高血压并发症高风险人群快速识别方法构建与实证分析  

Determination of critical indicators for identifying hypertension patients at high risk of complications:a literature review-based Delphi study and a preliminary empirical analysis

作　　者：陈凯悦 蒋绮蕴 王佳韵 张一英[3] 李安乐[3] 李俊[4] 李程跃 CHEN Kaiyue;JIANG Qiyun;WANG Jiayun;ZHANG Yiying;LI Anle;LI Jun;LI Chengyue(Department of Health Policy and Management,School of Public Health,Fudan University,Shanghai 200032,China;Health Development Strategy Research Center,Fudan University,Shanghai 200032,China;Jiading District Center for Disease Control and Prevention,Shanghai 200032,China;Minhang District Center for Disease Control and Prevention,Shanghai 201101,China)

机构地区：[1]复旦大学公共卫生学院卫生事业管理学教研室,上海200032 [2]复旦大学卫生发展战略研究中心,上海200032 [3]上海市嘉定区疾病预防控制中心,上海200032 [4]上海市闵行区疾病预防控制中心,上海201101

出　　处：《中国公共卫生》2023年第9期1108-1113,共6页Chinese Journal of Public Health

基　　金：国家自然科学基金(71774031,72074048);上海人才发展资金资助项目(2020128)。

摘　　要：目的构建高血压并发症高风险人群快速识别方法,为社区识别高血压并发症高风险人群提供技术支持。方法系统评阅截至2021年4月的国内外高血压并发症相关文献275篇、专业机构网条目36条、协会联盟官网条目89条、新闻舆情网站条目529条、指南规范10份和专业书籍7本,采用边界法梳理资料形成高血压并发症清单和主要并发症共性危险因素清单,邀请34名专家开展3轮专家咨询,确定高血压并发症高风险人群快速识别方法,并利用上海市闵行区2014年1月—2020年1月的62150例高血压患者健康档案数据,对37483例无并发症的高血压患者数据进行实证分析。结果高血压并发症的13个关键危险因素分别为血压控制不佳、高盐饮食、超重/肥胖(体质指数≥24.0)、服药不规律、年龄≥60岁、吸烟、有心血管疾病家族史、中心性肥胖、病程长、血脂异常、缺乏体育锻炼(包括久坐的生活工作方式)、心理压力大和过量饮酒;3轮专家咨询的积极系数分别为100.0%、100.0%和91.2%,专家权威系数分别为0.86、0.86和0.88,专家的积极程度和权威程度均较好;第1轮咨询的专家意见协调系数为0.281(P<0.05),专家意见协调性较好;最终确定的高血压并发症高风险人群快速识别方法为“具备≥5个关键危险因素”,对上海市闵行区高血压患者健康档案数据进行的实证分析结果显示,通过快速识别方法筛出的高风险人群占高血压患者的9.17%,数量适宜,有利于社区医生开展更精细化的管理。结论构建的高血压并发症高风险人群快速识别方法判断方式简单、可操作性强,能为社区发现高血压并发症高风险人群提供便捷工具。Objective To explore critical indicators for identifying hypertension patients at high risk of hypertensionrelated complications for prevention and control of complications among community hypertension patients.Methods With boundary analyses,the checklists of major hypertension complications and their risk factors were established through systematic reviews on hypertension-related literatures published domestically and internationally up to April 2021,including 275 research articles,36 entries on websites of professional institutions,89 entries on official websites of organizations and associations,529 entries on social medium websites,10 guidelines and standards issued by professional institutions,and 7 professional books.Three rounds of expert consultations involving 34 experts were conducted to screen out critical indicators of hypertension complications in the checklist established.Using the screenedout critical indicators and electric health records of 62150 community hypertension patients registered from January 2014 through January 2020 in Minhang district of Shanghai city,a subsequent empirical analysis was performed on the data on 37483 hypertension patients without complications at the enrollment of community-based disease management.Results Totally 13 critical indicators for hypertension complications were identified,including poor blood pressure control,high salt diet,overweight/obesity(body mass index≥24.0),irregular medication,aged≥60 years,smoking,excessive drinking,family history of cardiovascular disease,abdominal obesity,long disease course,dyslipidemia,lack of physical exercise,and psychological pressure.The three rounds of expert consultation achieved positive coefficients of 100.0%,100.0%,and 91.2%and authority coefficients of 0.86,0.86,and 0.88,respectively;the expert opinion coordination coefficient was 0.281 for the first round(P<0.05),indicating a good agreement among the experts.Resulted from the expert consultations,the hypertension patients with 5 or more of the 13 critical indicat

关 键 词：高血压并发症 高风险人群 快速识别方法 构建 实证分析 

分 类 号：R544.1[医药卫生—心血管疾病]