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Article(id=1240929921678242585, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401429, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1705852800000, receivedDateStr=2024-01-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790348690, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790348690, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790348690, creator=13701087609, updateTime=1773790348690, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1928, endPage=1932, ext={EN=ArticleExt(id=1240929921913123613, articleId=1240929921678242585, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on the relationship between lifestyle and high blood pressure among middle school students in Zhengzhou, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the clustering of lifestyle among middle school students in Zhengzhou and its correlation with high blood pressure, in order to provide a scientific basis for the development of effective strategies for preventing and controlling high blood pressure in adolescents. Methods A multi-stage cluster random sampling method was used to select 8 middle schools in Zhengzhou in 2021, with a total of 2 791 students included. A self-made questionnaire was used to investigate their general information and dietary and exercise behaviors, as well as measuring their height, weight, and blood pressure. A latent class clustering analysis was conducted, as well as a binary logistic regression analysis for correlation. Results In total 23.5% of the middle school students were reported to have high blood pressure, with a higher prevalence among junior high school students (26.0%) than high school students (20.2%) (χ2=12.760, P<0.001). A latent class clustering analysis of dietary and exercise behaviors identified two categories: sub-healthy and healthy lifestyles. Logistic regression analysis found that after adjusting for gender, ethnicity, age, grade, and BMI, the risk of high blood pressure in sub-healthy students was 1.357 times that of healthy students (OR=1.357, 95%CI: 1.083-1.701). Conclusion Sub-healthy lifestyles increase the risk of high blood pressure in adolescents, providing new information for exploring the risk factors of cardiovascular and metabolic abnormalities in adolescents as well as the prevention and control of high blood pressure in adolescents.

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目的 探索郑州市中学生的生活方式聚类状况及其与血压偏高的相关性，为提出防控青少年血压偏高的有效策略提供科学依据。方法 采用多阶段整群随机抽样，于2021年选取郑州市8所中学，共纳入2 791名学生。采用自制问卷对其一般资料和饮食运动行为进行调查，并对其身高、体重、血压进行测量。采用潜在聚类模型进行聚类分析，二元logistic回归模型进行相关性分析。结果 23.5%的中学生被报告有血压偏高，初中生的血压偏高发生率为26.0%，高于高中生的20.2%（χ2=12.760，P<0.001）。通过对饮食运动行为潜在聚类分析确定了亚健康和健康生活方式两个类别。Logistic回归分析发现，在调整了性别、民族、年龄、年级、BMI后，生活方式亚健康的学生发生血压偏高的风险是生活方式健康学生的1.357倍(OR=1.357，95%CI：1.083～1.701）。结论 亚健康的生活模式增加了青少年发生血压偏高的风险，为探索引起青少年心血管代谢异常的危险因素及青少年高血压的防控提供了新信息。

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王鲜，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=N7aoZPzKllJVCYEMla88cg==, magXml=FHh0cWyKoqyo7EJyZejAFw==, pdfUrl=null, pdf=aYVsvZAAtJCDR8jyGElHqw==, pdfFileSize=673585, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=GLPzoRLcCd0ELw4hGi7rzg==, mapNumber=null, authorCompany=null, fund=null, authors=

张茜（1984—），女，硕士，副高，研究方向：学校卫生

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张茜（1984—），女，硕士，副高，研究方向：学校卫生

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张茜（1984—），女，硕士，副高，研究方向：学校卫生

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3.西安交通大学第一附属医院妇产科
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Chinese Journal of Epidemiology, 2020, 41(9): 1445-1449., articleTitle=Detection of hypertension based on measurements at three occasions in different days and its relationship with obesity in children, refAbstract=null)], funds=[Fund(id=1240929928473014548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, awardId=82003478, language=CN, fundingSource=国家自然科学基金青年科学基金项目(82003478), fundOrder=null, country=null), Fund(id=1240929928561094941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, awardId=2022ZZUJG264, language=CN, fundingSource=郑州大学校级教学改革类项目(2022ZZUJG264), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240929922689069874, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, xref=1., ext=[AuthorCompanyExt(id=1240929922697458483, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929922689069874, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Health, Center for Disease Control and Prevention of Zhongmou, Zhengzhou, Hennan 451450, China), AuthorCompanyExt(id=1240929922705847092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929922689069874, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.郑州市中牟县疾病预防控制中心学校卫生科，河南 郑州 451450)]), AuthorCompany(id=1240929922793927478, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, xref=2., ext=[AuthorCompanyExt(id=1240929922835870519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929922793927478, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.郑州大学公共卫生学院儿童少年卫生学教研室，河南 郑州 450001)]), AuthorCompany(id=1240929922902979387, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, xref=3., ext=[AuthorCompanyExt(id=1240929922915562300, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929922902979387, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.西安交通大学第一附属医院妇产科)]), AuthorCompany(id=1240929922986865471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, xref=4., ext=[AuthorCompanyExt(id=1240929923003642688, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929922986865471, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.西安交通大学医学部公共卫生学院)]), AuthorCompany(id=1240929923058168645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, xref=5., ext=[AuthorCompanyExt(id=1240929923062362950, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, companyId=1240929923058168645, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.郑州市疾病预防控制中心公共卫生监测与评价所)])], figs=[ArticleFig(id=1240929927143420056, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=EN, label=Table 1, caption=

