history including school boys, adolescent boys, school girls and adolescent girls were 1.204 (0.952-1.522) (P=0.121),1.331 (1.047-1.692) (P=0.020),1.095 (0.847-1.416) (P=0.490) and 1.260 (1.070-1.483) (P=0.005), respectively. In children with dyslipidemia, 43.8% were with positive family history, 15.8% obese, 8.2% both obese and positive family history, and 51.3% either obese or positive family history. Conclusion: Family history combined with obesity is important in identifying dislipidemia in children.