儿童肥胖及高血压的交互作用与早期颈动脉损害的关联：前瞻性队列研究

In China, the prevalence of obesity and hypertension among children and adolescents are increasing over time. Childhood obesity is not only associated with hypertension, but also may have an interaction with hypertension in their association with cardiovascular disease throughout the life. Early change in the structure and function of carotid artery can reflect the status of vessels, and it is also a sensitive index to predict carotid atherosclerosis and cardiovascular diseases. However, there is scarce evidence from longitudinal studies about the association of early carotid artery damage with the interaction between obesity and hypertension among children and adolescents. This project is based on "Study on the Physical Fitness and Health Surveillance of Chinese School Students (2010)" of Jining in Shandong province. At baseline, 3800 children aged 7-17 years old were divided into four cohorts according to their weight and blood pressure, i.e., normal in weight and blood pressure, overweight with normal blood pressure, normal weight but with hypertension, both overweight and hypertension. These four cohorts will be followed and asked to take the examination in carotid artery. Based on the longitudinal data, we seek to investigate the association of early carotid artery damage with the interaction between obesity and hypertension among children and adolescents, and finally to provide references for primary prevention of cardiovascular disease.

中国儿童青少年肥胖与高血压的患病率均呈逐年上升的趋势。儿童肥胖不仅与儿童高血压的发生密切相关，而且儿童肥胖与高血压可能存在交互作用，二者一起可能会引起终生心血管病发生风险的增加。颈动脉结构和功能的改变是反应血管健康水平，预测早期动脉硬化和心血管病风险的一个有价值的指标。然而，国内有关儿童肥胖与高血压的交互作用预测早期颈动脉损害的前瞻性研究尚不多见。本项目拟通过前瞻性队列研究方法，以济宁市参加"2010年全国学生体质与健康调研"的3800名7-17岁儿童青少年为基线人群，根据基线时点分成四个队列（体重及血压均正常的儿童，肥胖但血压正常的儿童，体重正常但有高血压的儿童，肥胖且高血压的儿童），进行随访并检测颈动脉的结构与功能，分析儿童期肥胖与高血压的交互作用对颈动脉损害的影响，为实施心血管疾病的一级预防提供参考依据。

中国儿童青少年肥胖与高血压的患病率均呈逐年上升的趋势。儿童超重或肥胖不仅引起儿童高血压的发生风险增加，而且儿童肥胖与高血压单独或联合作用均可能引起终生心血管病发生风险的增加。早在心血管疾病发生前，在肥胖及高血压的人群中即可检测出血管、心脏、肝脏和肾脏等很多脏器的结构和功能的亚临床改变。然而，国内有关儿童肥胖与高血压预测早期靶器官损害的前瞻性研究尚不多见。本项目拟通过前瞻性队列研究方法，以山东省济南市城区7840名6-17岁儿童青少年为基线人群，通过非同日三时点的测量方法进行血压测量后，筛选出333名高血压儿童青少年。然后对333名儿童青少年进行了随访，检测其血生化指标并评估其靶器官（血管、心脏、肝脏和肾脏等）的结构和功能，分析儿童期肥胖与高血压对早期靶器官损害的影响，为实施心血管疾病的一级预防提供参考依据。本研究通过对333名儿童青少年的早期靶器官损害指标及生化指标的检测，发现（1）2/5的儿童青少年出现超重或肥胖，超重和肥胖儿童青少年中即出现糖代谢和脂质代谢异常，且超重和肥胖儿童青少年早期靶器官（心脏、血管、肝脏）损害已经较为严重。（2）儿童青少年高血压检出率较高，1/4的高血压儿童青少年存在靶器官损害，多数指标存在着性别和年龄差异。研究结果提示，首先应给予超重和肥胖儿童青少年早期关注，并积极采取措施控制其体重，以降低其高血压及相应靶器官损害的发生风险。其次，应加强对儿童青少年高血压 的筛查与诊断并及时治疗，及早对高血压儿童进行靶器官的检测和评估，从而降低成年心血管病的发生风险。本研究结果立足于儿童青少年，对于早期预防心血管病的发生风险，降低心血管病带来的社会负担具有重要公共卫生意义。