Latent cluster model fit indicators for lifestyle

, figureFileSmall=null, figureFileBig=null, tableContent=
模型kAICBICaBICentropyLMRBLRT类别概率（%）
2类1516 615.95416 704.96616 657.3060.447<0.001<0.00166.8/33.2
3类2316 449.23616 585.72116 512.6430.855<0.001<0.00182.4/8.8/8.8
4类3116 385.24516 569.20416 470.7070.7480.003<0.00166.2/16.5/9.8/7.5
5类3916 343.29716 574.72916 450.8130.7280.081<0.0014.6/11.4/45.6/19.7/18.8
), ArticleFig(id=1240929927235694757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=CN, label=表1, caption=

生活方式的潜在类别分析模型拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型kAICBICaBICentropyLMRBLRT类别概率（%）
2类1516 615.95416 704.96616 657.3060.447<0.001<0.00166.8/33.2
3类2316 449.23616 585.72116 512.6430.855<0.001<0.00182.4/8.8/8.8
4类3116 385.24516 569.20416 470.7070.7480.003<0.00166.2/16.5/9.8/7.5
5类3916 343.29716 574.72916 450.8130.7280.081<0.0014.6/11.4/45.6/19.7/18.8
), ArticleFig(id=1240929927336358065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=EN, label=Table 2, caption=

Response probability of adolescents with different lifestyles

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生活行为特征亚健康组（%）健康组（%）
含糖饮料11.83.6
油炸食物32.50
新鲜水果80.596.5
新鲜蔬菜87.999.4
规律早餐68.969.3
中高强度运动16.146.9
静坐时间66.436.0
), ArticleFig(id=1240929927453798591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=CN, label=表2, caption=

不同生活方式的青少年群体的反应概率

, figureFileSmall=null, figureFileBig=null, tableContent=
生活行为特征亚健康组（%）健康组（%）
含糖饮料11.83.6
油炸食物32.50
新鲜水果80.596.5
新鲜蔬菜87.999.4
规律早餐68.969.3
中高强度运动16.146.9
静坐时间66.436.0
), ArticleFig(id=1240929927588016331, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=EN, label=Table 3, caption=

Distribution of middle school students’ lifestyle cluster ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量亚健康组健康组χ2/t值P值
性别男280(51.8）1 147(51.0)0.1060.745
女261 (48.2)1 103(49.0)
民族汉族528(97.6)2 204(98.0)0.2710.603
其他13(2.4)46(2.0)
年级初中201(37.2)1 385(61.6)105.853<0.001
高中340(62.8)865(38.4)
BMI分组非超重肥胖381(70.4)1 504(66.8)4.9400.850
超重95(17.6)391(17.4)
肥胖65(12.0)355(15.8)
), ArticleFig(id=1240929927822897363, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=CN, label=表3, caption=

中学生生活方式聚类的分布情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量亚健康组健康组χ2/t值P值
性别男280(51.8）1 147(51.0)0.1060.745
女261 (48.2)1 103(49.0)
民族汉族528(97.6)2 204(98.0)0.2710.603
其他13(2.4)46(2.0)
年级初中201(37.2)1 385(61.6)105.853<0.001
高中340(62.8)865(38.4)
BMI分组非超重肥胖381(70.4)1 504(66.8)4.9400.850
超重95(17.6)391(17.4)
肥胖65(12.0)355(15.8)
), ArticleFig(id=1240929927927754976, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=EN, label=Table 4, caption=

