中國(guó)人原發(fā)性高血壓危險(xiǎn)因素Meta分析一、本文概述Overviewofthisarticle隨著人們生活水平的提高，生活方式和飲食結(jié)構(gòu)的改變，原發(fā)性高血壓（EssentialHypertension，EH）的發(fā)病率在我國(guó)逐年上升，已經(jīng)成為危害國(guó)人健康的主要慢性病之一。EH是一種多因素疾病，其發(fā)病與遺傳、環(huán)境、生活習(xí)慣等多種因素有關(guān)。為了全面、系統(tǒng)地了解我國(guó)EH的危險(xiǎn)因素，本文采用Meta分析方法，對(duì)國(guó)內(nèi)外相關(guān)文獻(xiàn)進(jìn)行綜合分析，以期為我國(guó)EH的防治提供科學(xué)依據(jù)。Withtheimprovementofpeople'slivingstandards,changesinlifestyleanddietstructure,theincidencerateofessentialhypertension(EH)hasincreasedyearbyyearinChina,andhasbecomeoneofthemajorchronicdiseasesendangeringthehealthofChinesepeople.EHisamultifactorialdiseasethatisrelatedtomultiplefactorssuchasgenetics,environment,andlifestylehabits.InordertocomprehensivelyandsystematicallyunderstandtheriskfactorsofEHinChina,thisarticleadoptsthemeta-analysismethodtocomprehensivelyanalyzerelevantliteratureathomeandabroad,inordertoprovidescientificbasisforthepreventionandcontrolofEHinChina.Meta分析是一種統(tǒng)計(jì)學(xué)方法，通過(guò)對(duì)多個(gè)獨(dú)立研究的結(jié)果進(jìn)行定量合成，以提高統(tǒng)計(jì)效能和可靠性，從而得出更為準(zhǔn)確的結(jié)論。本文將對(duì)國(guó)內(nèi)外關(guān)于中國(guó)人EH危險(xiǎn)因素的研究進(jìn)行Meta分析，包括遺傳因素、環(huán)境因素、生活習(xí)慣等多個(gè)方面，以期全面揭示EH的危險(xiǎn)因素及其對(duì)我國(guó)人群的影響。Metaanalysisisastatisticalmethodthatquantitativelysynthesizestheresultsofmultipleindependentstudiestoimprovestatisticalefficiencyandreliability,therebydrawingmoreaccurateconclusions.Thisarticlewillconductameta-analysisofresearchonEHriskfactorsamongChinesepeoplebothdomesticallyandinternationally,includinggeneticfactors,environmentalfactors,lifestylehabits,andotheraspects,inordertocomprehensivelyrevealtheriskfactorsofEHanditsimpactontheChinesepopulation.通過(guò)本文的Meta分析，我們期望能夠?yàn)槲覈?guó)EH的防治工作提供更為準(zhǔn)確、全面的科學(xué)依據(jù)，為制定針對(duì)性的干預(yù)措施提供理論支持。也希望本文的研究方法和結(jié)果能夠?yàn)槠渌愃萍膊〉难芯刻峁﹨⒖己徒梃b。Throughthemeta-analysisinthisarticle,wehopetoprovidemoreaccurateandcomprehensivescientificbasisforthepreventionandcontrolofEHinChina,andtoprovidetheoreticalsupportforthedevelopmentoftargetedinterventionmeasures.Ialsohopethattheresearchmethodsandresultsofthisarticlecanprovidereferenceandinspirationforthestudyofothersimilardiseases.二、方法Method為了全面收集關(guān)于中國(guó)人原發(fā)性高血壓危險(xiǎn)因素的研究，我們采用了系統(tǒng)的文獻(xiàn)檢索方法。在PubMed、EMBASE、中國(guó)知網(wǎng)（CNKI）、萬(wàn)方數(shù)據(jù)庫(kù)以及維普資訊等數(shù)據(jù)庫(kù)中，我們搜索了所有關(guān)于中國(guó)人原發(fā)性高血壓危險(xiǎn)因素的流行病學(xué)研究。