Comparison of Two Diagnosis Standards for Evaluating Hypertension in 18 Years Old Students in Yunnan China
-
摘要:
目的 以《中国高血压防治指南》（2022年修订版）为金标准，以《中国高血压临床实践指南》（2022年11月版）为检验标准，比较分析2种诊断标准判定云南省18岁学生血压偏高的流行趋势、分布特征，探究《新指南》用于判定云南省18岁学生高血压的科学性及合理性，为今后制定学生血压异常判定标准提高科学依据。 方法 利用云南省2021年16个州（市）、32个县（区）、61所学校开展的18岁中学生血压异常流行病学调查数据进行Kappa比较分析。共调查3 175人。 结果 《新指南》诊断评估值为≥130 mmHg/80 mmHg，低于金标准（≥140 mmHg/90 mmHg）。金标准判定云南省18岁中学生血压偏高的检出率为2.93%。《新指南》诊断标准判定检出率为16.13%。同一人群的血压偏高检出水平《新指南》明显高于金标准（χ2 = 498.31，P < 0.01）。《新指南》诊断的Kappa值0.27（P < 0.01），提示一致性较弱。真实性评价为：灵敏度100%、特异度86.40%、误诊率13.60%、约登指数为0.86、阳性似然比7.35。可靠性评价为：符合率86.80%。 结论 《新指南》诊断标准下调，考虑到了高血压防治的关口前移。但是目前将诊断标准下调的证据尚不充分，建议谨慎对待该问题。 Abstract:Objective By taking the “Guidelines for the Prevention and Treatment of Hypertension in China” （2022 revised edition） as the gold standard, and “Clinical Practice Guidelines for Hypertension in China” （November 2022 edition） as the test standard, to compare and analyze the epidemic trend and distribution characteristics of hypertension in 18-year-old students in Yunnan Province, and evaluate the scientifically and rationality of the new guidelines for diagnosing hypertension in 18-year-old students in Yunnan Province were explored, so as to improve the scientific basis for formulating the criteria for determining abnormal blood pressure in students in the future. Methods The survey of blood pressure among 18-year-old students investigated in 16 prefectures （cities）, 32 counties （districts） and 61 schools in Yunnan in 2021 were used Kappa for comparative analysis. A total of 3175 people were surveyed in this study. Results The diagnostic assessment of the new guideline is ≥130 mmHg/80 mmHg, which is lower than the gold standard （≥140 mmHg/90 mmHg）. To diagnose with the gold standard, t he prevalence of hypertension among 18-year-old students in Yunnan was 2.93%. The diagnostic criteria of the New Guidelines were 16.13%. The diagnostic value of the new guideline with hypertension was significantly lower than the gold standard, resulting in the prevalence level being significantly higher than the gold standard （χ2 = 498.31, P < 0.01）. The Kappa value was 0.27 （P < 0.01）, which indicated weak consistency with diagnosing in the New Guidelines. The authenticity evaluation was as follows: sensitivity 100%, specificity 86.40%, misdiagnosis rate 13.60%, Jordon index 0.86, positive likelihood ratio 7.35. The reliability evaluation: the compliance rate was 86.80%. Conclusions The diagnostic criteria of the New Guidelines have been lowered. Taking into account the threshold of hypertension prevention and treatment, it is moved forward. However, evidence to downgrade diagnostic criteria may not be sufficient and caution is advised. -
Key words:
- Students /
- Adolescent /
- Hypertension /
- Diagnosis standard /
- Evaluation index
-
表 1 2021年云南省18岁中学生不同判定标准的血压偏高统计表
Table 1. The prevalence of hypertension with different judgement standardds of different groups among 18 aged school students in Yunnan in 2021
变量 n ≥140/90 mmHg ≥130/80 mmHg 率差值（%） χ2 P 血压偏高人数 % 血压偏高人数 % 性别 男 1464 73 4.99 317 21.65 16.66 277.998 < 0.001* 女 1711 20 1.17 195 11.40 10.23 157.326 < 0.001* 民族 汉族 1512 61 4.03 294 19.44 15.41 263.338 < 0.001* 少数民族 1663 32 1.92 218 13.11 11.19 216.272 < 0.001* 城乡 城区 2226 82 3.68 394 17.70 14.02 395.862 < 0.001* 郊/县区 949 11 1.16 118 12.43 11.27 78.375 < 0.001* 经济状况 好 109 1 0.92 11 10.09 9.17 8.99 < 0.001* 中 902 20 2.22 131 14.52 12.30 120.38 < 0.001* 差 2164 72 3.33 370 17.10 13.77 361.12 < 0.001* 地区 昆明市 109 1 0.92 11 10.09 9.17 8.992 < 0.001* 昭通市 286 11 3.85 53 18.53 