儿童青少年血压偏高的4种简化筛查方法效果评价

李坤坤; 田纬; 陶梦梦; 曹文君

doi:10.16835/j.cnki.1000-9817.2024064

儿童青少年血压偏高的4种简化筛查方法效果评价

doi: 10.16835/j.cnki.1000-9817.2024064

李坤坤¹,
田纬¹,
陶梦梦¹,
曹文君^{1, 2, ,}

1.
山西医科大学公共卫生学院，太原 030000
2.
长治医学院公共卫生与预防医学系

基金项目:

山西省卫生健康委科研项目 2023002

山西省教育科学“十四五”规划项目 GH-220226

详细信息

作者简介:
李坤坤(1995-)，女，山西长治人，在读硕士，主要研究方向为儿童慢性病健康教育

通讯作者:
曹文君，E-mail: wjcao16@czmc.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R544 R193
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-10
- 修回日期: 2023-12-06
- 网络出版日期: 2024-03-02
- 刊出日期: 2024-02-25

Performance of four simplified screening methods of elevated blood pressure among children and adolescents

LI Kunkun¹,
TIAN Wei¹,
TAO Mengmeng¹,
CAO Wenjun^{1, 2
, ,}

1.
School of Public Health, Shanxi Medical University, Taiyuan (030000), Shanxi Province, China

摘要

摘要: 目的根据中国高血压防治指南(2018年修订版)对儿童青少年血压偏高常用的4种简化筛查方法进行效果评价，为儿童青少年血压异常的早期识别提供参考依据。方法于2021年10—11月，采用分层整群随机抽样方法对山西省某市5 211名儿童青少年进行体质监测，将中国高血压防治指南作为金标准，分别计算公式法、身高别法、年龄组别表格法和性别年龄别表格法筛查血压偏高的灵敏度、特异度、曲线下面积(AUC)和Kappa值等指标评价筛检效果。结果金标准、公式法、身高别法、年龄组别表格法和性别年龄别表格法筛查儿童青少年血压偏高率分别为21.9%，24.0%，21.1%，24.5%和20.2%。公式法、性别年龄别表格法与金标准判定结果差异均无统计学意义(χ²值分别为1.12，1.41，P值均>0.05)，而身高别法和年龄组别表格法与金标准判定结果差异均有统计学意义(χ²值分别为20.39，67.09，P值均＜0.05)。身高别法AUC最大，为0.94(95%CI=0.93~0.95)；年龄组别表格法AUC最小，为0.87(95%CI=0.86~0.88)。身高别法和性别年龄别表格法的Kappa值分别为0.89，0.89，均大于0.85，与金标准的筛查效果更吻合。分性别、年龄和体质量指数(BMI)情况比较时，男生、6~11岁和非超重肥胖组的筛查效果与总体一致，而女生、12~17岁、超重组和肥胖组的筛查效果与总体不同。年龄组别表格法的AUC(0.87)、Kappa值(0.71)和灵敏度(82.33%)均最低，筛查效果最差。结论身高别法筛查儿童青少年血压异常效果更好，该方法适用于儿童青少年血压异常的早期识别和自我检测。
- 血压 /
- 参考标准 /
- 曲线下面积 /
- 儿童 /
- 青少年
Abstract: Objective To evaluate the performance of four simplified screening methods of elevated blood pressure commonly used among children and adolescents according to Chinese guidelines for prevention and treatment of hypertension (revised in 2018), so as to provide a reference for the early detection of the elevated blood pressure among children and adolescents. Methods Stratified cluster random sampling method was used to monitor the physical fitness of 5 211 children and adolescents in a city of Shanxi Province from October to November 2021. Chinese guidelines for prevention and treatment of hypertension was considered as gold standard, and sensitivity, specificity, area under the curve (AUC) and Kappa value were calculated to evaluate the screening effectiveness of formula method, height-specific method, age group-specific method, sex and age-specific method for screening elevated blood pressure. Results The detection rates of elevated blood pressure among children and adolescents screened by gold standard, formula method, height-specific method, age group-specific method, sex and age-specific method were 21.9%, 24.0%, 21.1%, 24.5% and 20.2%, respectively. There was no significant difference between prevalence of elevated blood pressure screened by formula method, sex and age-specific method and gold standard(χ²=1.21, 1.41, P>0.05), whereas height-specific method and age group-specific method had significant differences with gold standard (χ²=20.39, 67.09, P < 0.05). AUC was the largest for height-specific method [0.94(95%CI=0.93-0.95)], and the smallest for age group-specific method [0.87(95%CI=0.86-0.88)]. The Kappa values of height-specific method (0.89) and sex and age-specific method (0.89) were both greater than 0.85, which were more consistent with the screening effectiveness of gold standard. When comparing by sex, age and body mass index (BMI), the screening effectivenesses were consistent with the overall in boys, 6-11 years and normal body weight groups, while the screening effectivenesses were different in girls, 12-17 years, overweight and obese groups. The AUC (0.87), Kappa value (0.71) and sensitivity (82.33%) of age group-specific method were the lowest and the screening effectiveness was the worst. Conclusion Height-specific method is more effective and can be used for early identification and self-detection of blood pressure abnormalities among children and adolescents.
- Blood pressure /
- Reference standards /
- Area under curve /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 4种简化方法预测不同特征儿童青少年血压偏高的ROC曲线

Figure 1. ROC curves for predicting elevated blood pressure by four simplified methods among children and adolescents with different characteristics

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表 1 不同性别儿童青少年基本特征比较(x±s)

