农村老年人臂间血压差与轻度认知功能障碍的关系研究  

Study on the Relationship between Inter-arm Blood Pressure Difference and Mild Cognitive Impairment in Rural Elderly People

作　　者：吴清悦 陈晓玲 周训琼 杨敬源[1] 周全湘 杨星 WU Qingyue;CHEN Xiaoling;ZHOU Xunqiong;YANG Jingyuan;ZHOU Quanxiang;YANG Xing(School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang 561113,China;Qiannan Medical College for Nationalities,Duyun 558000,China;School of Medical and Health Management,Guizhou Medical University,Guiyang 561113,China;Center of Medicine Economics and Management Research,Guizhou Medical University,Guiyang 561113,China)

机构地区：[1]贵州医科大学公共卫生与健康学院环境污染与疾病监控教育部重点实验室,贵州省贵阳市561113 [2]黔南民族医学高等专科学校,贵州省都匀市558000 [3]贵州医科大学医药卫生管理学院,贵州省贵阳市561113 [4]贵州医科大学医药经济管理研究中心,贵州省贵阳市561113

出　　处：《中国全科医学》2024年第29期3616-3622,3634,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(81760613);贵州医科大学国家自然科学基金培育项目(GMUMEN2022-A01)。

摘　　要：背景既往研究发现臂间血压差(IAD)和轻度认知功能障碍(MCI)均与心血管危险因素密切相关,但IAD与MCI之间是否存在关联尚不明确。目的探讨农村老年人IAD与MCI的关系,为明晰老年人认知功能下降的机制提供科学依据。方法于2019年7—8月采用多阶段整群随机抽样方法抽取贵州省2个县(区)5个乡镇的60岁及以上农村老年人进行问卷调查、一般体格检查、认知功能检查及双臂血压测量。采用简易精神状态评价量表(MMSE)评估认知功能,采用日常生活活动能力量表(ADL)评估日常生活功能状况。采用Spearman秩相关分析及二分类Logistic回归分析探究老年人IAD与MCI的关联性。结果本次调查共发放问卷1795份,排除问卷信息不完整、未进行血压测量、未进行血液检查对象,最终纳入1088名参与者的数据进行研究。1088名农村老年人中,共检出MCI患者138例(12.68%),臂间收缩压差(sIAD)≥10 mmHg(1 mmHg=0.133 kPa)者99例(9.10%),臂间舒张压差(dIAD)≥10 mmHg者80例(7.35%)。与IAD<10 mmHg人群相比,IAD≥10 mmHg人群的MCI患病率更高,MMSE总分、定向力、语言能力和延时回忆力得分较低(P<0.05)。相关性分析结果显示,sIAD与MMSE总分(r_(s)=-0.094)、定向力评分(r_(s)=-0.082)、语言能力评分(r_(s)=-0.065)和延迟回忆力评分(r_(s)=-0.104)呈负相关(P<0.05);dIAD与MMSE总分(r_(s)=-0.080)、定向力评分(r_(s)=-0.094)和注意计算力评分(r_(s)=-0.063)呈负相关(P<0.05)。多因素Logistic回归分析显示,sIAD每增加1 mmHg,MCI发生风险增加8.80%(OR=1.088,95%CI=1.046~1.131,P<0.001);sIAD≥10 mmHg(OR=2.169,95%CI=1.262~3.728,P<0.05)和dIAD≥10 mmHg(OR=1.926,95%CI=1.047~3.542,P<0.05)是老年人发生MCI的影响因素。结论农村老年人MCI患病率为12.68%,其IAD升高与MCI发生风险增加相关,IAD≥10 mmHg人群MCI患病风险高于IAD<10 mmHg人群。Background Previous studies have found that inter-arm blood pressure difference(IAD)and mild cognitive impairment(MCI)are both associated with cardiovascular risk factors,but it is unclear whether there is an association between IAD and MCI.Objective To explore the relationship between IAD and MCI in rural elderly persons and to provide a scientific basis for clarifying the mechanisms of cognitive decline in elderly persons.Methods From July to August 2019,the rural elderly residents aged 60 years and older were selected using the multi-stage cluster sampling method from 5 townships in 2 counties(districts)of Guizhou Province,and questionnaire surveys,general physical examinations,cognitive function assessments,and bilateral arm blood pressure measurements were carried out among them.Cognitive function was evaluated using the Mini-mental State Examination(MMSE)scale,and activities of daily living were assessed using the Activities of Daily Living Scale(ADL).Spearman rank correlation analysis and binary Logistic regression model were used to investigate the association between IAD and MCI in the elderly persons.Results A total of 1795 questionnaires were distributed,and data from 1088 participants were finally included in the study after excluding subjects with incomplete information on the questionnaires,those who did not undergo blood pressure measurements,and those who did not undergo blood tests.Among the 1088 rural elderly residents,138 patients(12.68%)with MCI,99 patients(9.10%)with systolic inter-arm blood pressure difference(sIAD)≥10 mmHg,and 80 patients(7.35%)with diastolic inter-arm blood pressure difference(dIAD)≥10 mmHg were detected.Individuals with IAD≥10 mmHg had a higher prevalence of MCI and lower MMSE scores,orientation scores,language scores,and delayed recall scores compared to those with IAD<10 mmHg(P<0.05).The results of correlation analysis showed that the sIAD was significantly negatively associated with the total MMSE score(r_(s)=-0.094),orientation score(r_(s)=-0.082),verbal ability

关 键 词：轻度认知功能障碍 臂间血压差 农村地区 老年人 横断面研究 

分 类 号：R741[医药卫生—神经病学与精神病学]