中小学生青春发动时相与心血管代谢危险因素的相关性

doi:10.19723/j.issn.1671-167X.2024.03.007

摘要/Abstract

摘要：

目的: 探索北京市中小学生青春发动时相与心血管代谢危险因素的相关性及存在的性别差异。方法: 分层整群抽取3 067名来自北京市房山区16所中小学校的学生，对其进行问卷调查、体格检查和血清实验室检测，采用多分类多因素Logistic回归模型分析中小学生青春发动时相与心血管代谢危险因素的相关性。结果: 男生青春发动时相提前和延迟检出率分别为14.73%和9.46%，女生为12.89%和10.99%。学生中心性肥胖、高血压、高血糖和血脂异常检出率分别为35.87%、19.95%、2.54%和26.31%，心血管代谢危险因素聚集1项、2项和3项及以上的检出率分别为29.21%、16.17%和9.36%。调整学段、地区、出生体质量、喂养方式、是否独生子女、父母最高文化程度和家庭月收入后，相较于青春发动适时组，青春发动提前组女生发生1个危险因素聚集、2个危险因素聚集和3个及以上危险因素聚集的风险分别提高1.94倍(95% CI=1.29~2.91)、2.97倍(95% CI=1.89~4.67)和2.02倍(95% CI=1.13~3.63)；男生青春发动时相与心血管代谢危险因素聚集的相关性无统计学意义(P>0.05)。结论: 青春发动时相提前是女生心血管代谢危险因素聚集的独立危险因素，应实施一级预防策略以减轻人群心血管代谢疾病负担。

关键词: 心血管代谢危险因素, 青春期发育, 中小学生

Abstract:

Objective: To explore the relationship between puberty timing and cardiovascular metabolic risk factors among primary and secondary students with different genders in Beijing. Methods: Using the method of stratified cluster sampling by urban and rural areas and school sections, 3 067 students from 16 primary and secondary schools in Fangshan District of Beijing were selected in October 2012, with questionnaire survey, physical examination and serum laboratory testing. In this study, we controlled for confounding factors such as school segments, current residence of the family, birth weight, feeding method, only child, highest educational level of parents, and monthly family income, and then the associations between cardiovascular metabolic risk factors and puberty timing among the primary and secondary students was analyzed by multivariate Logistic analysis. To ensure the reliability of the data, this study adopted strict quality control. Results: A total of 3 067 primary and middle school students aged 7 to 16 years were included in this study, including 1 575 boys and 1 492 girls. The prevalence of premature puberty was 14.73% among the boys and 12.89% among the girls, respectively. The prevalence of delayed puberty was 9.49% among the boys and 10.99% among the girls, respectively. The detection rates of central obesity, hypertension, hyperglycemia, and dyslipidemia among the primary and secondary students were 35.87%, 19.95%, 2.54% and 26.31%, respectively. The detection rates of 1 risk factor clustering, 2 risk factors clustering and more than 3 risk factors clustering were 29.21%, 16.17% and 9.36%, respectively. The difference in the detection rate of cardiovascular and metabolic risk factors in different youth stages was insignificant (P>0.05), the detection rate of risk factor aggregation of 0 was lower than that of the timely group and delayed group, and the detection rate of risk factors aggregation of 2 was higher than that of the timely group (P < 0.05).After adjusting the effects of learning stage, region, birth weight, feeding patterns, one-child, family income and the parents' educational levels, multivariate Logistic regression analysis showed that, compared with the on-time puberty group, the risk of 1 risk factor clustering, 2 risk factors clustering and more than 3 risk factors clustering increased by 1.94 times (95% CI=1.29-2.91), 2.97 times (95% CI=1.89-4.67) and 2.02 times (95% CI= 1.13-3.63) among the girls; It had not been found that the relationship between puberty timing and cardiovascular risk factor clustering among the boys (P>0.05). Conclusion: Premature puberty is an independent risk factor for the clustering of cardiometabolic risk factors in girls, and primary prevention strategies should be implemented to reduce the burden of cardiovascular metabolic diseases in the population.

Key words: Cardiovascular metabolic risk factors, Puberty timing, Primary and secondary students

中图分类号:

R179

张祖洪,陈天娇,马军. 中小学生青春发动时相与心血管代谢危险因素的相关性[J]. 北京大学学报（医学版）, 2024, 56(3): 418-423.

Zuhong ZHANG,Tianjiao CHEN,Jun MA. Associations between puberty timing and cardiovascular metabolic risk factors among primary and secondary students[J]. Journal of Peking University (Health Sciences), 2024, 56(3): 418-423.

