老年人血压昼夜节律与认知功能障碍的关系研究  

Association between blood pressure circadian rhythm and cognitive impairments in the elderly

作　　者：吴都[1] 王赛英[1] 

机构地区：[1]杭州市五云山疗养院内科,310008

出　　处：《浙江医学》2017年第23期2114-2117,共4页Zhejiang Medical Journal

基　　金：杭州市农业与社会发展科研计划项目(20170533B77)

摘　　要：目的探讨老年人血压昼夜节律与认知功能障碍的关系。方法随机选取疗休养的老年人363例,分析高血压患病情况与血压昼夜节律的关系、血压昼夜节律与认知功能障碍的关系。结果高血压与无高血压组均以非杓型为主,血压昼夜节律异常率分别为77.5%和76.3%;两组夜间血压下降率(△MBP)的差异无统计学意义(P>0.05)。蒙特利尔认知评估量表(Mo CA)总分比较:非杓型组、超杓型组、反杓型组均低于杓型组(均P<0.05),超杓型组、反杓型组均低于非杓型组(均P<0.05),反杓型组低于超杓型组(P<0.05);Mo CA各维度得分比较:超杓型组、反杓型组的命名、延迟回忆得分均低于杓型组(均P<0.05),亦均低于非杓型组(均P<0.05),超杓型组注意维度得分低于杓型组、非杓型组(均P<0.05)。不同血压昼夜节律分型者认知功能障碍发生率的差异有统计学意义(P<0.05)。经logistic多因素回归分析,血压昼夜节律异常是引起老年人认知功能障碍的危险因素(OR=2.437,95%CI:1.480~4.012),其中反杓型血压的影响相对较大(OR=5.305,95%CI:1.814~15.514)。结论老年人出现血压昼夜节律异常与是否患高血压无关,血压昼夜节律异常是影响老年人发生认知功能障碍的危险因素。Objective To explore the relationship between blood pressure circadian rhythm and cognitive impairments in the elderly. Methods Total 363 elderly subjects were enrolled in the study from Wuyunshan Sanatorium. The blood pressure was monitored and the cognition status was evaluated with Montreal Cognitive Assessment(MoCa). The relationship between the blood pressure rhythm and the cognitive impairments was analyzed. Results The blood pressure in both hypertension group and non-hypertension group mainly presented non-dipper type. The rate of the abnormal blood pressure rhythm was 77.5% and 76.3% in two groups, respectively. There was no significant difference in △MBP between two groups(P >0.05). The total MoCA scores of patients with non-dipper, super-dipper and reverse-dipper types were lower than that of those with dipper type(all P<0.05), the total MocA scores of super-dipper and reverse-dipper groups were lower than that of non-dipper group, while the total MoCA score of reverse-dipper group was lower than super-dipper group(all P<0.05). The scores of naming and delayed recall of super-dipper group and reverse-dipper group were lower than those of dipper group and non-dipper group(all P<0.05). The score of attention of per-dipper group was lower than that of dipper group and non-dipper group(all P<0.05). There were significant differences in the incidence of cognitive impairments among patients with different blood pressure rhythms(P<0.05). Logistic regression analysis showed that the abnormal blood pressure rhythm was a risk factor for cognitive impairments in the elderly(OR=2.437, 95%CI:1.480-4.012), particularly for reverse-dipper blood pressure(OR=5.305, 95%CI:1.814-15.514).Conclusion The abnormal blood pressure circadian rhythm may be not associated with hypertension in the elderly, while abnormal blood pressure rhythm is a risk factor for cognitive impairments in the elderly.

关 键 词：血压昼夜节律 认知功能障碍 老年人 

分 类 号：R544.1[医药卫生—心血管疾病]