天津市社区老年人血脂水平与轻度认知障碍发生关系病例对照研究

Association of blood lipid levels with mild cognitive impairment in the elderly:community-based case-control study in Tianjin city

目的了解天津市社区老年人血脂水平与轻度认知障碍(MCI)发生的关系,为采取MCI相应的预防措施提供参考依据。方法采用以社区为基础1:1匹配的病例对照研究方法,于2016年3月在天津市王顶堤街道辖区内随机选取4个社区卫生服务中心,将体检时诊断为MCI的210例≥65岁老年人作为病例组,按病例组同性别、年龄(±1岁)匹配210名认知正常老年人作为对照组,两组进行问卷调查和实验室检测,《精神障碍诊断和统计手册-V》(DSM-V)用于诊断MCI,采用多因素条件logistic回归模型分析社区老年人血脂水平与MCI发生的关系。结果天津市病例组MCI社区老年人和对照组认知正常社区老年人的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、LDL-C/HDL-C水平分别为186.50(160.75,215.00)mg/dL和195.50(168.00,217.25)mg/dL、101.00(77.75,121.00)mg/dL和100.00(79.75,123.00)mg/dL、58.50(46.75,71.25)mg/dL和58.00(47.00,70.00)mg/dL、1.71(1.30,2.35)和1.66(1.31,2.26),2组老年人TC、LDL-C、HDL-C、LDL-C/HDL-C水平差异均无统计学意义(均P>0.05);在调整了文化程度及是否患高血压、糖尿病、心脏病、脑卒中等混杂因素后,多因素条件logistic回归分析结果显示,天津市TC为200~240 mg/dL社区老年人发生MCI的风险为<200 mg/dL社区老年人的0.52倍(OR=0.52,95%CI=0.27~0.99),HDL-C为>40 mg/dL社区老年人发生MCI的风险为≤40 mg/dL社区老年人的0.30倍(OR=0.30,95%CI=0.14~0.67),LDL-C为100~130 mg/dL、130~160 mg/dL和>160 mg/dL社区老年人发生MCI的风险分别为<100 mg/dL社区老年人的2.37倍(OR=2.37,95%CI=1.21~4.65)、3.22倍(OR=3.22,95%CI=1.09~9.49)和9.33倍(OR=9.33,95%CI=1.59~54.61),LDL-C/HDL-C为>2.30社区老年人发生MCI的风险为<1.31社区老年人的0.37倍(OR=0.37,95%CI=0.16~0.88)。结论高水平的LDL-C为天津市社区老年人MCI发生的危险因素,而高水平的HDL-C和LDL-C/HDL-C比值及中等水平的TC则为天津市社区老年人MCI发生的保护因素。

Objective To explore the relationship between blood lipid and the risk of mild cognitive impairment(MCI)among community elderly for providing evidence to MCI prevention in the population.Methods A case-control study was conducted among residents aged 65 years and above in four communities of Tianjin city during March 2016.The cases were 210 MCI patients diagnosed while attending physical examination at community healthcare centers;the controls were 1:1 gender-and age(±1 year)-matched residents with normal cognitive ability.Face-to-face questionnaire interview,physical examination and laboratory detections were carried out among the participants.Diagnostic and Statistical Manual of Mental Disorders-V(DSM-V)was adopted in diagnosis and assessment of MCI.Multivariate conditional logistic regression analysis was used to explore the relationship between blood lipid and MCI in the elderly.Results No significant differences between the cases and controls were detected in total cholesterol(TC:186.50[25th,75th percentile:160.75,215.00]vs.195.50[168.00,217.25]mg/dL),low density lipoprotein-cholesterol(LDL-C:101.00[77.75,121.00]vs.100.00[79.75,123.00]mg/dL),high density lipoprotein-cholesterol(HDL-C:58.50[46.75,71.25]vs.58.00[47.00,70.00]mg/dL),and LDL-C/HDL-C(1.71[1.30,2.35]vs.1.66[1.31,2.26])(P>0.05 for all).The results of conditional multivariate logistic regression analysis showed that after adjusting for education,hypertension,diabetes,heart disease,and stroke,the LDL-C(mg/dL)of higher than 100 was associated with increased risk of MCI(100-130:odds ratio[OR]=2.37,95%confidence interval[CI]:1.21-4.65;130-160:OR=3.22,95%CI:1.09-9.49;>160:OR=9.33,95%CI:1.59-54.61);while,following factors were correlated to decreased risk of MCI:higher TC(200-240 vs.<200 mg/dL:OR=0.52,95%CI:0.27-0.99),higher HDL-C(>40 vs.≤40 mg/dL:OR=0.30,95%CI:0.14-0.67),and higher ratio of LDL-C/HDL-C(>2.30 vs.<1.31:OR=0.37,95%CI:0.16-0.88).Conclusion Higher serum LDL-C is a risk factor of MCI but higher serum HDL-C,LDL-C/HDL-C ratio and moderate TC are protective factors against MCI for community elderly in Tianjin city.