Distribution of elevated blood pressure in middle school students ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量血压偏高χ2/t值P值
性别男330(23.1)0.2790.598
女327(24.0)
民族汉族642(23.5)0.1190.730
其他15(25.4)
年级初中413(26.0)12.760<0.001
高中244(20.2)
BMI分组非超重肥胖343(18.2)92.126<0.001
超重146(30.0)
肥胖168(40.0)
含糖饮料高45(25.6)
低612(23.4)0.4290.521
油炸食物高86(28.6)
低571(22.9)4.7450.031
新鲜水果是598(23.5)
否59(24.0)0.0300.458
新鲜蔬菜是632(23.7)
否25(20.3)0.7390.447
中高强度运动高231(22.6)
低426(24.1)0.8650.379
静坐时间高304(23.6)
低353(23.5)0.0130.472
生活方式聚类亚健康组142(26.2)2.7340.102
健康组515(22.9)
), ArticleFig(id=1240929928049389804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=CN, label=表4, caption=

中学生血压偏高检出的分布情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量血压偏高χ2/t值P值
性别男330(23.1)0.2790.598
女327(24.0)
民族汉族642(23.5)0.1190.730
其他15(25.4)
年级初中413(26.0)12.760<0.001
高中244(20.2)
BMI分组非超重肥胖343(18.2)92.126<0.001
超重146(30.0)
肥胖168(40.0)
含糖饮料高45(25.6)
低612(23.4)0.4290.521
油炸食物高86(28.6)
低571(22.9)4.7450.031
新鲜水果是598(23.5)
否59(24.0)0.0300.458
新鲜蔬菜是632(23.7)
否25(20.3)0.7390.447
中高强度运动高231(22.6)
低426(24.1)0.8650.379
静坐时间高304(23.6)
低353(23.5)0.0130.472
生活方式聚类亚健康组142(26.2)2.7340.102
健康组515(22.9)
), ArticleFig(id=1240929928217161975, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=EN, label=Table 5, caption=

Logistic regression analysis of different lifestyle and elevated blood pressure

, figureFileSmall=null, figureFileBig=null, tableContent=
变量OR值（95%CI）P值OR*值（95%CI）P*值
性别男0.847（0.707～1.016）0.740
女1.0
民族汉族0.922（0.503～1.692）0.749
其他1.0
年级初中0.994（0.703～1.405）0.974
高中1.0
年龄0.894（0.770～0.936）0.001
BMI1.107（1.085～1.129）<0.001
生活方式亚健康1.199（0.967～1.487）0.0991.357（1.083～1.701）0.008
健康1.01.0
), ArticleFig(id=1240929928347185410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929921678242585, language=CN, label=表5, caption=

不同生活方式与血压偏高的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量OR值（95%CI）P值OR*值（95%CI）P*值
性别男0.847（0.707～1.016）0.740
女1.0
民族汉族0.922（0.503～1.692）0.749
其他1.0
年级初中0.994（0.703～1.405）0.974
高中1.0
年龄0.894（0.770～0.936）0.001
BMI1.107（1.085～1.129）<0.001
生活方式亚健康1.199（0.967～1.487）0.0991.357（1.083～1.701）0.008
健康1.01.0
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郑州市中学生的生活方式与血压偏高的关联性研究
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张茜 1 , 向婉婉 2, 3, 4 , 班晓蕾 2 , 吴汶灿 2 , 陈彦哲 5 , 邢艺苑 5 , 娄晓民 2 , 王鲜 2
现代预防医学 | 流行病与统计方法 2024,51(11): 1928-1932
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现代预防医学 | 流行病与统计方法 2024, 51(11): 1928-1932
郑州市中学生的生活方式与血压偏高的关联性研究
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张茜1, 向婉婉2, 3, 4, 班晓蕾2, 吴汶灿2, 陈彦哲5, 邢艺苑5, 娄晓民2, 王鲜2
作者信息
  • 1.郑州市中牟县疾病预防控制中心学校卫生科，河南 郑州 451450
  • 2.郑州大学公共卫生学院儿童少年卫生学教研室，河南 郑州 450001
  • 3.西安交通大学第一附属医院妇产科
  • 4.西安交通大学医学部公共卫生学院
  • 5.郑州市疾病预防控制中心公共卫生监测与评价所

    • 张茜（1984—），女，硕士，副高，研究方向：学校卫生

通讯作者:

