出生体重对儿童期和成年期高血压影响的队列研究

目的 研究出生体重对儿童期和成年期高血压的影响。方法 基于北京地区儿童血压研究队列资源,1987年基线调查时采用听诊法测量儿童期血压水平,记录Korotkoff第Ⅰ音为收缩压（SBP）、第Ⅳ音为舒张压（DBP-K4）、第Ⅴ音（消音）为舒张压（DBP-K5）,并根据2010年中国儿童血压参照标准P95诊断儿童高血压;2010年3月至2011年3月随访时采用相同方法测量成年期血压,以SBP≥140 mmHg（1 mmHg=0.133 kPa）和（或）DBP≥90 mmHg或正在服用降压药诊断为高血压。出生体重、是否早产及母乳喂养情况通过随访对象母亲的回忆进行问卷填写。采用多元线性回归分析出生体重与血压水平的关系,多因素Logistic回归模型分析出生体重与儿童期及成年期罹患高血压风险的关联。结果 出生体重有效数据936名（男492名,女444名）进入分析,其中低出生体重儿30名（3.2%）,巨大儿78名（8.3%）。出生体重与儿童期及成年期女性SBP呈负相关（P>0.05）。按低出生体重儿、巨大儿及出生体重正常进行分层分析,出生体重与儿童期血压水平的关联在不同出生体重间的规律不同,低出生体重组男性DBP-K5与出生体重呈正相关（b=32.32,P=0.030）,出生体重正常组女性SBP与出生体重呈负相关（b=-2.50,P=0.047）,巨大儿组控制性别后儿童期SBP与出生体重呈正相关（b=6.32,P=0.039）。多因素Logistic回归分析显示,低出生体重预测女性儿童期高血压（SBP与DBP-K4联合诊断）和成年期高血压的RR（95％CI）分别为5.00(1.32~18.88)和5.84(1.05~32.65);未见巨大儿对儿童期及成年期高血压的影响。 结论 不同出生体重与男女儿童血压水平的相关性不一致,低出生体重可增加儿童期及成年期女性罹患高血压的风险。

Influence of birth weight on childhood and adulthood hypertension: the BBS cohort study

Objective To study the effect of birth weight on childhood and adulthood hypertension. Methods All study participants came from whole population of 3 198 subjects (1 700 males, 53.2%) of the national project of the 7th Five Year Plan, named "Beijing children and aadolescents blood pressure study (BBS)". Baseline study was conducted in 1987, and data including height, weight and blood pressure at baseline and 2010 (March 2010 to March 2011) were analyzed. Blood pressure was measured by auscultation on right arm. Korotkoff Ⅰ, Ⅳ and Ⅴ were recorded as systolic blood pressure (SBP) and diastolic blood pressure (DBP-K4 and DBP-K5). Birth weight, premature delivery and breast feeding were recalled by participants' mothers. Childhood hypertension was defined as SBP and（or） DBP equal to or greater than the 95th percentile for age and gender. Adulthood hypertension was diagnosed as SBP ≥140 mmHg and(or) DBP ≥90 mmHg or the subjects who were taking anti-hypertension drugs presently, according to the China Guideline for Hypertension Prevention and Control issued in 2009. Low birth weight was defined as <2 500 g and macrosomia as ≥4 000 g. Multiple regression models were used to analyze the influence of birth weight on childhood and adulthood blood pressure levels and hypertension. Results A total of 1 126 adults (35.2%) from the BBS cohort were followed up and participated the clinical examination ,among which 936 subjects (492 males, 52.6%) with valid birth weight were analyzed. The proportion of low birth weight and macrosomia were 3.2% (30/936) and 8.3% (78/936), respectively. The prevalence rates of hypertension at childhood and adulthood were 11.0% and 13.4%, respectively. Trend of negative correlation between birth weight and childhood and adulthood SBP was observed in female, but it did not reach statistical significance (P>0.05). Relationships between birth weight and childhood SBP and DBP varied among birth weight categories and genders. With age, body mass index, premature delivery and breast feeding adjusted, relative risks (RRs) of low birth weight predicting female hypertension in childhood and adulthood were 500(1.32-18.88) and 5.84(1.05-32.65), respectively. However, in male, low birth weight was not statistically correlated with hypertension at childhood or adulthood. The relationship between macrosomia and childhood or adulthood hypertension was not significant in either males or females. Conclusions Relationships between birth weight and childhood blood pressure differed in low birth weight, macrosomia and normal birth weight groups, or in males and females. Low birth weight may increase the risk of female hypertension at both childhood and adulthood.