中老年人群不同长时收缩压变异性指标与认知功能的关系

Association between long term systolic blood pressure variability index and cognitive function in middle-aged and elderly people

目的探讨中老年人群不同长时收缩压变异性指标与认知功能的关系。方法在参加2006至2007年健康体检的101510名开滦集团职工中，采用单纯随机抽样方法抽取观察对象5440名。2012至2013年对该人群再次进行健康体检，采用简明精神量表（MMSE）进行认知功能状态评分，删除血压和MMSE评分资料不完整者，最终纳入统计分析的观察对象共3002名。长时收缩压变异性分别以2006至2007、2008至2009、2010至2011和2012至2013年4次健康体检收缩压的标准差、极差和平均真实变异性（ARV）表示。调查对象分别按照标准差、极差和ARV的四分位数进行分组，采用多因素线性逐步回归分析长时收缩压变异性指标与认知功能的关系。结果（1）在3002名观察对象中，男性1627名，女性1375名，年龄（50．86±9．93）岁，MMSE评分为（28．03±2．65）分。（2）标准差〈5．53mmHg组（1mmHg=0．133kPa）、标准差5．53—8．90mmHg组、标准差8．91～12．79mmHg组和标准差〉12．79mmHg组的MMSE评分分别为（28．21±2．18）分、（28．26±3．09）分、（28．10±2．40）分和（27．56±2．79）分（P〈0．05）；极差〈12．00mmHg组、极差12．00～20．00mmHg组、极差20．01—30．00mmHg组和极差〉30．00mmHg组的MMSE评分分别为（28．27±2．17）分、（28．25±3．09）分、（27．99±2．42）分和（27．49±2．81）分（P〈0．05）；ARV〈6．67mmHg组、ARV6．67～10．22mmHg组、ARV10．23～15．56mmHg组和ARV〉15．56mmHg组的MMSE评分分别为（28．27±2．20）分、（28．28±3．20）分、（28．00±2．42）分和（27．57±2．65）分（P〈0．05）。（3）校正年龄、性别、基线收缩压、体重指数、总胆固醇、空腹血糖、甘油三酯、C反应蛋白、是否吸烟、是否饮酒和是否体育锻炼后，多因素线性逐步回归分析显示：未服用降压药观察对象的长时收缩压变异性指标标准差（B=-0．129，P〈0．05）、极差（B=-0．131，P〈0．05）、ARV（B=-0．125，P〈0．05）与MMSE评分呈负相关；服用降压药观察对象的标准差（B=-0．329，P〈0．05）、极差（B=-0．314，P〈0．05）与MMSE评分呈负相关，平均真实血压变异性与MMSE评分无相关性（B=-0．233，P〉0．05）。结论在未服用降压药的中老年人群中，长时收缩压变异性指标标准差、极差、ARV与MMSE评分呈负相关；在服用降压药的中老年人群中，标准差、极差与MMSE评分呈负相关。临床试验注册号中国临床试验注册中心，注册号为ChiCTRTNC-11001489。

Objective To investigate the association between different long term systolic blood pressure variability （SBPV） and cognitive function in middle-aged and elderly people. Methods A total of 101 510 employees from the Tangshan Kailuan Group participated in the 2006-2007 annual physical examination, 5 440 cases were selected by simple randomly sampling method. After excluding participants who did not underwent 2012--2013 examination and without complete blood pressure and mini-mental state examination （MMSE） score, 3 002 participants （1 627 males, （50. 86 ± 9. 93 ） years old） with integrated data were included into the study. The long term SBPV was calculated by standard deviation （SD）, maximum-minimum difference （ MMD ） , average real variability （ ARV ） of mean systolic blood pressure measured in 2006-2007, 2008-2009, 2010-2011 and 2012-2013. Participants were grouped by the quartile of the different SBPV index. Multiple linear regressions analysis was used to analyze the correlation between the long term SBPV and cognitive function status. Results （ 1 ） The score of MMSE was 28.03 ± 2. 65. （ 2 ） The observation population was divided into four groups according to quartiles of different SBPV, respectively. The MMSE scores of SD 〈5.53 mmHg （ 1 mmHg =0. 133 kPa）group,SD 5.53 - 8.90 mmHg group, SD 8.91 - 12. 79 mmHg group and SD 〉 12. 79 mmHg group were 28.21 ± 2. 18,28. 26 ± 3.09, 28. 10 ±2.40 and 27.56 ± 2. 79, respectively （ P 〈 0. 05 ）. The MMSE scores of MMD 〈 12. 00 mmHg group, MMD 12.00 - 20. 00 mmHg group, MMD 20. 01 - 30. 00 mmHg group and MMD 〉 30. 00 mmHg were 28.27 ± 2. 17, 28.25 ± 3.09, 27.99 ± 2. 42 and 27.49 ± 2. 81, respectively （ P 〈 0.05 ）. The MMSE scores of ARV 〈6. 67 mmHg group, ARV 6. 67 - 10. 22 mmHg group, ARV 10. 23 - 15.56 mmHg group and ARV 〉 15.56 mmHg group were 28.27 ± 2. 20,28.28 ± 3.20,28.00 ± 2.42,27.57 ± 2. 65, respectively（P 〈 0. 05）. （3） Adjusted for age, gender, baseline systolic blood pressure, body weight index, total cholesterol, fasting blood glucose, triglyceride, C reactive protein, smoke, drink, physical activity , the step-wise regressions analysis showed that SD（B = - 0. 129 ,P 〈 0. 05 ）, MMD（B = - 0. 131, P 〈 0. 05 ） , ARV （ B = - 0. 125,P 〈 0. 05 ） had significant negative linear relationship with the MMSE score in the objects not taking the anti-hypertension drugs, and SD （ B = - 0. 329, P 〈 0. 05 ）, MMD （ B = -0. 314,P 〈 0. 05 ） , but not ARV（ B = - 0. 233 ,P 〉 0. 05 ） , had significant negative linear relationship with the MMSE score in the objects taking the anti-hypertension drugs. Conclusion The long term SBPV indexes （SD, MMD, ARV ） are negatively correlated with the MMSE score in middle-aged and elderly people not taking the anti-hypertension drugs, and SD, MMD are negatively correlated with the MMSE score in people taking the anti-hypertension drugs. Clinical Trail Registry Chinese Clinical Trail Registry, ChiCTRTNC-11001489.