新疆维吾尔自治区哈萨克族老年期痴呆患病率调查

Survey of the incidence of elderly dementia of Kazak ethnic group in Xinjiang Uygur Autonomous Region

目的 了解新疆维吾尔自治区（简称新疆）哈萨克族及汉族老年期痴呆和阿尔茨海默病（AD）的患病率及其流行特征.方法 采用分层多级整群抽样方法,根据新疆独特的地理环境及哈萨克族主要居住地,依据随机数字表法随机抽取新疆北疆的阿勒泰地区15个乡镇哈萨克族、汉族2个民族≥55岁的调查对象3 663人.调查采用筛查和确诊两阶段法,根据国际统一的诊断标准,美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）的标准诊断痴呆,AD诊断采用美国神经病学、语言障碍和卒中-老年性痴呆和相关疾病学会（NINCDS-ADRDA）的标准,应用美国国立神经系统疾病与卒中研究所和瑞士神经科学研究国际协会的标准诊断血管性痴呆（VaD）.结果 （1）哈萨克族、汉族AD粗患病率分别为5.88％（149/2 532）、4.45％ （48/1 078）,经年龄构成标化,分别为5.64％、4.73％;VaD粗患病率分别为2.69％ （68/2 532）、1.95％ （21/1 078）,标化率为2.43％、1.99％,两民族之间差异无统计学意义.（2）哈萨克族女性与男性AD患病率比较分别为7.32％ （96/1 311）、4.34％ （53/1 221）,差异有统计学意义（x2=15.807,P＜0.01）;汉族女性与男性AD患病率比较分别为6.02％（35/581）、2.62％ （13/497）,差异具有统计学意义（x2=12.571,P＜0.01）;无论是哈萨克族还是汉族,不同文化程度老年人AD患病率的差异均具有统计学意义;而相同文化程度、不同民族间AD患病率差异无统计学意义;两民族VaD患病率与文化程度无明显相关性.（3）两民族痴呆患病率随年龄增长急剧上升,特别是80岁以上人群AD患病率高达30.28％ （66/218）.结论 AD是新疆哈萨克族和汉族老年人的主要痴呆类型,VaD次之;两民族中女性AD患病率明显高于男性;AD的患病率随文化程度的降低而升高;AD和VaD的患病率随着年龄的增长而增高.

Objective To investigate the morbidity and epidemiology of dementia in old people and Alzheimer＇s disease （AD） in Kazak and Han ethnic groups in Xinjiang Uygur Autonomous Region.Methods Using stratified cluster random sampling method,we conducted this survey within 3 663 subjects randomly selected from the residences （≥ 55 years old） including Kazak and Han ethnic groups in Aletai area,northern Xinjiang.The diagnosis of dementia was confirmed by the American Diagnostic and Statistical Manual of Mental Disorders （DSM-Ⅳ） based on two-stage investigation including screening and confirmed diagnosis.The diagnostic criteria of AD was according to the reference standards of the American Institute of Neurology,the Language Barrier and Stroke and the AD and Related Disorders Association （NINCDS-ADRDA）.The diagnostic criteria of vascular dementia （VaD） was based on American National Institute of Neurological Disorders and Stroke Research Institute and the Swiss Neuroscience Research International Association （NINDS/AIREN）.Results （1） The crude prevalence rates of AD in Kazak and Han ethnic groups were 5.88% （149/2 532） and 4.45% （48/1 078）,respectively and the age-adjusted rates were 5.64% and 4.73%,respectively.These two rates of VaD in Kazak and Han ethnic groups were 2.69% （68/2 532） and 1.95% （21/1 078）,2.43% and 1.99%,respectively.There were no significant differences between two ethnic groups.（2） The AD morbidity in female and male was 7.32% （96/1 311） and 4.34% （53/1 221 ; x2 =15.807,P 〈 0.01） respectively in Kazak population; While it was 6.02% （35/581） and 2.62% （13/497; x2 =12.571,P 〈 0.01） in Hans.The morbidity difference was statistically significant in different educational levels.However,there was no statistically significant difference in subjects with same degree of education.In VaD,there was no correlation between educational level and morbidity in both Kazak and Han people.（3） The morbidity of dementia was sharply increased with age in two populations,especially in patients over 80 years old with the highest of 30.28% （66/218）.Conclusions AD is the main type of dementia in old Kazak and Han people in Xinjiang,while VaD is the second reason of dementia.The morbidity rate of AD in female is significantly higher than men in both two ethnic groups.The lower level of education is associated with the higher incidence of AD and the morbidity of AD and VaD is increased with age.