血清Klotho水平与老年高血压患者认知功能障碍及中医分型的相关性

Correlation between the Level of Serum Klotho and the Cognitive Dysfunction of Senile Patients with Hypertension and Traditional Chinese Medicine Syndrome Differentiation

目的:探索老年高血压患者血清Klotho水平与认知功能障碍以及中医分型之间的关系。方法:采用横断面调查的方法,回顾性收集115例老年高血压伴认知功能障碍患者为观察组;选择同期就诊的无认知功能障碍的老年高血压患者120例作为对照组。检测患者血清Klotho、内皮素-1(ET-1)和一氧化氮(NO)水平;应用蒙特利尔认知评估(MoCA)量表评估每个患者的整体认知能力,并评估血清Klotho水平与MoCA量表评分及血清NO、ET-1水平的相关性;对两组患者进行辨证分型,并对不同证型患者认知能力,血清Klotho、ET-1、NO水平进行比较。制作受试者工作特征(ROC)曲线,计算区分患者正常和异常认知的血清Klotho临界值;应用多元Logistic回归分析血清Klotho水平是否是发生认知功能障碍的独立危险因素。结果:观察组患者血清Klotho和NO水平显著低于对照组,而血清ET-1水平高于对照组,差异均有统计学意义(P<0.001或P<0.01);血清Klotho水平与MoCA量表评分、血清NO水平呈正相关(P<0.05),与ET-1水平呈负相关(P<0.05);所有患者中医辨证分型结果为肝火亢盛型(73例)、痰湿壅盛型(46例)、阴虚阳亢型(62例)、阴阳两虚型(54例),各中医分型患者在认知功能、血清Klotho、NO和ET-1水平方面比较,差异均有统计学意义(P<0.001),且痰湿壅盛型患者发生认知功能障碍比例最高,并具有最低的血清Klotho、NO水平和最高的血清ET-1水平,肝火亢盛型患者血清Klotho水平最高。诊断高血压患者具有认知功能障碍的血清Klotho水平临界值为103.8 ng/L。年龄、糖尿病、高甘油三酯、收缩期高血压和低血清Klotho水平(<103.8 ng/L)为高血压患者发生认知功能障碍的独立危险因素。结论:低血清Klotho水平是老年高血压患者认知功能受损的危险因素,可用于评估患者发生认知功能障碍的风险,且痰湿壅盛型患者发生认知功能障碍比例最高。

Objective:To explore the correlation between the level of serum Klotho and the cognitive dysfunction of senile patients with hypertension and traditional Chinese medicine(TCM)syndrome differentiation.Methods:Using a cross-sectional survey method,total 115 senile patients with hypertension and cognitive dysfunction were retrospectively collected as the observation group.A total of 120 senile patients with hypertension without cognitive dysfunction were selected as the control group.Serum levels of Klotho,endothelin-1(ET-1)and nitric oxide(NO)were detected.The Montreal Cognitive Assessment(MoCA)scale was used to evaluate the overall cognitive ability of each patient,and the correlation between serum Klotho level and MoCA score,serum NO,ET-1 level was evaluated.The two groups of patients were divided according to TCM syndrome differentiation,and the cognitive ability,serum Klotho,ET-1 and NO levels of patients with different types were compared.Receiver operating characteristic(ROC)curve was made to calculate serum Klotho threshold to distinguish normal and abnormal cognition.Multivariate Logistic regression was used to analyze whether serum Klotho level was an independent risk factor for cognitive dysfunction.Results:The serum levels of Klotho and NO in the observation group were significantly lower than those in the control group,and the level of ET-1 was significantly higher than that in the control group,the differences were statistically significant(P<0.001或P<0.01).Pearson correlation analysis showed that serum Klotho level was positively correlated with MoCA score and serum NO(P<0.05),and negatively correlated with ET-1(P<0.05).The results of TCM syndrome differentiation of all patients were as follows:hyperactive liver fire type(73 cases),excessive phlegm and dampness type(46 cases),yin deficiency and yang hyperactivity type(62 cases),and deficiency of both yin and yang type(54 cases).There were significant differences in cognitive function,serum Klotho,NO and ET-1 levels in patients with different TCM syndrome types,the differences were statistically significant(P<0.001).In addition,patients with excessive phlegm-dampness obstruction had the highest proportion of cognitive dysfunction,and had the lowest serum Klotho and NO levels and the highest serum ET-1 level,while patients with hyperactive liver fire had the highest serum Klotho level.The critical value of serum Klotho level in hypertensive patients with cognitive impairment was 103.8 ng/L.Age,diabetes,hypertriglyceridemia,systolic hypertension and low serum Klotho level(<103.8 ng/L)were independent risk factors for cognitive dysfunction in patients with hypertension.Conclusions:Low serum Klotho level is a risk factor for cognitive dysfunction in senile patients with hypertension,which can be used to evaluate the risk of cognitive dysfunction in patients,and patients with excessive phlegm and dampness obstruction have the highest proportion of cognitive impairment.