14.68 50.293 < 0.001* 曲靖市 161 13 8.07 40 24.84 16.77 42.779 < 0.001* 楚雄州 176 2 1.14 26 14.77 13.63 11.671 < 0.001* 玉溪市 170 4 2.35 24 14.12 11.77 24.920 < 0.001* 红河州 154 0 0 12 7.79 7.79 7.789 < 0.001* 文山州 177 2 1.13 8 4.52 2.29 42.733 < 0.001* 普洱市 121 4 3.31 22 18.18 14.87 18.615 < 0.001* 西双版纳州 157 2 1.27 23 14.65 13.38 11.803 < 0.001* 大理州 241 1 0.41 29 12.03 11.62 7.341 < 0.001* 保山市 211 22 10.43 87 41.23 30.80 35.006 < 0.001* 德宏州 233 10 4.29 45 19.31 15.02 43.651 < 0.001* 丽江市 217 4 1.84 22 10.14 8.30 36.120 < 0.001* 怒江州 182 3 1.65 20 10.99 9.34 24.707 < 0.001* 迪庆州 329 5 1.52 35 10.64 9.12 42.648 < 0.001* 临沧市 251 9 3.59 55 21.91 18.32 33.266 < 0.001* 合计 3175 93 2.93 512 16.13 13.20 498.305 < 0.001* *P < 0.05。 
下载: 导出CSV
表 2 《新指南》筛检云南省18岁儿童血压偏高效果的评价结果统计表（n）
Table 2. Evaluation of the New Guidelines on screening hypertension among 18-year-old children in Yunnan Province （n）
筛检试验标准（≥130/80 mmHg） 金标准（≥140/90 mmHg） χ2 P 血压偏高者 正常者 合计 阳性 93 419 512 498.305 < 0.001* 阴性 0 2663 2663 合计 93 3082 3175 *P < 0.05。
下载: 导出CSV
-
[1] WHO. Indicators for improving quality and coverage of services[M]. Geneva: WHO Press, 2021: 3. [2] Anchala Raghupathy,Kannuri Nanda K,Pant Hira,et al. Hypertension in India: a systematic review and meta-analysis of prevalence,awareness,and control of hypertension[J]. Journal of Hypertension,2014,32(6):1170-1177. doi: 10.1097/HJH.0000000000000146 [3] Ojji D B,Baldridge A S,Orji I A,et al. Characteristics,treatment,and control of hypertension in public primary healthcare centers in Nigeria: baseline results from the Hypertension Treatment in Nigeria Program[J]. Journal of Hypertension,2022,40(5):888-896. [4] Veghari Gholamreza,Sedaghat Mehdi,Maghsodlo Siavash,et al. Impact of literacy on the prevalence,awareness,treatment and control of hypertension in Iran[J]. Journal of Cardiovascular and Thoracic Research,2012,4(2):37-40. [5] Van M H,Lan V N,Huy T V,et al. Asian management of hypertension: Current status,home blood pressure,and specific concerns in Vietnam[J]. Journal of Clinical Hypertension,2020,22(3):497-500. [6] 田朝霞,李红梅. 2016年山西省汾阳市城区6岁~12岁儿童高血压现状分析[J]. 全科护理,2017,15(18):2274-2276. doi: 10.3969/j.issn.1674-4748.2017.18.040 [7] 温伟文,尹学亮,谭文泽,等. 顺德区乐从镇儿童高血压调查及相关因素分析[J]. 河南大学学报(医学版),2016,35(4):279-282. [8] 马苏娟,梁小华,杨亭,等. 重庆市丰都县学龄儿童高血压发生与营养的关系[J]. 中国当代儿科杂志,2016,18(7):639-644. [9] 张肖笑,熊丰,朱岷,等. 重庆市6~18岁儿童高血压现状分析[J]. 重庆医学,2016,45(14):1951-1953. doi: 10.3969/j.issn.1671-8348.2016.14.025 [10] 欧阳林静,黄谷志,罗德劲. 佛山市儿童高血压发病率及影响因素的研究[J]. 江西医药,2015,50(9):856-858. doi: 10.3969/j.issn.1006-2238.2015.09.004 [11] 徐海泉,胡小琪,刘爱玲,等. 我国6城市小学生高血压患病现状[J]. 中国学校卫生,2012,33(12):1409-1411. doi: 10.16835/j.cnki.1000-9817.2012.12.003 [12] 刘晓丽,陆强,马春明,等. 秦皇岛市7~12岁学龄儿童高血压现状及危险因素分析[J]. 中华高血压杂志,2012,20(8):729-732. doi: 10.16439/j.cnki.1673-7245.2012.08.035 [13] 杨巧玲,晏晓颖,安康,等. 北京市海淀区9-14岁儿童营养过剩和血压偏高关系分析[J]. 中国学校卫生,2010,31(10):1273-1274. [14] 邓晓娟,晏晓颖,徐亮,等. 广州市中学生血压偏高状况及其相关因素分析[J]. 中国学校卫生,2010,31(7):816-817. doi: 10.16835/j.cnki.1000-9817.2010.07.022 [15] 陈昭,沈维高,张小刚,等. 吉林市中小学生血压分布现状分析[J]. 华北大学学报,2002,3(1):34-37. [16] Yang Yunjuan,Min Jieqing,Chang Litao,et al. Prevalence trends of hypertension among 9-17 aged children and adolescents in Yunnan,2017-2019: A serial cross-sectional surveillance survey[J]. BMC Public Health,2021,21(1):338. doi: 10.1186/s12889-021-10258-1 [17] 国家心血管病中心,中国医师协会,中国医师协会高血压专业委员会,等. 中国高血压临床实践指南[J]. 中华心血管病杂志,2022,50(11):1050-1095. [18] 卫生部疾病控制局, 高血压联盟（中国）, 国家心血管病中心. 国家基本公共卫生服务项目国家基层高血压防治管理指南（2020版）[M]. 北京: 北京联合出版社, 2020: 21. [19] 陶芳标编. 儿童少年卫生学[M]. 第8版. 北京: 人民卫生出版社, 2017: 188. [20] 季成叶主编. 现代儿童少年卫生学 [M]. 第2版. 北京: 人民卫生出版社, 2010: 798-802. -