王鲜，E-mail:
Study on the relationship between lifestyle and high blood pressure among middle school students in Zhengzhou
Qian ZHANG1, Wan-wan XIANG2, 3, 4, Xiao-lei BAN2, Wen-can WU2, Yan-zhe CHEN5, Yi-yuan XING5, Xiao-min LOU2, Xian WANG2
Affiliations
  • Department of Health, Center for Disease Control and Prevention of Zhongmou, Zhengzhou, Hennan 451450, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202401429
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摘要
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目的 探索郑州市中学生的生活方式聚类状况及其与血压偏高的相关性，为提出防控青少年血压偏高的有效策略提供科学依据。方法 采用多阶段整群随机抽样，于2021年选取郑州市8所中学，共纳入2 791名学生。采用自制问卷对其一般资料和饮食运动行为进行调查，并对其身高、体重、血压进行测量。采用潜在聚类模型进行聚类分析，二元logistic回归模型进行相关性分析。结果 23.5%的中学生被报告有血压偏高，初中生的血压偏高发生率为26.0%，高于高中生的20.2%（χ2=12.760，P<0.001）。通过对饮食运动行为潜在聚类分析确定了亚健康和健康生活方式两个类别。Logistic回归分析发现，在调整了性别、民族、年龄、年级、BMI后，生活方式亚健康的学生发生血压偏高的风险是生活方式健康学生的1.357倍(OR=1.357，95%CI：1.083～1.701）。结论 亚健康的生活模式增加了青少年发生血压偏高的风险，为探索引起青少年心血管代谢异常的危险因素及青少年高血压的防控提供了新信息。

高血压  /  青少年  /  生活方式  /  聚类分析  /  生活方式聚类

Objective To explore the clustering of lifestyle among middle school students in Zhengzhou and its correlation with high blood pressure, in order to provide a scientific basis for the development of effective strategies for preventing and controlling high blood pressure in adolescents. Methods A multi-stage cluster random sampling method was used to select 8 middle schools in Zhengzhou in 2021, with a total of 2 791 students included. A self-made questionnaire was used to investigate their general information and dietary and exercise behaviors, as well as measuring their height, weight, and blood pressure. A latent class clustering analysis was conducted, as well as a binary logistic regression analysis for correlation. Results In total 23.5% of the middle school students were reported to have high blood pressure, with a higher prevalence among junior high school students (26.0%) than high school students (20.2%) (χ2=12.760, P<0.001). A latent class clustering analysis of dietary and exercise behaviors identified two categories: sub-healthy and healthy lifestyles. Logistic regression analysis found that after adjusting for gender, ethnicity, age, grade, and BMI, the risk of high blood pressure in sub-healthy students was 1.357 times that of healthy students (OR=1.357, 95%CI: 1.083-1.701). Conclusion Sub-healthy lifestyles increase the risk of high blood pressure in adolescents, providing new information for exploring the risk factors of cardiovascular and metabolic abnormalities in adolescents as well as the prevention and control of high blood pressure in adolescents.

