【作者】 蒋宏岩；

【导师】 姚兴家；

【作者基本信息】 中国医科大学 ， 儿少卫生与妇幼保健学， 2004， 硕士

【摘要】 前言 伴随着社会经济的发展，人民生活水平提高，世界范围内肥胖患病率普遍升高。20世纪80年代中后期，青少年群体的身体营养状态发生改变。1985年前后我国尚未出现肥胖的流行趋势；1995年前后处于超重率大幅度增长阶段，而肥胖检出率在极低的基数上开始出现成倍增长；2000年前后，进入肥胖的全面增长期，可以说，我国城市群体(男生)已进入发达国家青少年肥胖的快速流行早期，防治工作刻不容缓。 儿童肥胖症作为一种疾病，其危害性不容低估，常见的并发症有：心理问题、高血压、高胰岛素血症、高脂血症、生长激素分泌低下、心脏肥大、静脉血栓、肝脏良性脂肪变性(偶尔发展为脂肪肝)、肺通气量不足等。儿童时期肥胖很容易延续为成年人肥胖，并增加心、脑血管疾病、肿瘤、糖尿病等的发病率，所以预防肥胖应从儿童时期抓起。 目的 为了解近年来锦州市小学生肥胖情况，同时使用最新的2003年中国青少年肥胖问题学术会议公布的“中国儿童青少年超重和肥胖BMI值分类推荐意见”评价标准与传统的“身高标准体重”评价标准(2000年版)进行比较，了解在肥胖检出率，肥胖并发症方面的异同，找出适合基层工作的较好方法，并可作为儿童保健工作的有益指导。 调查对象与方法 1．研究对象 选择锦州市各项指标处于中等状况的解放路小学。于2003年9月对其1497名(男生750名，女生747名)8～11周岁学生进行检查，排除心、肾等重要脏器疾患，排除内分泌失常因素，并无服用皮质激素史等。对检出的肥胖学生做问卷调查和体格检查。 2.方法 2.1肥胖评价标准 方法一:身高标准体重法 使用2000年“中国学生体质与健康研究制定的身高别体重”判别标准。 方法二:BMI法 根据2003年中国儿童青少年肥胖问题学术会议公布的“中国儿童青少年超重和肥胖BMI值分类推荐意见”。 2.2.测量方法和标准 为减小和消除人为因素所造成的偏差，要求现场测试人员按照统一正确的方法操作，在测试前对所有测试人员进行严格培训，对所用仪器用前进行校正，按照正确的方法测量身高、体重、血压、心功能、肝脏B超、血糖等指标。 3.统计分析方法:采用SPsslO.O统计软件。实验结果 1.儿童肥胖状况 对1497名8一11周岁儿童，采用身高标准体重法检出肥胖儿童81名，肥胖检出率5.41%，其中肥胖男生57名，肥胖检出率为7.60%，肥胖女生24名，肥胖检出率为3.21%。采用BMI指数评价方法检出肥胖儿童75名，肥胖检出率5.01%，其中肥胖男生53名，肥胖检出率为7.07%，肥胖女生22名，肥胖检出率为2.95%。经统计学检验两种方法对于儿童肥胖判别及肥胖儿童性别间的检测均没有差异(P>0.05)。 2.肥胖与脂肪肝的关系 2.1两种肥胖评价方法对儿童脂肪肝检出率的比较 以身高标准体重评价方法判定的81名肥胖儿童中检出脂肪肝18例，非脂肪肝63例;以BMI指数评价方法判定的75名肥胖儿童中检出脂肪肝18例，非脂肪肝57例。BMI指数法与身高标准体重法比较，在判断脂肪肝检出率上没有差异(P>0.05)。 2.2 BMI指数与脂肪肝的关系 在以BMI指数判定的肥胖儿童中，BMI指数在20一21 .9和22一23 .9的组段无脂肪肝检出，在24一25 .9和大于26的组段，脂肪肝的检出人数分别为5、13。各组段间比较在脂肪肝检出率上有差别，P<0.01。 3.儿童血压的分析 3 .1两种肥胖评价方法对儿童高血压检出率的比较 以身高标准体重评价方法判定的81名肥胖儿童中检出高血压34例，正常高血压47例;以BMI指数评价方法判定的75名肥胖儿童中检出高血压34例，正常血压41例。BMI指数法与身高标准体重法比较，在判断儿童高血压检出率上没有差异(P>0.05)。 3.2 BMI指数与儿童高血压的关系 在以BMI指数判定的肥胖儿童中，BMI指数在20一21 .9组段检出儿童高血压1例，22一23.9、24一25.9和大于26的组段，儿童高血压的检出人数分别为8、9、16。各组段间比较在儿童高血压检出率上有差别，P<0.05。 4.儿童心功能分析 4.1两种肥胖评价方法对儿童心功能异常检出率的比较 以身高标准体重评价方法判定的81名肥胖儿童中检出心功能异常32例，心功能良好49例;以BMI指数评价方法判定的75名肥胖儿童中检出心功能异常32例，心功能良好43例。BMI指数法与身高标准体重法比较，在判断心功能异常检出率上没有差异(P>0.05)。 4.2 BMI指数与儿童心功能的关系 以BMI指数判定的肥胖儿童中，BMI指数在20一21 .9组段检出儿童心功能异常1例，22一23.9、24一25.9和大于26的组段，儿童心功能异常的检出人数分别为 10、6、15。各组段间比较在儿童心功能异常检出率上有差别，p<0 .05。 5.血糖与肥胖的关系 本次调查发现身高标准体重判别方法和BMI指数判别方法判别的肥胖儿童空腹血糖值均在正常范围内。讨论 1.肥胖儿童的分布状况 对1497名8一n周岁儿童，采用身高标准体重法检出肥胖儿童81名，肥胖检出率5.41%。其中肥胖男生57名，更多还原