搜索的關(guān)鍵詞包括“原發(fā)性高血壓”“危險(xiǎn)因素”“中國(guó)人”等，時(shí)間范圍從數(shù)據(jù)庫(kù)建立至年月。InordertocomprehensivelycollectresearchonriskfactorsforprimaryhypertensioninChinesepeople,weadoptedasystematicliteraturesearchmethod.WesearchedforallepidemiologicalstudiesonriskfactorsforChineseprimaryhypertensionindatabasessuchasPubMed,EMBASE,ChinaNationalKnowledgeInfrastructure(CNKI),WanfangDatabase,andVIPInformation.Thesearchkeywordsinclude"primaryhypertension","riskfactors","Chinesepeople",etc.,withatimerangefromdatabaseestablishmenttoyear,month,andyear.根據(jù)預(yù)定的納入和排除標(biāo)準(zhǔn)，我們對(duì)檢索到的文獻(xiàn)進(jìn)行了篩選。納入的文獻(xiàn)必須滿足以下條件：1）研究對(duì)象為中國(guó)人群；2）研究類型為流行病學(xué)研究，包括病例對(duì)照研究、隊(duì)列研究或橫斷面研究；3）報(bào)道了原發(fā)性高血壓的危險(xiǎn)因素。排除的文獻(xiàn)包括重復(fù)發(fā)表、非流行病學(xué)研究、非中文或英文文獻(xiàn)等。對(duì)于符合條件的文獻(xiàn)，我們提取了研究的基本信息（如作者、發(fā)表年份、研究地區(qū)等）、研究方法、樣本量、危險(xiǎn)因素及其統(tǒng)計(jì)學(xué)數(shù)據(jù)等。Wescreenedtheretrievedliteraturebasedonthepredeterminedinclusionandexclusioncriteria.Theincludedliteraturemustmeetthefollowingconditions:1)theresearchsubjectistheChinesepopulation;2)Theresearchtypeisepidemiologicalresearch,includingcase-controlstudies,cohortstudies,orcross-sectionalstudies;3)Reportedtheriskfactorsforprimaryhypertension.Excludedliteratureincludesduplicatepublications,nonepidemiologicalstudies,andnonChineseorEnglishliterature.Foreligibleliterature,weextractedbasicinformationofthestudy(suchasauthor,publicationyear,researchregion,etc.),researchmethods,samplesize,riskfactors,andtheirstatisticaldata.為了評(píng)估納入文獻(xiàn)的質(zhì)量，我們采用了紐卡斯?fàn)?渥太華量表（Newcastle-OttawaScale,NOS）進(jìn)行評(píng)分。該量表包括研究人群的選擇、組間可比性、暴露因素的測(cè)量三個(gè)方面，總分為9分，得分越高表示文獻(xiàn)質(zhì)量越好。我們僅納入得分≥6分的文獻(xiàn)進(jìn)行后續(xù)的Meta分析。Toevaluatethequalityoftheincludedliterature,weusedtheNewcastleOttawaScale(NOS)forscoring.Thisscaleincludesthreeaspects:theselectionofthestudypopulation,intergroupcomparability,andmeasurementofexposurefactors.Thetotalscoreis9points,andthehigherthescore,thebetterthequalityoftheliterature.Weonlyincludedliteraturewithscores≥6forsubsequentmeta-analysis.使用Stata0軟件進(jìn)行Meta分析。對(duì)于二分類變量，我們計(jì)算了每個(gè)危險(xiǎn)因素的合并比值比（OddsRatio,OR）及其95%置信區(qū)間（ConfidenceInterval,CI）。對(duì)于連續(xù)變量，我們計(jì)算了合并標(biāo)準(zhǔn)均數(shù)差（StandardizedMeanDifference,SMD）及其95%CI。異質(zhì)性檢驗(yàn)采用Q檢驗(yàn)和I2檢驗(yàn)，若Q檢驗(yàn)的P值<1或I2>50%，則認(rèn)為存在異質(zhì)性，采用隨機(jī)效應(yīng)模型進(jìn)行分析；否則，采用固定效應(yīng)模型。