脑血管反应性降低与高血压认知功能减退的相关性研究  

Cerebrovascular reactivity was associated with cognitive impairment in hypertension

作　　者：王瑾[1] 商清[1] 刘蕊[1] 屈秋民[1] 

机构地区：[1]西安交通大学第一附属医院神经内科,西安医学硕士710061

出　　处：《医学研究生学报》2016年第12期1260-1264,共5页Journal of Medical Postgraduates

基　　金：国家科技支撑计划项目(2015BAI13B01)

摘　　要：目的高血压与中老年认知功能障碍密切相关,但其机制尚无定论。文中旨在研究高血压对中老年脑血管反应性的影响,以及脑血管反应性与认知功能减退的关系,初步探讨高血压促进认知障碍的机制。方法收集2014年8月至2015年2月期间于西安交通大学第一附属医院门诊就诊的原发性高血压患者40例（高血压组）,并选择同时期40例门诊健康体检人员作为对照组。全部研究对象应用蒙特利尔认知评估量表（Montreal Cognitive Assessment,Mo CA）评价认知功能,以Mo CA得分≤25分为认知功能减退;通过经颅多普勒超声测定屏气指数（breath-holding index,BHI）反映脑血管反应性（cerebrovascular reactivity,CVR）,以两侧大脑中动脉BHI均值〈0.69为CVR减低,将研究对象按照CVR结果分为CVR降低组和CVR正常组。结果高血压组认知障碍患病率明显高于对照组（57.5%vs 27.5%,P〈0.01）;高血压组CVR减低发生率明显高于对照组（27.5%vs 7.5%,P〈0.05）。多因素Logistic回归分析显示,与CVR降低相关的因素包括年龄（OR=1.327,95%CI=1.058-1.664,P〈0.05）和高血压病程（OR=1.569,95%CI=1.107-2.224,P〈0.05）。CVR降低患者认知功能减退发生率明显高于CVR正常患者（92.9%vs 31.8%,P〈0.01）。多因素Logistic回归分析显示,与认知功能减退相关的因素包括年龄（OR=1.161,95%CI=1.041-1.294,P〈0.01）、高血压病史（OR=3.913,95%CI=1.036-14.777,P〈0.05）和BHI（OR=0.053,95%CI=0.007-0.421,P〈0.01）。结论高血压可加重CVR下降;而CVR下降与高血压患者认知功能减退具有一定关联。Objective Hypertension is closely associated with cognitive dysfunction in the elderly, but the mechanism re-mains unclear. This study aimed to investigate the effect of hypertension on cerebrovascular reactivity（ CVR） in middle aged and elderly patients, and the relationship between the CVR and cognitive impairment, and to explore the mechanisms of hypertension promoting cognitive impairment. Methods 40 middle aged and elderly primary hypertension patients from the Neurology Department of the First Affiliated Hospital of Xi^n Jiaotong University and 40 matched normal controls were recruited. All the subjects were assessed for cognitive function with Montreal Cognitive Assessment（ MoCA）. The MoCA scores less than 26 points is a standard of cognitive decline. Use the Breath-holding Index （ BHI） to reflect the function of the CVR, which was tested with ordinary Transcranial Doppler（ TCD）.. Mean BHI of both sides of the middle cerebral artery less than 0.69 is a standard of CVR lower. According to the result of CVR, subjects were divided into CVR declined group and normal CVR group. Results The prevalence of cognitive impairment in the hypertension group is significantly higher than in normal control group（57.5% vs 27.5% ,P 〈 0 .0 1 ） .CVR decline in the primary hypertension group is significantly higher than in normal control group（27.5% vs 7.5% ,P 〈 0 .05 ） .Multivariate logistic regression analysis shows that CVR de-cline are associated with age（ OR= 1.327, 95% CI= 1.058-1.664,P〈0.05） and the duration of hypertension（ OR = 1.569,95% Cl = 1.107-2.224,P〈0.05） .The prevalence of cognitive impairment in the CVR decline group is significantly higher than in the normal CVR group（92.9% vs 31.8%, P〈0.01） .Multivariate logistic regression analysis of cognitive impairment demonstrates that age（OR = 1.161, 95% CI= 1.041-1.294, P〈0.01） .hypertension（ OR = 3.913, 95% CI = 1.036-14.777, P〈0.05�

关 键 词：高血压 脑血管反应性 认知功能减退 屏气指数 

分 类 号：R749[医药卫生—神经病学与精神病学]