摘要
目的在西安市农村中老年人群队列中观察基线血脂水平与随访4年后认知功能减退的关系。方法数据来源于西安市农村地区中老年人群认知障碍队列,选择西安市鄠邑区2个自然村≥40岁人群为研究对象,于2014年10月—2015年3月完成基线调查,于2016、2018年进行2次随访。应用简易精神状态量表(MMSE)评估整体认知功能。2014年MMSE评分与2018年MMSE评分的差值(ΔMMSE)≥2分定义为认知功能减退。分别将基线血脂指标[总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-c)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-c)]水平根据25%分位数、75%分位数为界转化为3分类资料[Q 1(≤25%)vs.Q 2-Q 3(25%~75%)vs.Q 4(≥75%)],并以Q 2-Q 3组作为参照。采用多因素二元Logistic回归分析基线时血脂水平与认知功能减退的关系。采用交互效应分析、亚组分析研究年龄(<65岁vs.≥65岁)对血脂与认知功能减退关系的交互影响。结果基线资料完整且完成4年随访者1349例,基线年龄≥65岁235例(17.42%),认知功能减退230例(17.05%)。在<65岁亚组人群中,TC、TG、LDL-c、HDL-c与认知功能减退之间无显著关联。在≥65岁亚组人群中,与TC的Q 2-Q 3(4.37~5.61 mmol/L)组相比,TC的Q 1(≤4.37 mmol/L)组与认知功能减退风险无显著关联,但TC的Q 4(≥5.61 mmol/L)组与认知功能减退风险增加显著相关(OR=2.519,95%CI:1.217~5.214,P=0.013),年龄对TC的Q 4组与认知功能减退的关系存在交互效应(OR=2.202,95%CI:1.111~4.363,P=0.024);与TG的Q 2-Q 3(1.03~2.01 mmol/L)组相比,TG的Q 1(≤1.03 mmol/L)组与认知功能减退风险降低相关(OR=0.318,95%CI:0.120~0.838,P=0.020),年龄对TG的Q 1组与认知功能减退的关系存在交互效应(OR=0.344,95%CI:0.132~0.896,P=0.029),但TG的Q 4(≥2.01 mmol/L)组与认知功能减退风险无显著关联;与LDL-c的Q 2-Q 3(2.70~3.81 mmol/L)组相比,LDL-c的Q 1(≤2.70 mmol/L)组与认知功能减退风险无显著关联,但LDL-c的Q 4(≥3.81 mmol/L)组与认知功能减退风险增加显著相关(OR=2.367,95%CI:1.143~4.900,P=0.020),年龄对LDL-c的Q 4组与认知功能减退的关系存在交互效应(OR=2.237,95%CI:1.134~4.415,P=0.020);HDL-c与认知功能减退之间无显著关联。结论基线TC、TG、LDL-c与认知功能减退的关系受年龄交互影响,在≥65岁亚组人群中,基线血清TC、LDL-c高水平者认知功能减退风险较高,TG低水平者认知功能减退风险较低,基线HDL-c与认知功能减退之间无显著关联。
Objective To investigate the relationship between baseline serum lipid levels and cognitive decline after a 4-year follow-up in a cohort of middle-aged and elderly people in rural Xi’an.Methods The data were collected from the cognitive impairment cohort of middle-aged and elderly people in rural areas of Xi’an,Shaanxi Province.The cohort selected the population≥40 years old in two villages of Huyi District,Xi’an,as the research subjects.The baseline survey was completed from October 2014 to March 2015,and two follow-up visits were conducted in 2016 and 2018.The Mini-Mental State Examination(MMSE)was applied to assess the overall cognitive function.The MMSE score dropping between the 2014 and 2018(ΔMMSE)≥2 points were defined as cognitive decline.Baseline lipid levels[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-c),low-density lipoprotein cholesterol(LDL-c)]were converted into three classification data based on 25%quantile and 75%quantile[Q 1(≤25%)vs.Q 2-Q 3(25%-75%)vs.Q 4(≥75%)],and using the Q 2-Q 3 group as the reference group.The relationship between serum lipid levels and cognitive decline at baseline was analyzed by multivariate Logistic regression.Interaction effect analysis and subgroup analysis were made to investigate the interaction effect of age(<65 years vs.≥65 years)on the relationship between serum lipid and cognitive decline.Results There were 1349 participants with complete baseline data,and 235(17.42%)were≥65 years old at baseline;230 cases(17.05%)had cognitive decline.No significant association was found between TC,TG,LDL-c,HDL-c and cognitive decline in subgroups<65 years of age.In the subgroup≥65 years of age,the Q 1(≤4.37 mmol/L)group of TC was not significantly associated with the risk of cognitive decline compared with the Q 2-Q 3(4.37-5.61 mmol/L)group of TC,but the Q 4(≥5.61 mmol/L)group of TC was significantly associated with an increased risk of cognitive decline(OR=2.519,95%CI:1.217-5.214,P=0.013).Age had an interactive effect on the relationship between the Q 4 group of TC and cognitive decline(OR=2.202,95%CI:1.111-4.363,P=0.024).Compared with the Q 2-Q 3(1.03-2.01 mmol/L)group of TG,the Q 1(≤1.03 mmol/L)group of TG was associated with a lower risk of cognitive decline(OR=0.318,95%CI:0.120-0.838,P=0.020).Age had an interactive effect on the relationship between the Q 1 group of TG and cognitive decline(OR=0.344,95%CI:0.132-0.896,P=0.029).However,there was no significant correlation between the Q 4(≥2.01 mmol/L)group of TG and the risk of cognitive decline.Compared with the Q 2-Q 3(2.70-3.81 mmol/L)group of LDL-c,the Q 1(≤2.70 mmol/L)group of LDL-c was not significantly associated with the risk of cognitive decline,but the Q 4(≥3.81 mmol/L)group of LDL-c had significant association with an increased risk of cognitive decline(OR=2.367,95%CI:1.143-4.900,P=0.020).Age had an interactive effect on the relationship between the Q 4 group of LDL-c and cognitive decline(OR=2.237,95%CI:1.134-4.415,P=0.020).No significant association was found between HDL-c and cognitive decline.Conclusion No significant association was found between HDL-c and cognitive decline at baseline.The relationship of TC,TG and LDL-c with cognitive decline was affected by age.Only in participants over 65 years old,the risk of cognitive decline was higher in those with high baseline levels of TC and LDL-c.Those with low baseline serum TG levels had a lower risk of cognitive decline.
作者
胡宁薇
闫毓璐
魏珊
党亮君
王敬谊
王瑾
屈秋民
商苏杭
HU Ningwei;YAN Yulu;WEI Shan;DANG Liangjun;WANG Jingyi;WANG Jin;QU Qiumin;SHANG Suhang(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740-748,共9页
Journal of Xi’an Jiaotong University(Medical Sciences)
基金
国家科技部科技创新2030-“脑科学与类脑研究”重大项目(No.2021ZD0201808)。
作者简介
通信作者:商苏杭,主治医师.E-mail:shangsuhang@mail.xjtu.edu.cn;第一作者:胡宁薇;共同第一作者:闫毓璐。