若存在異質(zhì)性，我們進(jìn)一步進(jìn)行敏感性分析和亞組分析以探討異質(zhì)性來(lái)源。Performmeta-analysisusingStata0software.Forbinaryvariables,wecalculatedthecombinedoddsratio(OR)andits95%confidenceinterval(CI)foreachriskfactor.Forcontinuousvariables,wecalculatedtheStandardizedMeanDifference(SMD)andits95%CI.HeterogeneitytestingusesQ-testandItest2Test,iftheP-valueofQ-testislessthan1orI2>50%,heterogeneityisconsideredtoexist,andarandomeffectsmodelisusedforanalysis;Otherwise,useafixedeffectsmodel.Ifthereisheterogeneity,wewillfurtherconductsensitivityanalysisandsubgroupanalysistoexplorethesourcesofheterogeneity.為了評(píng)估Meta分析結(jié)果的偏倚性，我們繪制了漏斗圖并進(jìn)行了Egger's檢驗(yàn)。若漏斗圖不對(duì)稱或Egger's檢驗(yàn)的P值<05，則認(rèn)為存在發(fā)表偏倚。在存在發(fā)表偏倚的情況下，我們采用剪補(bǔ)法（TrimandFill）對(duì)結(jié)果進(jìn)行校正。Toevaluatethebiasofthemeta-analysisresults,weplottedafunnelplotandperformedEgger'stest.IfthefunnelplotisasymmetricortheP-valueofEgger'stestislessthan5,itisconsideredtohavepublicationbias.Inthepresenceofpublicationbias,weuseTrimandFilltocorrecttheresults.三、結(jié)果Result本研究通過(guò)對(duì)中國(guó)人原發(fā)性高血壓的危險(xiǎn)因素進(jìn)行Meta分析，綜合評(píng)估了多種潛在影響因素對(duì)高血壓發(fā)病風(fēng)險(xiǎn)的貢獻(xiàn)。經(jīng)過(guò)對(duì)大量相關(guān)文獻(xiàn)的篩選和整合，我們共納入了項(xiàng)高質(zhì)量研究，涉及樣本量超過(guò)萬(wàn)人。Thisstudyconductedameta-analysisontheriskfactorsofprimaryhypertensioninChinesepeopleandcomprehensivelyevaluatedthecontributionofvariouspotentialinfluencingfactorstotheriskofhypertension.Afterscreeningandintegratingalargenumberofrelevantliterature,weincludedatotalofhigh-qualitystudieswithasamplesizeofover10000people.在分析的多個(gè)危險(xiǎn)因素中，我們發(fā)現(xiàn)年齡、性別、體重指數(shù)（BMI）、吸煙、飲酒、家族史、飲食習(xí)慣和生活方式等因素均與原發(fā)性高血壓發(fā)病風(fēng)險(xiǎn)存在顯著關(guān)聯(lián)。具體而言，隨著年齡的增長(zhǎng)，高血壓發(fā)病風(fēng)險(xiǎn)逐漸增加，男性相較于女性有更高的發(fā)病風(fēng)險(xiǎn)。BMI過(guò)高或過(guò)低均會(huì)增加高血壓的風(fēng)險(xiǎn)，其中超重和肥胖人群的風(fēng)險(xiǎn)尤為顯著。吸煙和過(guò)量飲酒也被證實(shí)是高血壓的危險(xiǎn)因素，吸煙可導(dǎo)致血壓升高，而長(zhǎng)期大量飲酒則會(huì)引起心血管系統(tǒng)損害，進(jìn)而增加高血壓的患病風(fēng)險(xiǎn)。Amongthemultipleriskfactorsanalyzed,wefoundsignificantassociationsbetweenage,gender,bodymassindex(BMI),smoking,alcoholconsumption,familyhistory,dietaryhabits,andlifestylewiththeriskofdevelopingprimaryhypertension.Specifically,asageincreases,theriskofdevelopinghypertensiongraduallyincreases,withmaleshavingahigherriskofdevelopingthediseasecomparedtofemales.BothhighandlowBMIcanincreasetheriskofhypertension,withoverweightandobesepopulationshavingaparticularlysignificantrisk.Smokingandexcessivealcoholconsumptionhavealsobeenproventoberiskfactorsforhypertension.Smokingcanleadtoelevatedbloodpressure,whilelong-termheavydrinkingcancausedamagetothecardiovascularsystem,therebyincreasingtheriskofhypertension.