【作者】 段娟；

【导师】 杨宇；

【作者基本信息】 中南大学 ， 临床医学， 2012， 博士

【摘要】 目的：探讨高龄高血压患者的认知功能(Cognitive function, CF)和生活自理能力(Activity of daily living, ADL)现状及血压水平对认知功能和生活自理能力的影响,为临床干预措施提供依据。方法：选取2011年10月-2012年5月期间中南大学湘雅二医院老年心血管病区住院高龄高血压患者120例,其中男72例,女48例,年龄81-100岁,平均年龄85.2±3.8岁,平均收缩压(SBP)142.6±19.6mmHg,平均舒张压(DBP)76.5±11.0mmHg。研究对象按入院血压水平分成A组(SBP>150mmHg),B组(130<SBP≤150mmHg)和C组(SBP≤130mmHg),采用日常生活能力量表(ADL)和简易精神状态量表(mini-mental state examination, MMSE)来评估研究对象的日常生活能力和认知功能。采用踝臂指数(ankle brachial index, ABI)、颈-股脉搏波传导速度(Carotid-femoral pulse wave velocity, C-fPWV)和经颅多普勒(transcranial doppler, TCD)评价患者动脉硬化严重程度。同时收集患者性别、年龄、体重指数(BMI=体重／身高2)、文化程度,婚姻状况,高血压病程、吸烟史、饮酒史、降压药物使用、SBP、DBP、脉压(pulse pressu, PP),射血分数(ejection fraction,EF),血常规、总胆固醇(TC)、低密度脂蛋白(LDL-C).高密度脂蛋白(HDL-C).空腹血糖(FBS)、B型脑钠肽前体(NT-proBNP),肝肾功能,24小时尿蛋白、尿电解质等资料。探讨高龄高血压患者的认知功能和生活自理能力现状及血压水平对认知功能和生活自理能力的影响。采用SPSS19.0软件包进行分析。结果：1基本特征的比较三组患者基本特征除收缩压、舒张压、脉压外,其余均无统计学差异(P>0.05)。2降压药物使用情况所有入选对象中,CCB降压治疗人数最多,30人,其次是CCB+ACEI/ARB24人,单用ACEI/ARB23人,ACEI/ARB+利尿剂+CCB11人,ACEI/ARB+利尿剂7人,CCB+利尿剂3人,CCB+p阻滞剂3人,未规律服用降压药者16人。3生化指标及ABI、c-FPWV、TCD比较三组TC相比有显著性差异,A组、B组TC显著高于C组(P<0.05),A组和B组之间TC无显著性差异(P>0.05)。A组UACR显著高于B组和C组(P<0.05),B组和C组之间UACR无显著性差异(P>0.05)。A组ABI、TCD、c-fPWV较B组、C组有显著性差异(P<0.05),B组和C组两两之间比较无显著性差异(P>0.05)。三组血红蛋白(HB)、平均红细胞压积(HCT)、FBS、血K、Cr、ALT、AST、NT-proBNP、EF值、24小时尿电解质等指标相比均无统计学差异。4MMSE、ADL评分比较120例高龄高血压患者中,有认知功能减退者既MMSE评分异常者56人,占总人数的46.7%。生活自理能力有不同程度下降者88人,占总人数的73.3%。三组ADL评分无显著性差异,B组MMSE评分显著高于A、C组,A、C组之间MMSE评分无显著性差异(P>0.05)。5在MMSE评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、吸烟史、脑血管病史、高血压病程、合并糖尿病、SBP、PP、ABI、CFPWV、TCD方面有显著统计学差异(P<0.05)。6将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、PP、脑血管病史、TCD、UACR是影响认知功能的独立危险因素(P<0.05)。7在ADL评分正常者与异常者之间进行单因素分析,结果两组在年龄、婚姻状况、合并糖尿病、ABI、CFPWV、MMSE评分方面有显著统计学差异(P<0.05)。8将单因素分析中P<0.1的因素作为自变量引入Logistic回归模型进行非条件Logistic回归分析,结果：仅年龄、糖尿病病史、ABI是影响认知功能的独立危险因素(P<0.05)。结论：1高龄高血压患者血压水平与认知功能有关。年龄、脉压、脑血管病史、脑血流状态、24小时尿微量白蛋白是影响其认知功能的独立危险因素。应加强血压水平的调节与控制,以维持和提高高龄高血压患者的认知功能。2高龄高血压患者血压水平不影响生活自理能力。年龄、糖尿病、ABI是影响其生活自理能力的独立危险因素。更多还原

