摘要
目的探讨西安市农村中老年人基线血压与4年后认知功能下降的关系,以及年龄对两者关系的影响。方法研究以西安市鄠邑区2个自然村年龄≥40岁基线认知正常人群为研究对象,于2014年10月—2015年3月完成基线调查,于2016年、2018年进行2次随访。研究的血压指标包括高血压(无vs.有)、高收缩压(≥140 mmHg vs.<140 mmHg)、高舒张压(≥90 mmHg vs.<90 mmHg)。应用简易精神状态量表(Mini-Mental State Examination,MMSE)评估整体认知功能,将随访4年时MMSE评分下降≥4分定义为认知功能明显下降。采用多因素Logistic回归分析基线血压指标与认知功能明显下降的关系。采用亚组分析研究年龄(<65岁vs.≥65岁)对两者关系的影响。结果共纳入分析1350人,基线年龄≥65岁235例(17.4%),男性533人(39.5%);高血压671人(49.7%),收缩压(131.71±17.79)mmHg,高收缩压840人(62.2%);舒张压(82.18±10.56)mmHg,高舒张压395人(29.3%)。4年随访中,56例(4.2%)认知功能明显下降。在总人群、<65岁亚组人群、≥65岁亚组人群均未发现高血压、高收缩压与认知功能明显下降间的关联有统计学意义。在总人群(3.6%vs.5.6%,P=0.092)、≥65岁亚组人群(7.5%vs.8.2%,P=0.855)正常舒张压组和高舒张压组之间认知功能明显下降的发生率无统计学意义,而在<65岁亚组人群中,高舒张压组认知功能明显下降发生率高于正常舒张压组(5.1%vs.2.7%,P=0.043)。多因素分析显示,在总人群、≥65岁亚组人群未发现高舒张压与认知功能明显下降相关(OR=1.744,95%CI:0.953~3.192,P=0.071;OR=0.858,95%CI:0.221~3.338,P=0.825),而在<65岁亚组人群,高舒张压与认知功能明显下降显著相关(OR=2.051,95%CI:1.005~4.186,P=0.048)。结论在40~65岁中年人群中,高舒张压与4年认知功能明显下降相关,但在≥65岁人群中未见相关性。未发现高血压、高收缩压与认知功能明显下降之间的关联。
Objective To explore the relationship between blood pressure at baseline and significant decline in cognitive function after 4 years in middle-aged and elderly people in rural Xi’an,and the potential effect of age on the relationship.Methods Data were collected from a cohort of middle-aged and elderly people with cognitive impairment in rural Xi’an,Shaanxi Province.The cohort consisted of people aged≥40 years from a village in Huyi District,Xi’an.The baseline survey was completed between October 2014 and March 2015,and two follow-up visits were conducted in 2016 and 2018.Blood pressure parameters studied included hypertension and high systolic blood pressure(≥140 mmHg vs.<140 mmHg),and high diastolic blood pressure(≥90 mmHg vs.<90 mmHg).The Mini-Mental State Examination(MMSE)was used to assess the whole cognitive function,and the decline of MMSE score≥4 points in 4 years was defined as significant decline of cognitive function.Multivariate Logistic regression was used to analyze the relationship between blood pressure and cognitive function at baseline.Subgroup analysis was used to study the effect of age(<65 vs.≥65 years)on the relationship.Results We recruited a total of 1350 subjects in the analysis,including 235 subjects(17.4%)with baseline age≥65 years and 533 male subjects(39.5%);671 subjects(49.7%)had hypertension,with systolic blood pressure of(131.71±17.79)mmHg;840 subjects(62.2%)had high systolic blood pressure,with diastolic blood pressure of(82.18±10.56)mmHg;395(29.3%)had high diastolic blood pressure.During the 4-year follow-up,56 cases(4.2%)met the criteria for significant decline of cognitive function.We did not find significant association of hypertension and high systolic blood pressure with cognitive decline in the general population,<65-year-old subgroup,or≥65-year-old subgroup.The incidence of significant cognitive decline was not statistically significant in the total population(3.6%vs.5.6%,P=0.092),the≥65-year-old subgroup(7.5%vs.8.2%,P=0.855),the normal diastolic blood pressure group,or the high diastolic blood pressure group.However,in the subgroup<65 years,the incidence of cognitive decline was higher in the high diastolic blood pressure group than in the normal diastolic blood pressure group(2.7%vs.5.1%,P=0.043).Multivariate analysis showed that high diastolic blood pressure was not found to be associated with significant cognitive decline in the total population(OR=1.744,95%CI:0.953-3.192,P=0.071),the subgroup of≥65 years old(OR=0.858,95%CI:0.221-3.338,P=0.825),or the subgroup of≥65 years old.In the<65 age group,high diastolic blood pressure was significantly associated with cognitive decline(OR=2.051,95%CI:1.005-4.186,P=0.048).Conclusion High diastolic blood pressure is associated with 4-year cognitive decline in people aged 40-65 years,but not in those aged≥65.No association is found between hypertension or high systolic blood pressure and significant cognitive decline.
作者
汪妍余
彭伟
商苏杭
高玲
党亮君
王敬谊
屈秋民
屈彦
WANG Yanyu;PENG Wei;SHANG Suhang;GAO Ling;DANG Liangjun;WANG Jingyi;QU Qiumin;QU Yan(Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Huyi Hospital of Traditional Chinese Medicine,Xi’an 710300,China)
出处
《西安交通大学学报(医学版)》
北大核心
2025年第5期733-739,共7页
Journal of Xi’an Jiaotong University(Medical Sciences)
基金
科技创新2030项目(No.2021ZD0201808)
国家自然科学基金项目(No.82301364,No.82201580)
陕西省自然科学基础研究计划项目(No.2023-JC-YB-736)。
关键词
认知功能下降
危险因素
血压
队列研究
cognitive decline
risk factor
blood pressure
cohort study
作者简介
通信作者:屈彦,副主任护理师.E-mail:quyan1178@xjtufh.edu.cn;第一作者:汪妍余;共同第一作者:彭伟。