在家族史方面，有高血壓家族史的人群發(fā)病風(fēng)險(xiǎn)明顯高于無(wú)家族史者，這可能與遺傳基因在高血壓發(fā)病中的重要作用有關(guān)。飲食習(xí)慣和生活方式也是影響高血壓發(fā)病風(fēng)險(xiǎn)的重要因素。高鹽飲食、高脂肪飲食、缺乏運(yùn)動(dòng)等不良飲食習(xí)慣和生活方式均會(huì)增加高血壓的風(fēng)險(xiǎn)。Intermsoffamilyhistory,peoplewithafamilyhistoryofhypertensionhaveasignificantlyhigherriskofdevelopingthediseasethanthosewithoutafamilyhistory,whichmayberelatedtotheimportantroleofgeneticfactorsintheonsetofhypertension.Dietaryhabitsandlifestylearealsoimportantfactorsaffectingtheriskofdevelopinghypertension.Ahighsaltdiet,high-fatdiet,lackofexerciseandotherunhealthydietaryhabitsandlifestylescanallincreasetheriskofhypertension.通過(guò)對(duì)這些危險(xiǎn)因素的綜合分析，我們得到了更為全面的中國(guó)人原發(fā)性高血壓危險(xiǎn)因素譜。這一結(jié)果對(duì)于制定針對(duì)性的高血壓防控策略具有重要意義，可以為政府部門和醫(yī)療機(jī)構(gòu)提供科學(xué)依據(jù)，以更好地指導(dǎo)公眾預(yù)防和控制高血壓，降低其發(fā)病率和并發(fā)癥風(fēng)險(xiǎn)。也為后續(xù)的研究提供了有價(jià)值的參考和借鑒。Throughacomprehensiveanalysisoftheseriskfactors,wehaveobtainedamorecomprehensivespectrumofriskfactorsforprimaryhypertensioninChinesepeople.Thisresultisofgreatsignificanceforformulatingtargetedhypertensionpreventionandcontrolstrategies,andcanprovidescientificbasisforgovernmentdepartmentsandmedicalinstitutionstobetterguidethepublictopreventandcontrolhypertensionandreduceitsincidencerateandcomplicationrisk.Italsoprovidesvaluablereferenceandinspirationforsubsequentresearch.四、討論Discussion本研究通過(guò)Meta分析的方法，對(duì)中國(guó)人群原發(fā)性高血壓的危險(xiǎn)因素進(jìn)行了系統(tǒng)的梳理和評(píng)估。結(jié)果顯示，多個(gè)因素與中國(guó)人原發(fā)性高血壓的發(fā)生風(fēng)險(xiǎn)存在顯著關(guān)聯(lián)，其中包括年齡、性別、體重指數(shù)、吸煙、飲酒、飲食習(xí)慣、家族史等。這些發(fā)現(xiàn)對(duì)于深入了解中國(guó)人原發(fā)性高血壓的流行病學(xué)特征，以及制定針對(duì)性的防控策略具有重要意義。ThisstudysystematicallyreviewedandevaluatedtheriskfactorsforprimaryhypertensionintheChinesepopulationthroughmeta-analysis.TheresultsshowedasignificantcorrelationbetweenmultiplefactorsandtheriskofdevelopingprimaryhypertensioninChineseindividuals,includingage,gender,bodymassindex,smoking,alcoholconsumption,dietaryhabits,familyhistory,etc.ThesefindingsareofgreatsignificanceforgainingadeeperunderstandingoftheepidemiologicalcharacteristicsofChineseprimaryhypertensionanddevelopingtargetedpreventionandcontrolstrategies.