兒童原發性高血壓影響因素的Meta分析_《中國循證醫學雜志》

作者：

許睿瑋 ¹ , 嚴愷 ¹ ,  嚴衛麗 ²

1. 新疆醫科大學公共衛生學院（烏魯木齊 830054）；2. 復旦大學附屬兒科醫院臨床流行病學研究室（上海 210102）;

關鍵詞：

原發性高血壓兒童 Meta分析影響因素

DOI：

10.7507/1672-2531.20130100

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目的　探討兒童原發性高血壓的影響因素，為制定兒童原發性高血壓的預防控制措施提供科學依據。
方法　計算機檢索the Cochrane Libray、PubMed、ISI Web of Knowledge、Ovid、CNKI、VIP和WanFang Data，收集國內外2007年1月～2011年12月公開發表的關于兒童原發性高血壓影響因素的研究。應用Stata 11軟件進行Meta分析，根據齊性檢驗的結果選擇固定效應模型或隨機效應模型進行數據合并，計算各影響因素的合并比值比（OR）及其95%CI，采用Egger’s檢驗和繪制漏斗圖法評估發表偏倚。
結果　共納入13篇文獻，累計病例4 278例，對照37 230例。兒童原發性高血壓各影響因素的合并OR（95%CI）分別為：性別（男性）1.283（1.063，1.549）、年齡1.013（0.975，1.052）、超重2.622（1.985，3.464）、肥胖3.730（2.299，6.051）、腰圍1.060（1.036，1.085）、家族史1.189（0.956，1.480）、身體活動0.584（0.460，0.742）。
結論　現有證據表明，男性、超重、肥胖和腰圍是兒童原發性高血壓的危險因素，身體活動是兒童原發性高血壓的保護因素。

引用本文： 許睿瑋,嚴愷,嚴衛麗. 兒童原發性高血壓影響因素的Meta分析. 中國循證醫學雜志, 2013, 13(5): 564-573. doi: 10.7507/1672-2531.20130100 復制