【Abstract】 Objective:Study of the cognitive function and the ability of daily life status in the very elderly hypertensive patients and the effect of blood pressure levels on cognitive function and ability of daily life. Provide the evidence for clinical intervention measures.Methods:We randomly assigned120patients from the Second Xiangya Hospital who were80years of age or older. The number of male was72, female48. Aged from81to100years old with an average age85.2±3.8years old. The average SBP was142.6±19.6mm Hg and DBP76.5±11.0mm Hg. The object is divided into group A(SBP>150mm Hg, DBP<110mm Hg), group B (130mm Hg<SBP≤150mm Hg,DBP <110mm Hg) and group C (SBP≤130mm Hg, DBP<110mm Hg) according to the blood pressure level. To evaluate the daily living ability and cognitive function of research object by the ability of daily living scale (ADL) and mini-mental state examination (MMSE). To collect the patients’ general information and clinical laboratory data for comparison. Use SPSS19.0for statistics analysis.Results:1Comparison of basic characteristics:There was no significant difference among3groups except SBP, DBP and PP (P<0.05)2Drug use condition:In all the selected object,30persons has taken CCB as antihypertensive medicine.24patients has taken CCB+ACEI/ARB,23patients has taken ACEI/ARB,11patients has taken ACEI/ARB+diuretic+CCB,7patients has taken ACEI/ARB+diuretic,3patients has taken CCB+diuretics,3patients has taken CCB+beta blocker,16patients has not regularly taken antihypertensive medicine.3Comparison of biochemical and ABI, c-fPWV and TCD:The. TC level of group A and B are significantly higher than that in group C (P<0.05), but there were no significant difference between group A and group B; UACR, ABI, TCD and c-fPWV of group A is significantly higher than that in group B and C(P<0.05), but there were no significant difference between group B and C (P>0.05)4In all the selected120patients,56persons had MCI, accounting for46.67%of the total numberand88people had a decrease in ADL, accounting for73.33%. There was no significant difference among3groups in ADL. Group B had significantly higher MMSE score than group A, C, and there was no statistical significance between group A, C.5Comparison between normal cognition group and impaired cognition group:Univariant correlation analysis between the two groups showed that significant difference existed in age, marital status, smoking, history of cerebrovascular disease, diabetes mellitus, ABI, SBP, PP,UACR and LDH CFPWV and TCD (P<0.05).6Multiple logistic regression analysis demonstrated that only age, PP, TCD and history of cerebrovascular disease were related to cognitive impairment.7Comparison between normal ADL group and impaired ADL group: Univariant correlation analysis between the two groups showed that significant difference existed in age, smoking, diabetes mellitus, ABI, CFPWV TCD and MMSE(P<0.05).8Multiple logistic regression analysis demonstrated that only age, diabetes mellitus and ABI were related to ADL impairment.Conclusion:1The level of blood pressure is related to cognitive function in the very elderly hypertensive patients. Pulse pressure, age, history of cerebrovascular disease, cerebral blood flow and24hour urinary albumin is the independent risk factors of cognitive function. We Should contral the level of blood pressure in order to maintain and improve the cognitive function in the very elderly hypertensive patients.2The level of blood pressure do not affect the ability of daily life directl. Age, diabetes, ABI are independent risk factors of ADL更多还原