老年高血压患者认知功能与脂蛋白相关磷脂酶A2及同型半胱氨酸水平的相关性分析

Correlation analysis between cognitive function and lipoprotein-associated phospholipase A2 and homocysteine levels in elderly patients with hypertension

目的探讨老年高血压患者的认知功能障碍与脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)及同型半胱氨酸(homocysteine,Hcy)的关系。方法选取2014年12月至2018年1月首都医科大学宣武医院收治的年龄≥60岁的高血压患者155例,采用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评估患者的认知功能。依据MoCA评分结果将患者分为认知功能障碍组和认知功能正常组,分析两组患者的一般资料及Lp-PLA2和Hcy水平,评估认知功能与LP-PLA2和Hcy的相关性。结果155例患者中有102例(65.8%)存在认知功能障碍,53例(34.2%)认知功能正常。认知功能障碍组年龄、SBP、脉压、Hcy和Lp-PLA2水平均高于认知功能正常组[(77.1±8.9)岁比(70.6±6.9)岁,(141.01±18.12)mmHg比(134.06±16.04)mmHg(1 mmHg=0.133 kPa),(64.94±15.86)mmHg比(58.40±14.89)mmHg,(16.95±3.77)μmol/L比(14.58±4.17)μmol/L,(396.53±35.59)ng/ml比(370.74±32.13)ng/ml],MoCA总分低于认知功能正常组[(17.28±12.90)分比(29.33±0.95)分],差异均有统计学意义(P均<0.05)。Lp-PLA2和Hcy与MoCA评分呈负相关(P<0.05)。多因素logistic回归分析显示,Lp-PLA2(OR=1.369,95%CI:0.691~2.713,P=0.004)和Hcy(OR=1.292,95%CI:0.414~4.034,P=0.018)是老年高血压患者认知功能障碍的独立危险因素。结论Lp-PLA2和Hcy与老年高血压患者的认知功能有一定相关性,对高龄、收缩压更高的患者,在控制血压的同时,应重视并评估患者的认知功能。

Objective To investigate the relationship between cognitive dysfunction and lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)in elderly patients with hypertension.Methods A total of 155hypertensive patients aged≥60 years old admitted to Xuanwu Hospital,Capital Medical University from December 2014 to January 2018 were selected.The Montreal cognitive assessment scale(MoCA)was used to evaluate the cognitive function of the patients.According to the results of MoCA score,the patients were divided into cognitive dysfunction group and normal cognitive function group.The general data,LP-PLA2 and Hcy levels of the two groups were analyzed,and the correlation between cognitive function,LP-PLA2 and Hcy was evaluated.Results Among the 155 patients,102(65.8%)had cognitive dysfunction and 53(34.2%)had normal cognitive function.The age,SBP,pulse pressure,Hcy and Lp-PLA2 levels of the cognitive dysfunction group were higher than those of the normal cognitive function group[(77.1±8.9)years old vs.(70.6±6.9)years old,(141.01±18.12)mmHg vs.(134.06±16.04)mmHg(1 mmHg=0.133 kPa),(64.94±15.86)mmHg vs.(58.40±14.89)mmHg,(16.95±3.77)μmol/L vs.(14.58±4.17)μmol/L,(396.53±35.59)ng/ml vs.(370.74±32.13)ng/ml],the total MoCA score was lower than that of the normal cognitive function group[(17.28±12.90)points vs.(29.33±0.95)points],the differences were statistically significant(P<0.05).Lp-PLA2 and Hcy were negatively correlated with the total MoCA score(P<0.05).Multiple logistic regression analysis showed that Lp-PLA2(OR=1.369,95%CI:0.691-2.713,P=0.004)and Hcy(OR=1.292,95%CI:0.414-4.034,P=0.018)were independent risk factors for cognitive dysfunction in elderly patients with hypertension.Conclusions Lp-PLA2 and Hcy have a certain correlation with cognitive function in elderly patients with hypertension.For elderly patients with higher systolic blood pressure,attention should be paid to cognitive function in addition to treatment and control of blood pressure.