诊断切点的改变对中国高血压、高血脂、高血糖患病率的影响  

The impact of broadened diagnostic criteria on the prevalence of hypertension, hyperlipidemia and diabetes mellitus in China

作　　者：扈学俸[1,4] 韩笑然[1] 杨祖耀[1] 胡永华[2] 唐金陵[3] 

机构地区：[1]香港中文大学公共卫生及基层医疗学院,999077 [2] 北京大学公共卫生学院 [3]香港中文大学深圳研究院深圳卫生风险分析重点实验室,999077 [4]加拿大渥太华大学生物学系

出　　处：《中华预防医学杂志》2017年第5期369-377,共9页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金（81273171）

摘　　要：目的 高血压、高血脂和高血糖是可能引起心血管疾病并最终导致死亡的三种常见慢性病.20世纪80年代以来,中国高血压、高血脂和高血糖患者人数激增且尚无减缓的趋势,有关危险因素上升是重要原因,但由于在此过程中诊断切点下调过,危险因素上升可能不是患病率上升的唯一解释.本研究旨在估计诊断标准变化对这些疾病患病率影响的大小.方法 利用2002和2009年具有中国代表性的成年人健康调查数据（分别包括145254和8813名调查对象）,根据2000年前后新、旧两种诊断标准[＂新、旧＂切点：高血压：140/90和160/95 mmHg（1 mmHg=0.133 kPa）;高血脂：5.7和6.2 mmol/L;高血糖：7.0和7.8 mmol/L],分别估计高血压、高血脂和高血糖患病率及其他相关指标,以及诊断切点改变对它们的影响.并使用2000年全国普查人口的年龄、性别和城乡分布进行标化,估计诊断切点改变对全国患病率的影响,并对不同年份的患病率进行比较.结果 根据＂旧标准＂,2002年我国成年人高血压、高血脂和高血糖的标化患病率分别为8.21%、1.71%和1.43%,＂新标准＂下分别为19.18%、3.53%和2.66%;根据＂旧标准＂,2009年三种疾病的患病率分别为11.89%、9.34%和4.29%,＂新标准＂下分别为24.78%、18.36%和6.55%.由于采纳新的诊断标准,2002年三种疾病的总患病人次数增加了124%,2009年增加了95%.初步估计,从2002到2009年,因诊断标准改变导致全国增加的总患病人次数高达3.59亿.如果这三种疾病全部得到治疗,每年新增的药物费用总计2710亿,占2010年政府卫生总投入4800亿的56%.结论 中国约50%的高血压、高血脂和高血糖患病率可归因于诊断切点的降低.西方国家的诊断标准不一定直接适用于中国的实际,因诊断标准修订所引起的慢性病负担的＂增加＂应引起决策者和指南制定者的重视.在确定治疗切点时,除了治疗的效果、不良反应及费�Objective The burden of chronic disease has been continuously increasing in China since the early 1980s. Besides the worsening of risk factors, the change in diagnostic criteria is very likely an important explanation for the increase in the prevalence of hypertension, hyperlipidemia and diabetes mellitus, three commonest, major chronic conditions that can lead to major vascular events and deaths. This study aims to estimate the contribution of changes in diagnostic criteria to the increase in the prevalence of the three conditions in China. Methods The data from two representative nation-wide surveys in China in 2002 and 2009, with 145254 and 8813 adults included respectively, were used to estimate the prevalence rate of the three conditions and the proportion attributable to the change in diagnostic criteria around year 2000. The new and old cutoff values for hypertension, hyperlipidemia, and hyperglycemia were 140/90 and 160/95 mmHg （1 mmHg=0.133 kPa）, 5.7 and 6.2 mmol/L, and 7.0 and 7.8 mmol/L, respectively. The＆amp;nbsp;prevalence was standardized according to the distribution of age, sex and rural-urban residence of the 2000 national census of the country so as to compare between the old and new diagnostic criteria and project the situation for the entire country. Results The standardized prevalence of hypertension, hyperlipidemia, and diabetes mellitus for the entire Chinese adult population in 2002 was 8.21%, 1.71%and 1.43%according to the immediate previous diagnostic criteria, and 19.18%, 3.53%and 2.66%according to the new criteria. In 2009, the prevalence was 11.89%, 9.34%and 4.29%according to the old criteria, and 24.78%, 18.36%and 6.55%according to the new criteria. The total cumulative prevalence of the three conditions was increased by 124%in 2002 and 95%in 2009 as a result of change in diagnostic criteria. Put it differently, the change in diagnostic criteria increased the number of the three conditions from 2002 to 2009 by approximately 359 million and could increase the annual drug costs b

关 键 词：高血压 血脂异常 高血糖症 患病率 过度诊断 

分 类 号：R181.3[医药卫生—流行病学] R54[医药卫生—公共卫生与预防医学] R58