Table 1. Comparison of basic characteristics among children and adolescents by sex (x±s)

性别	人数	身高/cm	体重/kg	BMI/ (kg·m^-2)	SBP/ mmHg	DBP/ mmHg
男	2 627	150.4±17.7	47.3±18.3	20.1±4.3	110.0±14.1	68.7±8.8
女	2 584	147.1±14.4	44.2±14.7	19.8±4.0	105.6±12.4	69.1±8.5
t值		188.60	98.46	5.36	38.02	-3.06
P值		＜0.01	＜0.01	0.02	＜0.01	0.08
注：1 mmHg=0.133 kPa。

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表 2 4种简化方法与金标准筛检儿童青少年血压偏高检出率

Table 2. Detection rates of elevated blood pressure in children and adolescents by four simplified methods and gold standard

性别	人数	金标准	公式法	身高别法	年龄组别表格法	性别年龄别表格法
男	2 627	590(22.5)	648(24.7)	620(23.6)	772(29.4)	547(20.8)
女	2 584	553(21.4)	605(23.4)	478(18.5)	507(19.6)	504(19.5)
合计	5 211	1 143(21.9)	1 253(24.0)	1 098(21.1)	1 279(24.5)	1 051(20.2)
注：()内数字为检出率/%。

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表 3 不同性别儿童青少年4种简化方法筛检血压偏高的效果比较

Table 3. Comparion of effect of four simplified methods for screening elevated blood pressure among children and adolescents by sex

性别	方法	AUC值(95%CI)	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%	Kappa值
男	公式法	0.92(0.91~0.94)	90.00	94.26	81.94	97.02	0.81
(n=2 627)	身高别法	0.95(0.94~0.96)	93.56	96.66	89.03	98.11	0.89
	年龄组别表格法	0.88(0.86~0.90)	88.14	87.63	67.36	96.23	0.68
	性别年龄别表格法	0.93(0.92~0.95)	87.97	98.63	94.88	96.49	0.89
女	公式法	0.92(0.90~0.93)	88.61	94.34	80.99	96.82	0.80
(n=2 584)	身高别法	0.92(0.90~0.94)	84.63	99.51	97.91	95.96	0.89
	年龄组别表格法	0.86(0.84~0.88)	76.13	95.77	83.04	93.65	0.74
	性别年龄别表格法	0.93(0.91~0.94)	86.44	98.72	94.84	96.39	0.88
合计	公式法	0.92(0.91~0.93)	89.33	94.30	81.48	96.92	0.81
(n=5 211)	身高别法	0.94(0.93~0.95)	89.24	98.08	92.90	97.01	0.89
	年龄组别表格法	0.87(0.86~0.88)	82.33	91.69	73.57	94.86	0.71
	性别年龄别表格法	0.93(0.92~0.94)	87.23	98.67	94.86	96.49	0.89

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表 4 不同年龄组儿童青少年4种简化方法筛检儿童青少年血压偏高的效果比较

Table 4. Comparion of effect of four simplified methods for screening elevated blood pressure among children and adolescents by age

年龄/岁	方法	AUC值(95%CI)	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%	Kappa值
6~11	公式法	0.91(0.89~0.93)	89.27	95.81	76.43	97.04	0.77
(n=2 368)	身高别法	0.94(0.93~0.96)	89.68	98.56	94.26	97.31	0.90
	年龄组别表格法	0.85(0.82~0.87)	78.14	91.20	70.05	94.06	0.67
	性别年龄别表格法	0.92(0.90~0.94)	85.02	98.93	95.46	96.16	0.88
12~17	公式法	0.93(0.91~0.94)	89.37	95.62	85.80	96.82	0.84
(n=2 843)	身高别法	0.93(0.92~0.95)	88.91	97.68	91.88	96.75	0.88
	年龄组别表格法	0.89(0.87~0.91)	85.52	92.12	76.24	95.56	0.74
	性别年龄别表格法	0.94(0.92~0.95)	88.91	98.45	94.44	96.77	0.89

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表 5 不同BMI组儿童青少年4种简化方法筛查儿童青少年血压偏高效果比较

Table 5. Comparion of effect of four simplified methods for screening elevated blood pressure among children and adolescents by BMI

BMI	方法	AUC值(95%CI)	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%	Kappa值
非超重肥胖组	公式法	0.91(0.90~0.93)	87.52	95.06	79.48	97.21	0.79
(n=3 530)	身高别法	0.93(0.92~0.95)	87.68	98.48	92.65	97.34	0.88
	年龄组别表格法	0.86(0.84~0.88)	78.04	93.23	71.59	95.11	0.69
	性别年龄别表格法	0.91(0.90~0.93)	83.73	98.93	94.47	96.53	0.87
超重组	公式法	0.93(0.90~0.95)	90.61	94.86	86.38	96.56	0.84
(n=926)	身高别法	0.94(0.92~0.96)	90.20	97.65	93.25	96.52	0.89
	年龄组别表格法	0.88(0.85~0.91)	85.71	90.02	75.54	94.60	0.73
	性别年龄别表格法	0.95(0.92~0.97)	90.20	98.97	96.93	96.56	0.91
肥胖组	公式法	0.91(0.88~0.93)	92.45	88.98	81.94	95.61	0.79
(n=755)	身高别法	0.94(0.92~0.96)	92.08	96.33	93.13	95.74	0.89
	年龄组别表格法	0.87(0.84~0.90)	89.43	84.90	76.21	93.69	0.72
	性别年龄别表格法	0.95(0.93~0.97)	92.83	96.74	93.89	96.15	0.90

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