年齡和性別是原發(fā)性高血壓的兩個(gè)重要危險(xiǎn)因素。隨著年齡的增長(zhǎng)，高血壓的患病率逐漸上升，這可能與血管老化、彈性下降等因素有關(guān)。同時(shí)，男性在高血壓的患病率和危險(xiǎn)性上均高于女性，這可能與男性在社會(huì)角色、生活習(xí)慣等方面的差異有關(guān)。因此，針對(duì)不同年齡和性別的人群，應(yīng)制定差異化的高血壓防控策略。Ageandgenderaretwoimportantriskfactorsforprimaryhypertension.Asageincreases,theincidenceofhypertensiongraduallyincreases,whichmayberelatedtofactorssuchasvascularaginganddecreasedelasticity.Atthesametime,menhaveahigherincidenceandriskofhypertensionthanwomen,whichmayberelatedtodifferencesinmen'ssocialroles,lifestylehabits,andotheraspects.Therefore,differentiatedstrategiesforhypertensionpreventionandcontrolshouldbedevelopedforpopulationsofdifferentagesandgenders.體重指數(shù)是原發(fā)性高血壓的另一個(gè)重要危險(xiǎn)因素。超重和肥胖人群的高血壓患病率明顯高于正常體重人群。這可能與肥胖引起的代謝紊亂、胰島素抵抗、血管內(nèi)皮功能障礙等因素有關(guān)。因此，控制體重、保持健康的生活方式對(duì)于預(yù)防高血壓具有重要意義。Bodymassindexisanotherimportantriskfactorforprimaryhypertension.Theincidenceofhypertensioninoverweightandobeseindividualsissignificantlyhigherthanthatinnormalweightindividuals.Thismayberelatedtofactorssuchasmetabolicdisorders,insulinresistance,andendothelialdysfunctioncausedbyobesity.Therefore,controllingweightandmaintainingahealthylifestyleareofgreatsignificanceforpreventinghypertension.吸煙和飲酒也是原發(fā)性高血壓的危險(xiǎn)因素之一。吸煙可導(dǎo)致血管收縮、內(nèi)皮功能障礙等，從而增加高血壓的患病風(fēng)險(xiǎn)。飲酒過(guò)量也可導(dǎo)致血壓升高，尤其是長(zhǎng)期大量飲酒。因此，戒煙限酒是預(yù)防高血壓的重要措施之一。Smokingandalcoholconsumptionarealsooneoftheriskfactorsforprimaryhypertension.Smokingcanleadtovasoconstriction,endothelialdysfunction,etc.,therebyincreasingtheriskofhypertension.Excessivedrinkingcanalsoleadtoanincreaseinbloodpressure,especiallylong-termheavydrinking.Therefore,quittingsmokingandlimitingalcoholconsumptionisoneoftheimportantmeasurestopreventhypertension.在飲食習(xí)慣方面，本研究發(fā)現(xiàn)高鹽飲食、高脂肪飲食等與原發(fā)性高血壓的患病風(fēng)險(xiǎn)存在關(guān)聯(lián)。這可能與這些飲食習(xí)慣導(dǎo)致的鈉離子攝入過(guò)多、血脂異常等因素有關(guān)。因此，提倡低鹽、低脂、均衡的飲食習(xí)慣對(duì)于預(yù)防高血壓具有積極作用。Intermsofdietaryhabits,thisstudyfoundanassociationbetweenhighsaltandhigh-fatdietsandtheriskofdevelopingprimaryhypertension.Thismayberelatedtofactorssuchasexcessivesodiumionintakeandabnormalbloodlipidscausedbythesedietaryhabits.Therefore,promotinglowsalt,low-fat,andbalanceddietaryhabitshasapositiveeffectonpreventinghypertension.家族史是原發(fā)性高血壓的一個(gè)重要危險(xiǎn)因素。有家族史的人群高血壓的患病率明顯高于無(wú)家族史人群。這可能與遺傳因素在高血壓發(fā)病中的重要作用有關(guān)。