老年人动态血压参数与轻度认知障碍的相关性

Correlation between parameters of ambulatory blood pressure and mild cognitive impairment in older adults

目的探讨老年人动态血压参数与轻度认知障碍(MCI)的相关性。方法选取2020年3月至7月于长海医院完成年度体检的306例离退休人员为研究对象,收集人群一般资料、实验室检查及病史资料。采用便携式动态血压计记录各个时段平均血压、血压标准差、血压变异系数及晨峰血压、昼夜节律。使用蒙特利尔认知评估量表(MoCA)评估人群认知功能,根据结果将人群分为轻度认知障碍(MCI)组(218例)和认知功能正常组(88例)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ2检验进行组间比较。采用Spearman秩相关分析动态血压与MCI的相关性。采用多因素logistic回归模型分析MCI的影响因素。结果与无认知障碍组比较,MCI组平均血压、血压标准差、血压变异系数及昼夜节律均显著增高,差异有统计学意义(P<0.05)。相关性分析结果显示,MOCA总分与24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h平均收缩压标准差、白天平均收缩压标准差、夜间平均收缩压标准差、白天平均舒张压标准差、24 h平均收缩压变异系数、24 h平均舒张压变异系数、白天平均收缩压变异系数、夜间平均收缩压变异系数、夜间平均舒张压变异系数呈负相关(r=-0.151,-0.144,-0.136,-0.202,-0.253,-0.158,-0.253,-0.210,-0.190,-0.220,-0.178,-0.119;P<0.05);与24 h平均舒张压、白天平均舒张压、夜间平均舒张压呈正相关(r=0.163,0.157,0.138;P<0.05)。多因素logistic回归分析结果显示,年龄、24 h收缩压变异系数、昼夜节律中非杓型和反杓型(B=11.000,OR=1.115,P<0.01;B=0.270,OR=1.305,P<0.01;B=1.496,OR=4.646,P<0.01;B=1.306,OR=3.690,P<0.05)是老年人发生MCI的独立危险因素。结论老年人动态血压变异与MCI发生密切相关,控制异常的血压变异可能有利于避免MCI的发生。

Objective To investigate the correlation between parameters of ambulatory blood pressure and mild cognitive impairment(MCI)among the elderly.Methods A total of 306 retired cadres who had finished the annual health examination at Changhai Hospital from March to July in 2020 were enrolled as the research subjects.Their general data,results of laboratory tests,and medical history were collected.Portable ambulatory blood pressure monitor was used to record the average blood pressure,standard deviation of blood pressure,variation coefficient of blood pressure,morning blood pressure surge and circadian rhythm at the different time intervals.Montreal cognitive assessment(MoCA)was employed to evaluate the cognitive function.According to the results,the subjects were divided into MCI group(n=218)and the normal cognition group(n=88).SPSS statistics 26.0 was adopted for data analysis.Student′s t test,Mann-Whitney U test,or Chi-square test was performed for intergroup comparison depending on data type.Spearman rank correlation analysis was conducted to analyze the correlation of ambulatory blood pressure and MCI.Multivariate logistic regression model was established to analyze the influencing factors for MCI.Results Compared with the normal cognition group,higher average blood pressure,standard deviation of blood pressure,variation coefficient of blood pressure,and circadian rhythm were observed in the MCI group(P<0.05).Correlation analysis indicated that the total MoCA score was negatively correlated with 24-hour mean systolic blood pressure,daytime mean systolic blood pressure,night mean systolic blood pressure,24-hour mean systolic blood pressure standard deviation,daytime mean systolic blood pressure standard deviation,night mean systolic blood pressure standard deviation,daytime mean diastolic blood pressure standard deviation,24-hour mean systolic blood pressure coefficients of variation,24-hour mean diastolic blood pressure coefficients of variation,daytime mean systolic blood pressure coefficiens of variation,night mean systolic blood pressure coeffients of variation,and night mean diastolic blood pressure coeffients of variation(r=-0.151,-0.144,-0.136,-0.202,-0.253,-0.158,-0.253,-0.210,-0.190,-0.220,-0.178,-0.119;P<0.05),and positively correlated with 24-hour mean diastolic blood pressure,daytime mean diastolic blood pressure,and night mean diastolic blood pressure(r=0.163,0.157,0.138;P<0.05).Multivariate logistic regression analysis showed that age,24-hour mean systolic blood pressure coeffients of variation,non-dipper and reverse-dipper in the circadian rhythm(B=11.000,OR=1.115,P<0.01;B=0.270,OR=1.305,P<0.01;B=1.496,OR=4.646,P<0.01;B=1.306,OR=3.690,P<0.05)were independent risk factors for occurrence of MCI among the elderly.Conclusion Ambulatory blood pressure variability is closely associated with the occurrence of MCI among the elderly.Controlling abnormal blood pressure variability may be beneficial in preventing the occurrence of MCI.