Hypertension  /  Adolescents  /  Lifestyle  /  Cluster analysis  /  Lifestyle clustering
张茜, 向婉婉, 班晓蕾, 吴汶灿, 陈彦哲, 邢艺苑, 娄晓民, 王鲜. 郑州市中学生的生活方式与血压偏高的关联性研究. 现代预防医学, 2024 , 51 (11) : 1928 -1932 . DOI: 10.20043/j.cnki.MPM.202401429
Qian ZHANG, Wan-wan XIANG, Xiao-lei BAN, Wen-can WU, Yan-zhe CHEN, Yi-yuan XING, Xiao-min LOU, Xian WANG. Study on the relationship between lifestyle and high blood pressure among middle school students in Zhengzhou[J]. Modern Preventive Medicine, 2024 , 51 (11) : 1928 -1932 . DOI: 10.20043/j.cnki.MPM.202401429
正文
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高血压，是全球公认的心血管疾病发生发展的重要可控危险因素，已经成为了全球的主要公共卫生问题之一[1-2]。在中国，儿童青少年高血压的发病率达9%[3]。高血压从儿童期一直持续到成年期，与不良心脏病变和血管损伤有关[4]。因此，儿童和青少年高血压的早期发现和有效预防是心血管疾病初级预防的关键[4]。血压状况与特定生活方式行为有关，包括肥胖、缺乏体育活动和不健康饮食[5-6]。并且任何因素都不是孤立存在的，因此研究生活方式因素组合的影响更有意义[7-8]。但是关于整体生活方式行为对健康影响的研究还很少，目前关于生活方式行为与心血管风险的研究主要集中于国外，国内研究较为缺乏。因此，本研究基于2021年河南省学生常见病和健康影响因素监测与干预工作项目，于2021年8月开展调查，旨在了解郑州市中学生血压偏高的流行现状和生活方式现况，并探讨生活方式与血压偏高的相关性，提出更优更佳的干预方式。
1　对象与方法
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1.1　研究对象
研究对象来自郑州市2021年儿童青少年常见病健康管理研究，共2 791名初中、高中及职高生。此研究已通过郑州大学生命科学伦理委员会审查（No.ZZUIRB2021-100），所有研究对象均在调查之前签署了知情同意书。
1.2　抽样方法
该横断面研究采用多阶段整群随机抽样的方法，选取郑州市8所中学（4所初中、3所高中、1所职高）一至三年级的学生，各年级以整班为单位，每个年级至少选取80名学生，每所学校至少抽取240名学生开展调查，不足部分由附近同等类型学校补充。
1.3　调查方法
对抽取的学生开展匿名自填问卷调查（自制问卷）和体格检查。问卷调查包括学生的基本情况和健康影响因素，其中基本情况包括性别、民族、出生日期、年级等，健康影响因素包括饮食摄入情况、身体活动和静态活动等。体格检查主要对身高、体重和血压等生长发育情况进行测量。身高测量由专业人员进行测试，两人一组（一人测试，一人记录）；受检者赤足，呈“三点一线”站立姿势，两足跟并拢，足尖分开约60°；读数时，检测人员双眼与水平板平面等高，然后将读数以cm为单位（精确到0.1）填入记录表内，要求误差不得超过0.5 cm。体重测量使用电子体重计或杠杆称，受检者穿短衣裤、赤足，自然站立；以kg为单位，读数精确到0.1。血压测量使用电子血压计、立柱式水银血压计和医用听诊器进行检测；三种测量仪器均要求受试者取坐位，右臂自然前伸，掌心向上，与心脏保持同一水平；测量血压时，应相隔1～2 min后进行一次重复测量，记录2次收缩压和舒张压读数的平均值；如果收缩压或舒张压的2次读数相差5 mm Hg以上，应隔1～2 min后进行第三次测量，取3次读数的平均值作为测量结果。
1.4　判定标准
血压偏高：参照2018年发布的国家卫生行业标准WS/T 610-2018《7～18岁儿童青少年血压偏高筛查界值》,将收缩压（SBP）和（或）舒张压（DBP）≥同性别、同年龄、同身高百分位人群P95血压作为界值判定血压偏高[9]。超重、肥胖：依据2018年国家卫生健康委员会发布的学龄儿童青少年超重与肥胖筛查界值将身体质量指数（body mass index，BMI）分为非超重肥胖、超重和肥胖[10]。生活方式（二分类）：过去一周里，每天次饮用含糖饮料或食用油炸食物≥1次认定为高，<1次认定为低；食用新鲜水果蔬菜的情况，分为是（少于每天1次和每天一次及以上）和否（从来不吃）；规律吃早餐的情况，分为是（天天吃）和否（从来不吃或有时吃）；至少60 min及以上中高强度运动（可累积）的情况（中高强度运动是指让你气喘吁吁或者心跳加快的运动，如跑步、篮球、足球、游泳、健身房内跳健身操、搬重物等），分为高（每周≥3天）和低（每周<3）；每天静坐>9 h为静坐时间高，≤9 h为静坐时间低。
