血压变异性与阿尔茨海默病精神行为症状的相关性

Correlation between blood pressure variability and behavioral and psychological symptoms of dementia in Alzheimer′s disease

目的分析血压变异性(BPV)与阿尔茨海默病(AD)精神行为症状(BPSD)的相关性。方法本研究为回顾性队列研究,连续收集2023年2月1日至8月31日首都医科大学附属北京天坛医院AD生物标志物与生活方式研究队列中的69例AD患者为研究对象,根据伴或不伴BPSD分为BPSD组(50例)和对照组(19例)。收集患者入组年龄、性别、受教育年限、高血压病史、糖尿病病史、脑梗死病史、高脂血症病史、吸烟史、饮酒史及载脂蛋白E等位基因ε4(APOEε4)携带情况等一般资料,同时收集24 h动态血压监测仪器采集的包括平均收缩压、舒张压及全天、日间、夜间收缩压和舒张压的标准差(SD)、变异系数(CV)等12项BPV指标。采用蒙特利尔认知评估(MoCA)量表评估其总体认知功能,日常生活活动能力评定(ADL)-14项量表评估其日常生活能力;采用假设检验比较两组间一般资料、MoCA评分、ADL-14项评分、平均血压及BPV指标;采用多因素logistic回归分析AD患者BPSD的相关因素;采用Spearman相关分析评估AD伴BPSD患者神经精神问卷(NPI)总分与BPV指标的相关性。结果BPSD组高血压患者比例、MoCA评分均显著低于对照组[44.00%比73.70%、(9.72±5.60)比(14.53±5.52)分],ADL-14项评分、夜间收缩压CV均显著高于对照组[23.00(17.00,29.25)比14.00(14.00,17.00)分、8.89%±2.26%比7.52%±2.30%](均P<0.05)。ADL-14项评分(OR=1.379,95%CI:1.131~1.681)及夜间收缩压CV(OR=1.387,95%CI:1.003~1.918)升高是AD患者出现BPSD的正相关因素(均P<0.05)。AD伴BPSD患者中日间收缩压SD(r=0.375)、日间收缩压CV(r=0.357)均与NPI总分呈正相关(均P<0.05)。结论BPV与AD患者BPSD存在相关性,夜间收缩压CV与BPSD发生呈正相关,NPI总分与日间收缩压SD及CV呈正相关,提示控制BPV是改善AD患者BPSD的潜在治疗措施。

Objective To analyze the correlation between blood pressure variability(BPV)and behavioral and psychological symptoms of dementia(BPSD)in patients with Alzheimer′s disease(AD).Methods In this retrospective cohort study,sixty-nine patients with AD from Beijing Tiantan Hospital,Capital Medical University,the Chinese Imaging,Biomarkers and Lifestyle Study of Alzheimer′s Disease were consecutively collected from February 1 to August 31,2023.The patients were divided into the BPSD group(50 patients)and the control group(19 patients)according to with or without BPSD.The patients′general information were collected,such as age at enrolment,gender,duration of education,and history of hypertension,diabetes,cerebral infarction,hyperlipoidemia,smoking,alcohol consumption,and carrier status of apolipoprotein E epsilon4 allele(APOEε4).The 24-hour ambulatory blood pressure monitoring instruments were also used to collect the patients′mean systolic blood pressure,mean diastolic blood pressure and 12 BPV indicators,which covered standard deviation(SD)and coefficient of variation(CV)of systolic and diastolic blood pressure throughout the day,daytime and nighttime.The Montreal Cognitive Assessment(MoCA)was used to assess their cognitive function,and the Activity of Daily Living(ADL)-14 items was used to assess their daily living abilities;hypothesis tests were used to compare the general information,MoCA scores,ADL-14 items scores,mean blood pressure and BPV indicators between the two groups;the multivariate logistic regression analysis was conducted to explore the related factors of BPSD in AD patients;Spearman correlation analysis was used to test the correlation between the total score of neuropsychiatric inventory(NPI)and BPV indicators in AD patients with BPSD.Results In the BPSD group,the incidence rate of hypertension and MoCA scores were both significantly lower than those in the control group[44.00%vs 73.70%,(9.72±5.60)vs(14.53±5.52)points],but ADL-14 items scores and nocturnal systolic blood pressure CV were both significantly higher[23.00(17.00,29.25)vs 14.00(14.00,17.00)points,8.89%±2.26%vs 7.52%±2.30%](all P<0.05).Elevated ADL-14 items scores(OR=1.379,95%CI:1.131-1.681)and nocturnal systolic blood pressure CV(OR=1.387,95%CI:1.003-1.918)were positive correlation factors for the risk of BPSD in AD patients(all P<0.05).The daytime systolic blood pressure SD(r=0.375)and CV(r=0.357)were both positively correlated with total NPI scores in AD patients with BPSD(all P<0.05).Conclusion BPV is correlated with BPSD in AD patients.Nocturnal systolic blood pressure CV is a positive correlation factor for the risk of BPSD in AD patients,and the total scores of NPI in AD patients are positively correlated with daytime systolic blood pressure SD and CV.It suggests that controlling BPV is a potential therapeutic measure to improve the BPSD of AD patients.