动态血压变异性与主观认知下降进展的相关性

Correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline

目的分析动态血压变异性与主观认知下降(SCD)进展的相关性。方法本研究为前瞻性观察性研究,采用整体抽样法,连续选取2016年1月1日—2017年6月30日常熟市第一人民医院和常熟市辛庄人民医院门诊SCD患者100例,基线期搜集人口学特征资料,使用汉化版SCD-Q9问卷自评SCD情况,使用蒙特利尔认知评估量表(MoCA)评估客观认知功能损害情况。所有患者入组时进行24 h动态血压监测,计算24 h收缩压变异系数(SCV)和舒张压变异系数(DCV)。随访期为首次就诊之后4年,每年评估1次MoCA量表,最终83例完成随访纳入研究。根据随访结束时的MoCA评分<26分和≥26分将患者分为进展组(39例)和非进展组(44例),进展组计算基线及末次MoCA评分差值。采用χ^(2)检验比较两组人口学特征差异,采用秩和检验比较两组24 h SCV和24 h DCV差异,采用多重线性回归分析进展组24 h SCV与MoCA评分差值、SCD-Q9得分的相关性。结果SCD患者4年进展率为46.99%(39/83);进展组与非进展组基线年龄、性别、文化程度、既往病史、吸烟史、SCD-Q9得分、MoCA评分差异均无统计学意义(均P>0.05)。进展组24 h SCV显著高于非进展组[13.4%(9.9%,15.6%)比10.9%(9.7%,12.7%),U=594.50,P=0.016];两组24 h DCV差异无统计学意义(P>0.05);进展组24 h SCV与MoCA评分差值呈负相关(r=-0.368,P=0.021)。结论动态血压变异性与SCD进展存在相关性,高24 h SCV可能是SCD进展的诸多因素之一,具有一定的预测价值。

Objective To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline(SCD).Methods In this prospective observational study,the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology,Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 12016 to June 302017.The baseline demographic characteristics of the patients were collected.The Chinese version of SCD-Q9 questionnaire was used to self-evaluate SCD,and the Montreal Cognitive Assessment Scale(MoCA)was used to evaluate objective cognitive impairment.All patients received 24 h ambulatory blood pressure monitoring,and 24 h systolic coefficient of variation(SCV)and diastolic coefficient of variation(DCV)were calculated.The follow-up period was 4 years after the first visit,and the MoCA scale was evaluated once a year.Finally,83 patients completed the follow-up and were included in this study.According to the MoCA score at the end of follow-up(<26 or≥26),the patients were divided into progression group(39 cases)and non-progression group(44 cases).The difference of MoCA score between baseline and last follow-up was calculated in the progression group.The difference in demographic characteristics between the two groups was compared withχ^(2) test.The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test.The correlation between 24 h SCV and MoCA score difference or SCD-Q9 score in the progression group were tested by multiple linear regression analysis.Results The 4-year progression rate of SCD patients was 46.99%(39/83).There was no significant differences in baseline age,gender,education level,medical history,smoking history,SCD-Q9 score and MoCA score between the progressive group and the non-progressive group(all P>0.05).The 24 h SCV in the progressive group was significantly higher than that in the non-progressive group[13.4%(9.9%,15.6%)vs 10.9%(9.7%,12.7%),U=594.50,P=0.016].There was no significant difference in 24 h DCV between the two groups(P>0.05).In progressive group,the 24 h SCV was negatively correlated with MoCA score difference(r=-0.368,P=0.021).Conclusion There is a correlation between ambulatory blood pressure variability and SCD progression,high 24 h SCV may be one of the factors of SCD progression and has certain predictive value.