1.5　质量控制
调查人员均接受过专业培训。资料收集时当面核对受检者的年级、身份编码、性别、公历出生年月日、有无疾病史；对检测各项指标的数据逐项检查；观察受检者，视其情况推测可疑数据；在每天的检测过程中，以随机方式按5%的比例抽取复测对象进行体格检查（身高、体重）和视力检查复测，以检验检测误差。视力检查的复测对象不包括佩戴角膜塑形镜者。数据采用Epi Data进行录入并进行双录入一致性检验，题目中设置有逻辑界值和允许录入范围，并实时检查录入数据的合理性、正确性，保障数据录入质量。
1.6　统计分析
用Epi Data 3.1建数据库，用Mplus 7.0和SPSS 21.0进行统计分析。定量变量符合正态分布，采用（）表示，否则采用［M（P25，P75）］表示。定性变量采用百分比表示。定量变量和定性变量的组间比较分别采用t检验和χ2检验。生活方式危险因素聚类状况根据研究对象各类生活方式危险因素（含糖饮料、油炸食物、新鲜水果、新鲜蔬菜、规律早餐、中高强度运动、静坐时间）的不同观察水平，将具有相似生活方式的个体归为同一个潜在类别，构建潜在类别模型，尽可能减小类别内差异和增加类别间差异，进而获得生活方式危险因素类别状况以及各类别的人数比重。潜在分析模型的估计采用全信息极大似然法。使用Bootstrap似然比检验（BLRTs）确定了最优类数。LMR和BLRT的效应值小于0.05，则模型是成立的，模型选择的标准包括赤池信息准则（AIC）、贝叶斯信息准则（BIC）、调整贝叶斯信息准则（aBIC）和熵（entropy）。使用二元logistic回归模型检验类别与血压偏高之间的关系。双侧检验α=0.05。
2　结果
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2.1　中学生的一般资料
排除数据不全者，共纳入2 791名研究对象，其中男生1 427名，占51.1%；初中生1 586名，占56.8%，高中生1 205名，占43.2%；年龄为（15.1±1.8）岁；BMI为（21.9±4.4）kg/m2；超重肥胖者有906名，占32.5%；收缩压为（115.9±13.2）mm Hg，舒张压（72.0±8.5）mm Hg,血压偏高者657名，占23.5%。缺乏运动在中学生群体中非常普遍，一半以上的中学生中高强度运动不足，占63.3%，另外近一半的学生静坐时间超过9 h，占46.1%。就饮食行为而言，油炸食物高摄入量的青少年有301名，占10.8%；含糖饮料高摄入量的青少年有176名，占6.3%；过去一周里不吃新鲜水果和蔬菜的学生分别占8.4%和4.4%；早餐不规律在中学生群体中较为常见，占30.8%。分析样本与初始样本的性别（χ2=0.072，P=0.788）、民族（χ2=0.001，P=0.970）、年级（χ2=0.015，P=0.903）、年龄（t=0.433，P=0.665）无明显差异，分析数据的代表性较好。
2.2　中学生生活方式的聚类分组情况
2.2.1　中学生生活方式的潜在类别分析
对7种饮食运动行为进行潜在类别分析，模型拟合指数见表1。其中2类、3类和4类模型的LMR和BLRT在0.01水平上显著，而5类模型的LMR不显著，2类和4类模型的AIC、BIC和aBIC较3类模型略有下降，结合结果的可解释性，本研究选取2类模型。
2.2.2　中学生生活方式聚类的命名和分类结果
根据2组的生活行为特征，将它们命名为亚健康组（1组）和健康组（2组）。亚健康组的反应概率占中学生群体的33.2%，有较高比例的含糖饮料（11.8%）、油炸食物（32.5%）食用情况和静坐时间高于9 h（66.4%）的情况，且中高强度运动天数3 d及以上的比例较低，为16.1%；与之相比，健康组（66.8%）的含糖饮料的摄入情况较少，油炸食品基本不摄入，运动时间更长，静坐时间更短，所占比例分别3.6%、0、46.9%和36.0%。见表1、2。
2.2.3　中学生生活方式聚类的分布情况
表3总结了这两个组的特征。亚健康生活方式的男生占51.8%，女生占48.2%；健康生活方式的初中生占61.6%，多于高中生的38.4%；而亚健康生活方式的高中生占68.2%，多于初中生的37.8%（均P<0.001）。不同BMI的健康组和亚健康组的分布差异无统计学意义（P=0.850）。
2.3　中学生血压偏高的检出情况
血压偏高的检出率为23.5%，其中男生中血压偏高者320名，占23.1%，女生327名，占24.0%；初中生中血压偏高检出率占26.0%，高于高中生的20.2%；超重和肥胖学生中血压偏高检出率为30.0%和40.0%，高于非超重肥胖学生的18.2%；高油炸食物组学生中血压偏高的检出率为28.6%，高于低油炸食物组的22.9%，差异有统计学意义。见表4。
