出生体重与学龄前儿童血压关系的研究

目的 分析出生体重与学龄前儿童收缩压(SBP)、舒张压(DBP)的关系。方法 选择在上海市闵行妇幼保健院产科出生，于2006年3月至2010年11月接受常规健康体检的2～6岁儿童，采用电子血压计测量SBP、DBP和心率，并测量身高和体重。血压评价参照1997年“日本学龄前儿童正常血压和高血压参考值”，以SBP或DBP≥其性别、年龄相对应的P95诊断为高血压。采用多元线性回归分析出生体重与血压的关系，多因素Logistic回归模型分析儿童期患高血压风险的危险因素。结果 4 642名学龄前儿童进入分析，其中男性2 458例（53%）；低出生体重儿占3.2 %(148/4 642)，巨大儿占5.4%（251/4 642）。男童SBP水平和高血压患病率均高于女童（P分别为<0.001和0.002）。低出生体重儿SBP、DBP与正常出生体重儿童无明显差异（P分别为0.492和0.398）；巨大儿DBP低于正常出生体重儿童（P=0.003）。多因素Logistic回归显示低出生体重儿、巨大儿与发生儿童高血压无统计学关联，而心率高于平均水平发生高血压的危险增高，OR= 2.55，95%CI＝1.96～3.31。结论 在学龄前儿童中，男童SBP高于女童。未发现低出生体重、巨大儿与儿童期患高血压有统计学关联；心率、体重对血压水平的影响较为明显。

A study on the relationship between birth weight and preschool children's blood pressure

Objective In order to find out the relationship between birth weight and systolic and diastolic blood pressure in preschool children. Methods Date for 4 642 healthy preschool children aged 2 to 6 were collected. All these children were born in Shanghai Minhang Maternal and Child Health Hospital. After rest in the sitting position for 5-10 min, the blood pressure (BP) and heart rate (HR) were measured on the right arm at the level of the heart, using appropriate size of cuff, by automated BP recorder (Model 45NEO-E6, Welch Allyn, USA). Elevated blood pressure was defined as systolic blood pressure (SBP)and/or diastolic blood pressure(DBP) equal or greater than the 95th percentile for gender and age, according to the reference based on Japanese preschool children(1997). Low birth weight was defined as <2 500 g and macrosomia as ≥4 000 g. Multiple regression models were used to analyze the association between birth weight and childhood hypertension. Results In total 4 642 children were analyzed in this study, with 2 458 (52.9%) being boys. The proportions of low birth weight and macrosomia were 3.2%(148/4 642) and 5.4%(251/4 642),respectively. The prevalence rate of hypertension was more common in boys than girls(9.4% vs 6.9%，P<0.05). Trend of negative correlation between birth weight and childhood DBP was observed in children with birth weight over 4 000 g. With gender, age, heart rate, body height and body weight adjusted, the relationship between birth weight and childhood hypertension was not significant in either low birth weight or macrosomia group. Rapid heart rate may increase the risk of hypertension at childhood (OR=2.55, 95%CI:1.96-3.33). Conclusion Blood pressure levels of preschool children were not significantly associated with birth weight. Rapid heart rate may increase the risk of hypertension.