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参考文献 25

1	陶芳标. 青春发动时相提前与青少年卫生系列述评(1): 早期生长模式与青春发动时相提前[J]. 中国学校卫生, 2008, 29 (3): 193- 195. doi: 10.3969/j.issn.1000-9817.2008.03.001
2	中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545.
3	Prentice P , Viner RM . Pubertal timing and adult obesity and cardiometabolic risk in women and men: A systematic review and meta-analysis[J]. Int J Obes (Lond), 2013, 37 (8): 1036- 1043. doi: 10.1038/ijo.2012.177
4	Ajala O , Mold F , Boughton C , et al. Childhood predictors of cardiovascular disease in adulthood. A systematic review and meta-analysis[J]. Obes Rev, 2017, 18 (9): 1061- 1070. doi: 10.1111/obr.12561
5	席波. 预防成年期心血管疾病应始于儿童期[J]. 中华预防医学杂志, 2019, 53 (7): 657- 660.
6	Petersen AC , Crockett L , Richards M , et al. A self-report measure of pubertal status: Reliability, validity, and initial norms[J]. J Youth Adolesc, 1988, 17 (2): 117- 133. doi: 10.1007/BF01537962
7	李丹, 史慧静, 张越, 等. 青春发育事件自我评定量表在城市青少年人群中的适用性研究[J]. 中华流行病学杂志, 2012, 33 (6): 580- 583. doi: 10.3760/cma.j.issn.0254-6450.2012.06.008
8	韩慧, 汤建军, 华海晨, 等. 蚌埠市青少年青春发动时相与进食行为的关系[J]. 中国学校卫生, 2019, 40 (8): 1166- 1168.
9	赵志雅, 徐慧琼, 汪姗姗, 等. 初中生青春发动时相与心理亚健康相关性及性别差异[J]. 中国公共卫生, 2021, 37 (2): 270- 274.
10	中国学生体质与健康研究组. 2010年中国学生体质与健康调研报告[M]. 北京: 高等教育出版社, 2012: 32- 47.
11	中华医学会儿科学分会内分泌遗传代谢学组, 中华医学会儿科学分会心血管学组, 中华医学会儿科学分会儿童保健学组, 等. 中国儿童青少年代谢综合征定义和防治建议[J]. 中华儿科杂志, 2012, 50 (6): 420- 422. doi: 10.3760/cma.j.issn.0578-1310.2012.06.005
12	American Academy of Pediatrics . Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report[J]. Pediatrics, 2011, 128 (Suppl 5): 213- 256.
13	高梅影, 薛琨, 郭红卫, 等. 不同方法、标准评价上海市浦东新区学龄儿童超重肥胖率[J]. 中国儿童保健杂志, 2020, 28 (2): 131- 134.
14	陈华, 杨丽丽, 梁亚军, 等. 济南市城区7~17岁儿童青少年腹型肥胖流行现状分析[J]. 中国儿童保健杂志, 2018, 26 (5): 496- 499.
15	杨清梅, 马萍, 董洋洋, 等. 2017—2019年银川市12~18岁青少年心血管代谢危险因素的流行现状[J]. 卫生研究, 2021, 50 (3): 454- 459.
16	胡霄, 姜红如, 张兵, 等. 中国十五省7~17岁儿童青少年心血管代谢性危险因素的流行特征[J]. 环境与职业医学, 2021, 38 (8): 833- 838.
17	程红, 陈芳芳, 叶佩玉, 等. 2013—2015年中国7城市6~17岁儿童青少年心血管代谢危险因素的流行特征[J]. 中华预防医学杂志, 2018, 52 (11): 1130- 1135. doi: 10.3760/cma.j.issn.0253-9624.2018.11.007
18	Le-Ha C , Beilin LJ , Burrows S , et al. Age at menarche and childhood body mass index as predictors of cardio-metabolic risk in young adulthood: A prospective cohort study[J]. PLoS One, 2018, 13 (12): e209355.
19	Chan NP , Choi KC , Nelson EA , et al. Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: A cross-sectional study[J]. BMC Pediatr, 2015, 15 (1): 136. doi: 10.1186/s12887-015-0446-0
20	Remsberg KE , Demerath EW , Schubert CM , et al. Early menarche and the development of cardiovascular disease risk factors in adolescent girls: The fels longitudinal study[J]. J Clin Endocrinol Metab, 2005, 90 (5): 2718- 2724. doi: 10.1210/jc.2004-1991
21	Ramírez-Vélez R , García-Hermoso A , Agostinis-Sobrinho C , et al. Pubertal stage, body mass index, and cardiometabolic risk in children and adolescents in Bogotá, Colombia: The cross-sectional fuprecol study[J]. Nutrients, 2017, 9 (7): 644. doi: 10.3390/nu9070644
22	许媛媛, 孙丽, 郭欣, 等. 超重肥胖与青少年青春发动时相的相关性及性别差异研究[J]. 中华预防医学杂志, 2017, 51 (9): 792- 795. doi: 10.3760/cma.j.issn.0253-9624.2017.09.004
23	Fonseca MJ , Oliveira A , Azevedo I , et al. Association of pubertal development with adiposity and cardiometabolic health in girls and boys-findings from the generation XXI birth cohort[J]. J Adolesc Health, 2019, 65 (4): 558- 563. doi: 10.1016/j.jadohealth.2019.05.014
24	Berentzen NE , Wijga AH , van Rossem L , et al. Pubertal timing and cardiometabolic markers at age 16 years[J]. J Pediatr, 2017, 187, 158- 164. doi: 10.1016/j.jpeds.2017.04.008
25	Loomba-Albrecht LA , Styne DM . Effect of puberty on body composition[J]. Curr Opin Endocrinol Diabetes Obes, 2009, 16 (1): 10- 15. doi: 10.1097/MED.0b013e328320d54c