2.4　生活方式与血压偏高的相关性
以是否血压偏高为因变量，生活方式分组为自变量（1=亚健康组，2=健康组）进行logistic回归分析，结果显示，在调整了性别、民族、年龄、年级等协变量后，亚健康生活模式增加了青少年血压偏高的发生风险（P=0.008），生活方式亚健康的学生相较于健康生活方式的学生发生血压偏高的风险增加0.357倍（OR=1.357，95%CI 1.083～1.701）。见表5。
3　讨论
收起
本研究发现中学生血压偏高的检出率达23.5%，高于1995—2014年中国儿童青少年血压偏高检出率[11]。2021年三亚地区的研究显示，未成年人的高血压患病率为16.34%，高中生的血压偏高的检出率要更高，为22.73%[12]；2022年安徽省高中生和初中生血压偏高率分别为25.6%和23.7%[13]，本研究高中生与初中生血压偏高检出率与之类似，分别为26.0%和20.2%，近1/4的初中生血压偏高，高血压的发生日益“低龄化”。郑州市初中生中血压偏高检出率为26.0%，要高于高中生的20.2%，这与廉启国、叶卓俊等人[14-15]的研究结果一致，这可能与该年龄段学生正处于青春期发育有关。有研究表明[16]，儿童青少年刚步入青春期时会出现内分泌功能活跃和第二次生长突增，生长激素分泌增加会提高心肌收缩力，增加心脏输出量，导致钠水潴留，从而使血压升高。这可能与性早熟导致的青春期提前有密切联系[17]。造成青少年群体中血压偏高检出率更高的原因可能为儿童少年生活方式的改变、血压筛选标准的改变、环境和社会经济学因素、抽样方法不同等，也说明我国在青少年高血压防控方面仍面临着巨大的挑战。通过潜在聚类分析，确定了两种生活方式模式：健康生活方式和亚健康生活方式。通过logistic回归分析发现，不同的生活方式集群与血压偏高的发生风险有显著关联，为青春期心血管代谢异常的危险因素的发现提供了新信息。近年来，生活方式聚类与某些代谢疾病之间关联性研究也被证实，腰围、体力活动、久坐和睡眠相关的生活方式模式与代谢健康之间存在关联[18-19]。本研究聚类结果与其他研究报告的生活模式的结果一致[20-21]，提示近五分之一的中学生处于亚健康的生活模式，说明关于健康生活方式在儿童青少年中缺乏普及，父母、老师和教育部门应引起重视，加强学生饮食和运动方面的健康教育。
目前国内关于儿童青少年生活方式与血压偏高的研究较少，而本研究结果对此进行了完善。与其他横断面研究相同的是，本研究的血压测量方法采用两次测量取均值；与其他研究不同的是，本研究采用潜在类别分析方法探索生活方式集群和血压偏高的关联性。然而，本研究也有一定的局限性。首先，中学生血压偏高与高血压家族史、家庭经济地位（父母教育程度、父母职业等）等关系密切，而本研究未对相关因素进行调查分析，是一个很大的缺陷；其次，潜在类别区分未达到预期效果，如不适度的熵和部分重叠的风险剖面；再次，使用自我报告问卷调查生活方式因素，可能存在回忆偏倚；最后，国内外儿童青少年高血压指南均推荐，儿童青少年高血压的判定应基于非同日三时点血压测量值[22]，因此未来研究我们将进一步优化相关测量方法。
总之，亚健康的生活模式增加了青少年发生血压偏高的风险，本研究为探索引起青少年心血管代谢异常的危险因素及青少年高血压的防控提供了新信息，将更有效地预防和改善成年期发生的慢性非传染性疾病。
基金
收起
  • 国家自然科学基金青年科学基金项目(82003478)
  • 郑州大学校级教学改革类项目(2022ZZUJG264)
文献
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202401429
  • 接收时间：2024-01-22
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2024-01-22
基金
国家自然科学基金青年科学基金项目(82003478)
郑州大学校级教学改革类项目(2022ZZUJG264)
作者信息
    1.郑州市中牟县疾病预防控制中心学校卫生科，河南 郑州 451450
    2.郑州大学公共卫生学院儿童少年卫生学教研室，河南 郑州 450001
    3.西安交通大学第一附属医院妇产科
    4.西安交通大学医学部公共卫生学院
    5.郑州市疾病预防控制中心公共卫生监测与评价所

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species		 占总种数比例
Percentage of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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