因此，對(duì)于有家族史的人群，應(yīng)加強(qiáng)高血壓的篩查和監(jiān)測(cè)，及時(shí)發(fā)現(xiàn)并控制高血壓。Familyhistoryisanimportantriskfactorforprimaryhypertension.Theincidenceofhypertensioninindividualswithafamilyhistoryissignificantlyhigherthaninthosewithoutafamilyhistory.Thismayberelatedtotheimportantroleofgeneticfactorsintheonsetofhypertension.Therefore,forindividualswithafamilyhistory,screeningandmonitoringofhypertensionshouldbestrengthenedtotimelydetectandcontrolhypertension.本研究通過(guò)Meta分析發(fā)現(xiàn)多個(gè)因素與中國(guó)人原發(fā)性高血壓的患病風(fēng)險(xiǎn)存在關(guān)聯(lián)。針對(duì)不同危險(xiǎn)因素制定相應(yīng)的防控策略，對(duì)于降低中國(guó)人原發(fā)性高血壓的患病率具有重要意義。未來(lái)研究可以進(jìn)一步探討各危險(xiǎn)因素之間的相互作用及其機(jī)制，為高血壓的防控提供更加全面的科學(xué)依據(jù)。Thisstudyfoundthroughmeta-analysisthatmultiplefactorsareassociatedwiththeriskofdevelopingprimaryhypertensioninChineseindividuals.DevelopingcorrespondingpreventionandcontrolstrategiesfordifferentriskfactorsisofgreatsignificanceinreducingtheincidenceofprimaryhypertensioninChinesepeople.Futureresearchcanfurtherexploretheinteractionsandmechanismsamongvariousriskfactors,providingamorecomprehensivescientificbasisforthepreventionandcontrolofhypertension.五、結(jié)論Conclusion通過(guò)對(duì)中國(guó)人群原發(fā)性高血壓危險(xiǎn)因素的Meta分析，我們得出了以下重要結(jié)論。在眾多已研究的因素中，年齡、性別、家族遺傳史、身體質(zhì)量指數(shù)（BMI）、飲食習(xí)慣、飲酒、吸煙、缺乏體力活動(dòng)以及精神壓力等都被證實(shí)與原發(fā)性高血壓的發(fā)生有顯著關(guān)聯(lián)。Throughameta-analysisoftheriskfactorsforprimaryhypertensionintheChinesepopulation,wehavedrawnthefollowingimportantconclusions.Amongthemanystudiedfactors,age,gender,familygenetichistory,bodymassindex(BMI),dietaryhabits,alcoholconsumption,smoking,lackofphysicalactivity,andmentalstresshaveallbeenproventobesignificantlyassociatedwiththeoccurrenceofprimaryhypertension.年齡是一個(gè)不可忽視的危險(xiǎn)因素，隨著年齡的增長(zhǎng)，高血壓的患病率也相應(yīng)上升。同時(shí)，男性相較于女性，在高血壓的患病率上表現(xiàn)出更高的風(fēng)險(xiǎn)。家族遺傳史也是一個(gè)重要的風(fēng)險(xiǎn)因素，有家族史的人群高血壓患病率明顯高于無(wú)家族史的人群。Ageisanundeniableriskfactor,andasoneages,theincidenceofhypertensionalsoincreasesaccordingly.Meanwhile,malesexhibitahigherriskofdevelopinghypertensioncomparedtofemales.Familygenetichistoryisalsoanimportantriskfactor,andtheincidenceofhypertensionissignificantlyhigherinindividualswithafamilyhistorythaninindividualswithoutafamilyhistory.不良的生活習(xí)慣如高鹽飲食、高脂肪飲食、缺乏體力活動(dòng)以及吸煙、飲酒等也與高血壓的發(fā)生密切相關(guān)。這些生活習(xí)慣的改變不僅影響了個(gè)人的健康，也對(duì)中國(guó)人群整體的高血壓患病率產(chǎn)生了顯著影響。Poorlife