【Abstract】 Following the development of social economics and peopled living standard raised, the prevalence rate of obesity increases in the whole world. In the late of 1980s,nutritional status of teenagers changed. There was no epidemic tendency of obesity about in 1985; about in 1995, the rate of overweight was in the stage of increasing in a large range and the detectable rate of obesity was on the lowest cardinal number; about in 2000, obesity stepping into the stage of overall increasing , we can say the crowd ( boys) of the town of China has stepped into the early stage of quick epidemic of child and adolescent obesity in developed country , therefore, work of prevention and cure is imminent.Obesity of children as a disease has hazardous, the common complications are: psychological problem high blood pressure hyperinsulinism?hyperlipi-demia a lower secretion of growth hormone hypertrophy of heart venous thrombus benign fatty degeneration of liver (to develop fatty liver occasionally) and deficient quantity of lung ventilation, etc. The obesity of children can be easy to continue to be obesity of adult and increase the incidence rate of heart and cerebral vessels diseases tumor and diabetes, etc. Therefore, preventing o-besity should start in children period.ObjectiveTo understand the obese status of pupils in the city of Jin Zhou recently, we used the latest evaluated criterion of " the recommended notion of the value of BMI classification to the child and adolescent of China who is overweight and obese" announced by the academic meeting on the problem of obese child andadolescent of China in 2003 comparing with traditional criterion of " weight for height" in 2000 for the same time, understanding if there is difference in the detectable rate and complication of obesity, finding a good method suits for the basal service, to be a beneficial instruction to the children care service.Subjects and methods1. subjectsWe selected Liberation Road primary school in the city of Jin Zhou which all kinds of items were in the middle status. We investigated 1497 pupils ( boys750, girls747) who was 8-11 years old in September 2003 and excluded heart and kidney etc important organs diseases and factors of abnormal endocrine and the children had not the history of taking cortex hormone. We performed questionnaire investigation and physical examination on the detected obese pupils.2. methods2. Ithe evaluation criterion of obesityMethod one: weight for heightUsing the judged criterion of " weight for height formulated by investigation on physical ability and health of Chinese students " in 2000Method two: BMIAccording to " the recommended notion of the value of BMI classification to the child and adolescent of China who is overweight and obese" announced by the academic meeting on the problem of obese child and adolescent of China in 2003.2. 2 measuring methods and criterionTo decrease and preclude the errors caused by the personal factors, we demanded the scene testing personnel perform according to an uniformed and right method. All testing personnel were trained strictly before test. We corrected all eo ipments before using and measured the items of height , weight blood pressure cardiac function and blood sugar etc according to right methods.3. Statistical analysis: SPSS10.0 statistical softwareResults1. the obesity status of childrenWe detected eighty - one obese children judging by the method of weight for height during 1497 children 8 ~ 11 years old, the detectable rate of obesity was 5. 41%. There were fifty - seven obese boys, the detectable rate was 7. 60% ;There were twenty - four obese girls, the detectable rate was 3. 21%. We detected seventy - five obese children judging by the method of BMI, the detectable rate of obesity was 5.01 %. There were fifty - three obese boys, the detectable rate was 7. 07% ;There were twenty - two obese girls, the detectable rate was 2. 95%. The detectable effects of the two evaluated methods of obesity on judging the o更多还原