中医体质类型与轻度认知障碍关系的研究

The association between mild cognitive impairment and constitution classification of traditional medicine

目的:探讨中医体质类型与轻度认知障碍(Mild Cognitive Impairment,MCI)的关系,并简易构建MCI风险预警模型。方法:通过在已建立的中国农村延缓失智和失能的多模干预研究(Multimodal Interventions to Delay Dementia and Disability in Rural China, MIND-China)中,纳入3833例≥60岁老年受试者。通过问卷调查的形式采集人口学、基础疾病和神经心理学资料,并采用《老年人中医药服务记录表》来评估中医体质。应用Petersen’s的诊断标准定义MCI。利用R统计软件进行logistic回归分析并构建MCI风险预测模型。结果:MIND-China队列中老年人群以偏颇体质为主(69.03%),其中痰湿质最多(58.31%),其次是阳虚质(23.61%)。MCI患者中最常见的中医体质是痰湿质(56.24%),其次是平和质(31.39%)。多因素logistic回归分析提示,增龄(P<0.001,OR=1.041,95%CI:1.024-1.057)、中风(P=0.047, OR=1.242, 95%CI:0.999-1.537)和气郁质(P=0.013, OR=1.306, 95%CI:1.056-1.611)能够增加MCI的发病风险,而教育(P<0.001,OR=0.574,95%CI:0.482-0.684)能够减少MCI的发病风险。通绘制受试者工作曲线(receiver operating characteristic curve, ROC),曲线下面积为0.625。结论:中医体质为气郁质的老年人,罹患MCI的风险明显增加。

Objective: To explore the relationship between constitutional types of Chinese medicine and Mild cognitive impairment(MCI) and to construct an early warning model for MCI risk. Methods: In the established Multimodal Interventions to Delay Dementia and Disability in Rural China(MIND-China) study, 3833 elderly subjects aged ≥60 years were included. The data collected included demographic, underlying disease and neuropsychological data. MCI was defined by following the Petersen’s criteria that were operationalized in the Mayo Clinic Study of Aging. Logistic regression analysis and MCI risk prediction models were constructed using R statistical software, and the final prediction results were presented using columnar plots. Results: The MIND-China cohort was dominated by the abnormal constitution(69.03%), of which Phlegm-wetness type was the most common with(58.31%), followed by Yang-deficiency type(23.61%). The most constitutional types of Chinese medicine among MCI patients was Phlegm-wetness type(56.24%), followed by balanced type(31.39%). Multi-factorial logistic regression analysis suggested that increasing age(P<0.001, OR=1.041,95%CI:1.024-1.057), stroke(P=0.047,OR=1.242,95%CI:0.999-1.537) and Qi-depression type(P=0.013,OR=1.306,95%CI:1.056-1.611) were able to increase the risk of developing MCI, while education(P<0.001,OR=0.574,95%CI:0.482-0.684) was able to reduce the risk of developing MCI. By using the risk score model to calculate the total risk score for each subject and plotting the receiver operating characteristic curve(ROC), the area under the curve was 0.625. Conclusion: Older adults with Qidepression type are significantly associated with an increased likelihood of MCI.