儿童期至成年期的血压变化对成年期肾脏早期损害影响的队列研究  

Influence of change in blood pressure status from childhood to adulthood on renal dysfunction：a cohort study

作　　者：闫银坤[1] 侯冬青[1] 刘军廷[1] 程红[1] 赵小元[1] 米杰[1] Yan Yinkun;Hou Dongqing;Liu Junting;Cheng Hong;Zhao Xiaoyuan;Mi Jie.(＊Departmentof Epidemiology,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所流行病学研究室,北京100020

出　　处：《中华预防医学杂志》2018年第11期1140-1145,共6页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金（81803254、81172746）;北京自然科学基金（7184193）;国家重点研发计划项目（2016YFCl300101、2016YFC0900602）;北京市优秀人才培养资助项目（2017000021469G246）

摘　　要：目的探讨儿童期至成年期血压变化对肾脏早期损害的影响。方法研究对象来源于国家“七五”科技攻关项目“北京儿童血压队列”，采用整群抽样方法，于1987年在北京市朝阳区、西城区及海淀区抽取中、小学校各6所，将3198名6-18岁学生纳入研究，并于2010--2012年进行随访和体检，最终共纳入1222名研究对象。研究内容主要包括基线期的身高、体重和血压的测量，以及随访期的尿微量白蛋白、肌酐、胱抑素C和血压的测定。根据儿童期及成年期血压状态，将研究对象分为4组：儿童期（基线时点）至成年期（随访时点）持续血压正常组、儿童期血压正常高值／高血压一成年期血压正常组、儿童期血压正常一成年期血压正常高值／高血压组及儿童至成年期持续血压正常高值／高血压组，采用多元线性回归分析儿童至成年期血压变化与成年期肾脏损害相关指标的关联。结果儿童期、成年期的血压正常高值／高血压检出率分别为17．9％（219例）、39．9％（486例）。成年期尿微量白蛋白的P50（P25-P75）为5．7（3．0-12．0）mg／L，肾小球滤过率及胱抑素C分别为（118．0±19．8）％、（0．734±0．184）mg／L。以儿童期至成年期持续血压正常组为参照，调整性别及年龄后，儿童期血压正常．成年期血压正常高值／高血压组的尿微量白蛋白及胱抑素C的B（95％CI）值分别为0．502（0．320-0．684）、0．049（0．025-0．073）。进一步调整性别、年龄、成年BMI、吸烟及饮酒后，儿童期血压正常成年期血压正常高值／高血压组尿微量白蛋白和胱抑素C的B（95％CI）值分别为0．322（0．128-0．516）、0．032（0．007-0．057）。结论血压正常的儿童在成年期血压若升高，其肾脏损害的危险增高，维持正常血压水平对于预防慢陛肾病有重要意义。Objective To investigate the influence of change in blood pressure status from childhood to adulthood on renal damage. Methods Data were obtained from Beijing Blood Pressure Cohort initiated from 1987.3 198 children and adolescents aged 6-18 years from 6 primary and 6 middle schools in Chaoyang, Xicheng and Haidian Districts of Beijing were enrolled at baseline by using a cluster random sampling method, and 1 222 participants were followed up during 2010-2012. The measurements included weight, height, and blood pressure at baseline and mieroalbumin, serum creatinine, cystatin C and blood pressure at follow-up. Based on blood pressure status in childhood and adulthood, the participants were divided into four groups： participants with normal blood pressure in both childhood and adulthood, participants with elevated blood pressure in childhood but normal blood pressure in adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood, and participants with elevated blood pressure in both childhood and adulthood. Multivariate linear regression model was used to investigate the association of change in blood pressure from childhood to adulthood on renal dysfunction. Results The prevalence of elevated blood pressure in childhood and adulthood was 17.9% and 39.9%,respectively. The P50 （P25-P75） of microalbumin was 5.7（3.0-12.0）mg/L, and the concentration of eGFR and cystatin C were （118.0± 19.8）% and （0.734±0.184）mg/L, respectively. With adjustment for sex, baseline age and follow-up years, compared with participants with persistently normal blood pressure from childhood to adulthood, participants with normal blood pressure in childhood but elevated blood pressure in adulthood had significantly higher levels of mieroalbumin （13=0.502, 95%CI： 0.320-0.684） and cystatin C （13=0.049, 95%CI： 0.025-0.073）. After adjustment for sex, baseline age, follow-up duration, and adult BMI, smoking and drinking, participants with normal blood pressure in childhood

关 键 词：血压 肾功能不全 慢性 儿童 队列研究 

分 类 号：R726.9[医药卫生—儿科]