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Risk factors	Boys, n (%)	Girls, n (%)	Total, n (%)	χ²	P
Central obesity	542 (34.41)	558 (37.40)	1100 (35.87)	2.97	0.09
Hypertension	335 (21.27)	277 (18.57)	612 (19.95)	13.06	0.01
Hyperglycaemia	48 (3.05)	30 (2.01)	78 (2.54)	3.32	0.07
High TG	307 (19.49)	313 (20.98)	620 (20.22)	1.05	0.31
High TC	68 (4.32)	70 (4.69)	138 (4.50)	0..25	0.62
Low HDL-C	85 (5.40)	70 (4.69)	155 (5.05)	0.79	0.37
High LDL-C	63 (4.00)	76 (5.09)	139 (4.53)	2.12	0.15
Dyslipidemia	407 (25.84)	400 (16.81)	807 (26.31)	0.37	0.54
Numbers of risk factor				6.83	0.08
0	737 (46.79)	651 (43.63)	1388 (45.26)
1	429 (27.24)	467 (31.30)	896 (29.21)
2	254 (16.13)	242 (16.22)	496 (16.17)
≥3	155 (9.84)	132 (8.85)	287 (9.36)

Gender	Puberty timing	Total, n (%)	Numbers of risk factor, n (%)				χ²	P
Gender	Puberty timing	Total, n (%)	0	1	2	≥3	χ²	P
Boy	Delay	149 (9.46)	68 (45.64)	40 (26.85)	30 (20.13)	11 (7.38)	7.45	0.282
	On-time	1 194 (75.81)	570 (47.74)	313 (26.21)	187 (15.66)	124 (10.38)
	Early	232 (14.73)	99 (42.67)	76 (32.76)	37 (15.95)	20 (8.61)
Girl	Delay	164 (10.99)	79 (48.17^a)	46 (28.05)	25 (15.24)	14 (8.54)	30.43	＜0.001
	On-time	1 136 (76.14)	521 (45.86^a)	348 (30.63)	168 (14.79^a)	99 (8.71)
	Early	192 (12.87)	51 (26.56)	73 (38.02)	49 (25.52)	19 (9.90)

Numbers of risk factor	Gender	Puberty timing	β	OR	95% CI
1	Boys	Early	0.28	1.33	0.93-1.88
		Delay	-0.04	0.96	0.60-1.53
	Girls	Early	0.66	1.94	1.29-2.91
		Delay	-0.19	0.83	0.55-1.25
2	Boys	Early	0.09	1.10	0.71-1.69
		Delay	0.15	1.16	0.68-1.97
	Girls	Early	1.09	2.97	1.89-4.67
		Delay	-0.07	0.94	0.56-1.56
≥3	Boys	Early	-0.15	0.86	0.49-1.52
		Delay	-0.14	0.87	0.43-1.78
	Girls	Early	0.71	2.02	1.13-3.63
		Delay	-0.02	0.98	0.53-1.83

[1]	李成跃, 王浩, 阿力木江·依米提·塔尔肯. 1985——2019年新疆维吾尔族中小学生生长发育的长期趋势[J]. 北京大学学报（医学版）, 2024, 56(5): 802-808.
[2]	闫晓晋,刘云飞,马宁,党佳佳,张京舒,钟盼亮,胡佩瑾,宋逸,马军. 《中国儿童发展纲要(2011-2020年)》实施期间中小学生营养不良率变化及其政策效应分析[J]. 北京大学学报（医学版）, 2023, 55(4): 593-599.
[3]	温萌萌, 朱广荣, 王海雪. 中国11~18岁汉族男生肥胖与首次遗精年龄的相关性分析[J]. 北京大学学报（医学版）, 2015, 47(3): 406-409.
[4]	宋逸, 张冰, 胡佩瑾, 马军. 2010年中国26个少数民族9~18岁女生月经初潮年龄现状分析与比较[J]. 北京大学学报（医学版）, 2014, 46(3): 360-365.
[5]	季成叶, 胡佩瑾, 何忠虎. 中国儿童青少年生长长期趋势及其公共卫生意义[J]. 北京大学学报（医学版）, 2007, 39(2): 126-131.