诊室血压联合动态血压监测诊断高血压研究  

Office blood pressure combined with ambulatory blood pressure monitoring in hypertension diagnosis

作　　者：丁芳[1,2] 俞蔚 胡世云[1,2] 宣诚 俞柳燕[4] 陈奇峰 范敏华 刘庆敏 徐小玲[1,2] 严静 DING Fang;YU Wei;HU Shiyun;XUAN Cheng;YU Liuyan;CHEN Qifeng;FAN Minhua;LIU Qingmin;XU Xiaoling;YAN Jing(The Provincial Center for Cardio-Cerebral-Vascular Disease,Zhejiang Hospital,Hangzhou,Zhejiang 310013,China;不详)

机构地区：[1]浙江医院,浙江杭州310013 [2]浙江省心脑血管病防治研究中心 [3]诸暨第二人民医院 [4]诸暨市疾病预防控制中心 [5]绍兴市疾病预防控制中心 [6]杭州市江干区闸弄口社区卫生服务中心 [7]杭州市疾病预防控制中心

出　　处：《预防医学》2020年第5期460-465,共6页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：十二五国家科技支撑计划项目(2014BAI08B01);浙江省重大科技专项(2014C03045-1);浙江省医药卫生科技计划项目(2018ZH002)。

摘　　要：目的评价诊室血压(OBP)联合动态血压监测(ABPM)诊断高血压的价值。方法于2015—2018年选取诸暨市和杭州市的4个社区161名无高血压病史,且首日OBP为120~159 mm Hg/80~99 mm Hg的35~79岁常住居民为研究对象,测量ABPM(1周内)和非同日3次OBP(4周内),采用ROC曲线评价OBP(一日血压升高和三日血压均升高2种标准)联合ABPM(24 h、白天时段、夜间时段、任一时段平均血压升高4种标准)诊断隐蔽性高血压(MH)和白大衣高血压(WCH)的效果。结果以三日OBP为金标准,一日OBP联合4种ABPM标准诊断MH的ROC曲线下面积(AUC)为0.79~0.81,灵敏度为57.58%~62.77%,特异度为100.00%;诊断WCH的AUC值为0.95~0.98,灵敏度为100.00%,特异度为88.96%~96.80%。Kappa值均<0.6,一致性不高。以任一时段ABPM升高为金标准,联合相同OBP标准时,24 h、白天时段和夜间时段标准诊断MH的AUC值为0.90~0.92,灵敏度为79.17%~83.90%,特异度为100.00%,Kappa值均>0.6,一致性较好;联合一日OBP标准时,Kappa值>0.8,一致性极好;诊断WCH的AUC值为0.95~1.00,灵敏度为100.00%,特异度为89.54%~99.37%,白天时段与任一时段ABPM标准的Kappa值>0.6,一致性较好。结论一日OBP可替代三日OBP用于排除MH和诊断WCH,但准确性不如三日OBP;24 h或白天时段替代任一时段ABPM标准是可行可靠的。Objective To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension.Methods The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018.They were performed OBP measurements on other two days in 4 weeks and ABPMin a week.There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours,daytime,nighttime and either of the above time.Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPMcriteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH).Results Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH.The Kappa values were all less than 0.6,known as low consistency.Taking either time of ABPMas a golden standard,24 hours,daytime and nighttime ABPMcriteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00%in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency.Conclusions If limited by options,1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy;24 hours or daytime ABPMinstead of either time of ABPMwas reliable.

关 键 词：高血压 诊断 诊室血压 动态血压监测 白大衣高血压 隐蔽性高血压 

分 类 号：R544.1[医药卫生—心血管疾病]