1.	Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
2.	Lawes CMM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet, 2008, 371(9623): 1513-1518.
3.	Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA, 2007, 298(8): 874-879.
4.	McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr, 2007, 150(6): 640-644. e641.
5.	Sorof JM, Lai D, Turner J, et al. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics, 2004, 113(3): 475-482.
6.	鞠紅, 劉啟貴. 大連市某區6-17歲兒童高血壓患病率的調查分析. 中國公共衛生, 2010, (6): 677-678.
7.	張勤, 葉艷, 任修勤, 等. 個舊地區學齡前兒童高血壓檢出率及其影響因素. 中國兒童保健雜志, 2004, 12(4): 310-312.
8.	National High Blood Pressure Education Program Working Groupon High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 2004, 114(2Suppl 4th Report): 556-576.
9.	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2007. URL: http://www.ohri ca/programs/clinical epidemiology/oxford htm.2008.
10.	Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev, 1987, 9: 1-30.
11.	Higgins J, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12.	Pardee PE, Norman GJ, Lustig RH, et al. Television viewing and hypertension in obese children. Am J Prev Med, 2007, 33(6): 439-443.
13.	Haysom L, Williams RE, Hodson EM, et al. Cardiovascular risk factors in Australian indigenous and non‐indigenous children: A population‐based study. J Paediatr Child Health, 2009, 45(1-2): 20-27.
14.	Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, et al. Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years. J Am Diet Assoc, 2009, 109(6): 996-1003.
15.	So HK, Sung RYT, Li AM, Choi KC, et al. Higher exercise frequency associated with lower blood pressure in Hong Kong adolescents: a population-based study. J Hum Hypertens, 2010, 24(10): 646-651.
16.	Maldonado J, Pereira T, Fernandes R, et al. An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. “Hypertension in Children”. Blood Press, 2011, 20(3): 153-157.
17.	Ovbiagele B, Hutchison P, Handschumacher L, et al. Impact of an urban community hypertension screening program on participating high school students. Ethn Dis, 2011, 21(1): 68-73.
18.	Siklar Z, Berberoglu M, Erdeve SS, et al. Contribution of clinical, metabolic, and genetic factors on hypertension in obese children and adolescents. J Pediatr Endocrinol Metab, 2011, 24(1-2): 21-24.
19.	李偉榮, 翟屹, 沈沖, 等. 我國三省7～13歲兒童血壓升高影響因素的初步分析. 中華疾病控制雜志, 2011, 15(11): 931-934.
20.	沈謹, 施小明, 趙啟慧, 等. 兒童青少年血壓升高影響因素分析. 中國公共衛生, 2010, (10): 1220-1221.
21.	Leung LCK, Sung RYT, So HK, et al. Prevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk. Arch Dis Child, 2011, 96(9): 804-809.
22.	鄧曉娟, 晏曉穎, 徐亮, 等. 廣州市中學生血壓偏高狀況及其相關因素分析. 中國學校衛生, 2010, 31(7): 816-817.
23.	趙仁兵, 王予川, 崔玉霞, 等. 貴陽市兒童高血壓危險因素流行病學調查. 中華醫學會第五次全國兒科中青年學術交流大會論文匯編(上冊). 2008.
24.	Ak?? N, Pala K, Meriç-Utku A, et al. Hypertension in children (12–14 years)–a case–control study in Bursa, Turkey. Turk J Pediatr, 2009, 51(5): 437-443.
25.	陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
26.	Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab, 2011, 15 Suppl 4: S367-373.
27.	Raj M, Sundaram KR, Paul M, et al. Obesity in Indian children: time trends and relationship with hypertension. Natl Med J India, 2007, 20(6): 288-293.
28.	Uno K, Yamada T, Ishigaki Y, et al. Hepatic peroxisome proliferator-activated receptor-gamma-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J, 2012, 33(10): 1279-1289.
29.	Chen J, Gu D, Huang J, et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet, 2009, 373(9666): 829-835.
30.	Cruz ML, Huang TT, Johnson MS, et al. Insulin sensitivity and blood pressure in black and white children. Hypertension, 2002, 40(1): 18-22.
31.	Kotchen TA. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am J Hypertens, 2010, 23(11): 1170-1178.
32.	Engeli S, Bohnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension, 2005, 45(3): 356-362.
33.	Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health, 2006, 27(1): 465-490.
34.	孟玲慧, 米杰. 北京市學齡兒童腰圍、腰圍身高比分類標準對心血管代謝危險因素的篩查效度. 中國循證兒科雜志, 2009, 3(5): 324-332.
35.	張世偉, 馬軍, 張衡, 等. 兒童青少年體質量指數和腰圍與血壓的關系. 中國學校衛生, 2008, 29(5): 437-439.
36.	Katzmarzyk PT, Srinivasan SR, Chen W, et al. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics, 2004, 114(2): e198-205.
37.	Maximova K, O’Loughlin J, Paradis G, et al. Declines in physical activity and higher systolic blood pressure in adolescence. Am J Epidemiol, 2009, 170(9): 1084-1094.
38.	Kelley GA, Kelley KS, Tran ZV. The Effects of Exercise on Resting Blood Pressure in Children and Adolescents: A Meta‐Analysis of Randomized Controlled Trials. Preventive cardiology, 2003, 6(1): 8-16.
39.	Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States advance data from vital and health statistics. Hyattsville MD: National Center for Health Statistics, No. 314. 2000.
40.	Greenacre P. Height and Weight Standard Deviation Score Calculator. New South Wales, Australia: The Children’s Hospital at Westmead, 2145, 1997.
41.	Cole T, Bellizzi M, Flegal K, et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 2000, 320: 1-6.
42.	中國肥胖問題工作組. 中國學齡兒童青少年超重、肥胖篩查體重指數值分類標準. 中華流行病學雜志, 2004, 25(2): 97-102.
43.	L eung S S, Lau JT, Tse LY, et al. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health, 1996, 32: 103-109.
44.	季成葉, 馬軍, 何忠虎, 等. 中國漢族學齡兒童青少年腰圍正常值. 中國學校衛生, 2010, 31(3): 257-259.

1. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365(9455): 217-223.
2. Lawes CMM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet, 2008, 371(9623): 1513-1518.
3. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA, 2007, 298(8): 874-879.
4. McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr, 2007, 150(6): 640-644. e641.
5. Sorof JM, Lai D, Turner J, et al. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics, 2004, 113(3): 475-482.
6. 鞠紅, 劉啟貴. 大連市某區6-17歲兒童高血壓患病率的調查分析. 中國公共衛生, 2010, (6): 677-678.
7. 張勤, 葉艷, 任修勤, 等. 個舊地區學齡前兒童高血壓檢出率及其影響因素. 中國兒童保健雜志, 2004, 12(4): 310-312.
8. National High Blood Pressure Education Program Working Groupon High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 2004, 114(2Suppl 4th Report): 556-576.
9. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2007. URL: http://www.ohri ca/programs/clinical epidemiology/oxford htm.2008.
10. Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev, 1987, 9: 1-30.
11. Higgins J, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
12. Pardee PE, Norman GJ, Lustig RH, et al. Television viewing and hypertension in obese children. Am J Prev Med, 2007, 33(6): 439-443.
13. Haysom L, Williams RE, Hodson EM, et al. Cardiovascular risk factors in Australian indigenous and non‐indigenous children: A population‐based study. J Paediatr Child Health, 2009, 45(1-2): 20-27.
14. Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, et al. Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years. J Am Diet Assoc, 2009, 109(6): 996-1003.
15. So HK, Sung RYT, Li AM, Choi KC, et al. Higher exercise frequency associated with lower blood pressure in Hong Kong adolescents: a population-based study. J Hum Hypertens, 2010, 24(10): 646-651.
16. Maldonado J, Pereira T, Fernandes R, et al. An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. “Hypertension in Children”. Blood Press, 2011, 20(3): 153-157.
17. Ovbiagele B, Hutchison P, Handschumacher L, et al. Impact of an urban community hypertension screening program on participating high school students. Ethn Dis, 2011, 21(1): 68-73.
18. Siklar Z, Berberoglu M, Erdeve SS, et al. Contribution of clinical, metabolic, and genetic factors on hypertension in obese children and adolescents. J Pediatr Endocrinol Metab, 2011, 24(1-2): 21-24.
19. 李偉榮, 翟屹, 沈沖, 等. 我國三省7～13歲兒童血壓升高影響因素的初步分析. 中華疾病控制雜志, 2011, 15(11): 931-934.
20. 沈謹, 施小明, 趙啟慧, 等. 兒童青少年血壓升高影響因素分析. 中國公共衛生, 2010, (10): 1220-1221.
21. Leung LCK, Sung RYT, So HK, et al. Prevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk. Arch Dis Child, 2011, 96(9): 804-809.
22. 鄧曉娟, 晏曉穎, 徐亮, 等. 廣州市中學生血壓偏高狀況及其相關因素分析. 中國學校衛生, 2010, 31(7): 816-817.
23. 趙仁兵, 王予川, 崔玉霞, 等. 貴陽市兒童高血壓危險因素流行病學調查. 中華醫學會第五次全國兒科中青年學術交流大會論文匯編(上冊). 2008.
24. Ak?? N, Pala K, Meriç-Utku A, et al. Hypertension in children (12–14 years)–a case–control study in Bursa, Turkey. Turk J Pediatr, 2009, 51(5): 437-443.
25. 陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
26. Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab, 2011, 15 Suppl 4: S367-373.
27. Raj M, Sundaram KR, Paul M, et al. Obesity in Indian children: time trends and relationship with hypertension. Natl Med J India, 2007, 20(6): 288-293.
28. Uno K, Yamada T, Ishigaki Y, et al. Hepatic peroxisome proliferator-activated receptor-gamma-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J, 2012, 33(10): 1279-1289.
29. Chen J, Gu D, Huang J, et al. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet, 2009, 373(9666): 829-835.
30. Cruz ML, Huang TT, Johnson MS, et al. Insulin sensitivity and blood pressure in black and white children. Hypertension, 2002, 40(1): 18-22.
31. Kotchen TA. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am J Hypertens, 2010, 23(11): 1170-1178.
32. Engeli S, Bohnke J, Gorzelniak K, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension, 2005, 45(3): 356-362.
33. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health, 2006, 27(1): 465-490.
34. 孟玲慧, 米杰. 北京市學齡兒童腰圍、腰圍身高比分類標準對心血管代謝危險因素的篩查效度. 中國循證兒科雜志, 2009, 3(5): 324-332.
35. 張世偉, 馬軍, 張衡, 等. 兒童青少年體質量指數和腰圍與血壓的關系. 中國學校衛生, 2008, 29(5): 437-439.
36. Katzmarzyk PT, Srinivasan SR, Chen W, et al. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics, 2004, 114(2): e198-205.
37. Maximova K, O’Loughlin J, Paradis G, et al. Declines in physical activity and higher systolic blood pressure in adolescence. Am J Epidemiol, 2009, 170(9): 1084-1094.
38. Kelley GA, Kelley KS, Tran ZV. The Effects of Exercise on Resting Blood Pressure in Children and Adolescents: A Meta‐Analysis of Randomized Controlled Trials. Preventive cardiology, 2003, 6(1): 8-16.
39. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC growth charts: United States advance data from vital and health statistics. Hyattsville MD: National Center for Health Statistics, No. 314. 2000.
40. Greenacre P. Height and Weight Standard Deviation Score Calculator. New South Wales, Australia: The Children’s Hospital at Westmead, 2145, 1997.
41. Cole T, Bellizzi M, Flegal K, et al. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 2000, 320: 1-6.
42. 中國肥胖問題工作組. 中國學齡兒童青少年超重、肥胖篩查體重指數值分類標準. 中華流行病學雜志, 2004, 25(2): 97-102.
43. L eung S S, Lau JT, Tse LY, et al. Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health, 1996, 32: 103-109.
44. 季成葉, 馬軍, 何忠虎, 等. 中國漢族學齡兒童青少年腰圍正常值. 中國學校衛生, 2010, 31(3): 257-259.

《中國循證醫學雜志》

兒童原發性高血壓影響因素的Meta分析

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《中國循證醫學雜志》

兒童原發性高血壓影響因素的Meta分析

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