2种诊断标准用于云南省18岁学生血压偏高的比较  

Comparison of Two Diagnosis Standards for Evaluating Hypertension in 18 Years Old Students in Yunnan China

作　　者：杨云娟 查远翊[5] 李图南 YANG Yunjuan;ZHA Yuanyi;LI Tunan(Xi’an Jiaotong University,Shanxi Xi’an 710061;School Health Department,Yunnan Centers for Disease Control and Prevention,Kunming Yunnan 650022;School of Publc Health,Kunming University of Medical,Kunming Yunnan 650500;School of Publc Health,Dali University,Dali Yunnan 671003;Graduate School,Kunming University of Medical,Kunming Yunnan 650500,China)

机构地区：[1]西安交通大学公共卫生学院,陕西西安710061 [2]云南省疾病预防控制中心学校卫生所,云南昆明650022 [3]昆明医科大学公共卫生学院,云南昆明650500 [4]大理大学公共卫生学院,云南大理671003 [5]昆明医科大学研究生院,云南昆明650500

出　　处：《昆明医科大学学报》2023年第3期44-48,共5页Journal of Kunming Medical University

基　　金：云南省医学学科带头人项目(D-2018007);昆明市中青年学术和技术带头人项目(KMRCD-2018011);昆明市西山区科技局项目(西科字34号)。

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。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 3 175 people were surveyed in this study. Results The diagnostic assessment of the new guideline is ≥130 mm Hg/80 mm Hg,which is lower than the gold standard (≥140 mm Hg/90 mm Hg). To diagnose with the gold standard,the 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 (χ~2 = 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%,specificity86.40%,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 advis

关 键 词：学生 青少年 高血压 诊断标准 评价指标 

分 类 号：R544.1[医药卫生—心血管疾病]