高血压儿童腰围发育曲线及其与高血压相关性的研究

目的 了解高血压儿童腰围发育曲线特点,探讨与儿童高血压相关的腰围正常值合理切点.方法 研究对象为安徽省北、中、南3个地市的8194名7～17岁汉族城乡中小学生,测量腰围与血压.以LMS( lambda-mu-sigma)法拟合腰围随年龄变化的百分位数曲线.建立Logistic回归模型,计算不同百分位数腰围学生发生高血压的OR值.结果 高血压男生的腰围发育曲线明显向上平行偏离总体男生标准曲线,而高血压女生腰围发育曲线在12岁前向上逐渐偏离总体女生标准曲线,之后逐渐回归.男生腰围上升至同年龄别第60百分位数、女生腰围上升至同年龄别第70百分位数时,高血压发生风险即开始显著增加,男生腰围p60～组、P70～组、P80～组和P90～组的OR值从1.88(95％CI:1.18 ～2.99)逐渐上升至4.87(95％CI:3.31 ～7.16),女生腰围P70～组、P80～组和P90～组的OR值从1.71 (95％CI:1.07～2.73)逐渐上升至3.32(95％ CI:2.16～5.09).结论 高血压男生和女生的腰围发育曲线轨迹明显不同.从第85百分位数向下适当降低儿童腰围正常值切点有利于儿童心血管疾病风险的预防.

Relationship between waist circumference development curve of children and hypertension and risk of hypertension

Objective The 85th percentile of waist circumference (WC) is considered an appropriate cutoff for Chinese children in the prediction of cardiovascular risks in previous researches,but the risk for hypertension of moderate WC maybe underestimated.The purpose of this study was to understand the characteristics of the WC curve trajectory of children with hypertension and to determine the appropriate cutoffs for waist circumference for Chinese school-age children and adolescents for predicting hypertension risk factors.Methods A total of 8194 Han children aged 7-17 years were selected from schools in Suzhou,Hefei,and Chizhou cities in Anhui province by stratified cluster sampling. WC and blood pressure were accurately measured in all subjects. LMS (lambda-mu-sigma) method was used to construct WC centile curves. Optimal WC cutoffs were determined by comparing the performance of different percentile sets of WC cutoffs in predicting hypertension risk factors.Results The fitted LMS curves of WC for the group of boys with hypertension deviate in parallel from that for the corresponding curve in the entire boy study population with higher WC.The WC curves for the group of girls with hypertension gradually upward deviated from the corresponding curve before 12 years of age and then gradually returned to the corresponding curve. WC of boys at the percentiles of 60 was already associated with an increased risk of hypertension and hazard ratio of WC at percentiles of 60,70,80,and 90 increased from 1.88 (95％ CI: 1.18-2.99) to 4.87 (95％ CI:3.31-7.16). WC of girls at the percentiles of 70 was already associated with an increased risk of hypertension and hazard ratio of WC at percentiles of 70,80,and 90 increased from 1.71 (95％ CI: 1.07-2.73) to 3.32 ( 95％ CI: 2.16-5.09 ). Conclusions The WC growth trajectory of children with hypertension varies with gender.WC is an independent predictor of childhood hypertension,even when it is well within what is now defined as the normal range of WC.Thus,it is helpful to prevent the risk of cardiovascular disease of children using the paramenter that WC cut-off level lower than 85th percentile.