中医体质类型与阿尔茨海默病关系的研究  

The association between Alzheimer's disease and constitution classification of traditional medicine

作　　者：王丽丹 刘可可 王永祥 侯婷婷[1,2] 张宪达 张忠林 丛琳 杜怡峰[1,2] Wang Lidan;Liu Keke;Wang Yongxiang;Hou Tingting;Zhang Xianda;Zhang Zhonglin;Cong Lin;Du Yifeng(Department of Neurology,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,China;Department of Neurology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Yanlou Town Health Center,Yanggu County,Liaocheng 252323,China)

机构地区：[1]山东大学附属省立医院神经内科,济南250021 [2]山东第一医科大学附属省立医院神经内科,济南250021 [3]山东省聊城市阳谷县闫楼镇卫生院,聊城252323

出　　处：《中华行为医学与脑科学杂志》2022年第6期541-547,共7页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金(81861138008);山东省中西医结合专病防治及阿尔茨海默病(老年痴呆)防治项目(YXH2019ZXY008)。

摘　　要：目的探讨中医体质类型与阿尔茨海默病(Alzheimer’s disease,AD)的关系,并构建AD风险预警模型。方法在已建立的中国农村延缓失智和失能的多模干预研究(multimodal interventions to delay dementia and disability in rural China,MIND-China)中,纳入4033例≥60岁老年被试者。采集人口学、既往病史和神经心理学评估资料,并采用老年人中医药服务记录表评估被试中医体质。应用2011年美国国立老化研究院和阿尔茨海默病协会发布的NIA-AA诊断标准进行临床很可能AD诊断。利用R统计软件进行Logistic回归分析并构建AD风险预测模型,采用列线图对最终预测结果进行展示。结果MIND-China队列中老年人群以偏颇体质为主(69.28%),其中痰湿质最多(58.05%),其次是阳虚质(23.85%)。AD患者中最常见的中医体质是痰湿质(54.35%),其次是气郁质(38.04%)。多因素Logistic回归分析提示,年龄(β=0.101,P<0.001,OR=1.107,95%CI:1.069~1.146)和气郁质(β=0.622,P=0.016,OR=1.862,95%CI:1.116~3.076)能够增加AD的发病风险,而教育(β=-1.047,P<0.001,OR=0.351,95%CI:0.205~0.584)能够减少AD的发病风险。通过使用风险评分模型计算各研究对象所得风险总分并绘制受试者工作曲线(receiver operating characteristic curve,ROC),曲线下面积为0.769,校准曲线表现出良好的预测与实际的一致性。结论中医体质为气郁质的老年人,罹患AD的风险明显增加。Objective To explore the relationship between constitutional types of Chinese medicine and Alzheimer's disease(AD)and to construct an early warning model for AD risk.Methods In the established multimodal interventions to delay dementia and disability in rural China(MIND-China)study,4033 elderly subjects aged≥60 years old were included.The data including demographic,underlying disease and neuropsychological data were collected.The Chinese medicine service record form for the elderly was used to assess constitutional types of Chinese medicine and to apply the NIA-AA diagnostic criteria published by the National Institute on Aging and the Alzheimer's Association in 2011 for the diagnosis of clinically likely AD.Logistic regression analysis and AD risk prediction models were constructed using R statistical software,and the final prediction results were presented using columnar plots.Results The MIND-China cohort was dominated by the abnormal constitution(69.28%),of which Phlegm-wetness type was the most common(58.05%),followed by Yang-deficiency type(23.85%).The most constitutional type of Chinese medicine among AD patients was Phlegm-wetness type(54.35%),followed by Qi-depression type(38.04%).Multi-factorial logistic regression analysis suggested that increasing age(β=0.101,P<0.001,OR=1.107,95%CI=1.069-1.146)and Qi-depression type(β=0.622,P=0.016,OR=1.862,95%CI=1.116-3.076)were able to increase the risk of developing AD,while education(β=-1.047,P<0.001,OR=0.351,95%CI=0.205-0.584)was able to reduce the risk of developing AD.By using the risk score model to calculate the total risk score for each subject and plotting the receiver operating characteristic curve(ROC),the area under the ROC was 0.769 and the calibration curve showed excellent consistency between prediction and reality.Conclusion Older adults with Qi-depression type are significantly associated with an increased likelihood of AD.

关 键 词：阿尔茨海默病 中医体质类型 气郁质 MIND-China队列 

分 类 号：R277.7[医药卫生—中医学]