【作者】 金鑫；

【导师】 李拥军；

【作者基本信息】 河北医科大学 ， 内科学， 2010， 硕士

【摘要】 目的:目前,随着我国老龄化进程不断加剧,老年痴呆已成为严重危害老年人身心健康的公共卫生问题。主要表现进行性加重、全面认知功能衰退、行为障碍和日常生活能力下降。由痴呆所产生个人、家庭和社会负担正在成为一个倍受关注的社会问题。认知功能(Cognition)是人体对外界事物的认识能力,是大脑高级中枢的重要功能之一,认知功能损害是痴呆早期的重要临床特征,近年来,很多研究认为高血压是脑血管疾病的主要危险因子,并和认知减退、痴呆密切相关。微量白蛋白尿(MAU)不仅代表肾小球内皮功能的受损,也是全身血管内皮细胞受损的一个重要标志,与全身动脉粥样硬化密切相关,对高血压和心血管疾病等血管相关疾病的进展、预测、治疗效果评价等也具有重要参考价值。本研究旨在通过观察老年高血压病患者认知功能损害与微量白蛋白尿的关系,探讨影响老年高血压患者认知功能的危险因素,从而提供更为敏感、特异、廉价、实用的检测手段及指标。方法:选取在河北医科大学第二医院心内科就诊的老年高血压患者197例,其中男性98例,女性99例,平均(68.08士6.69)岁。所选患者均符合2005年《中国高血压防治指南》诊断标准,年龄≥60岁;除外继发性高血压、糖尿病、肾脏疾病、大量蛋白尿(UAER > 200ug/min)、脑血管疾病、精神病、严重听力、视力和语言障碍、肿瘤,外伤及近期手术者。根据国际通用的简易智力状况量表(mini mental state examination, MMSE)得分对患者进行认知功能评定,将患者分为两组:认知功能障碍组(N=38)及认知功能正常组(N=159)。收集一般临床资料,包括性别,年龄,婚姻状况、文化程度、职业、60岁前体脑力劳动、收入,生活行为(吸烟、饮酒),慢性病及其危险因素、相关并发症情况等,测量身高、体重及血压,进行高血压分级,计算体重指数(BMI),测定总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、尿酸(UA)及24小时尿白蛋白排泄率(UAER)等指标, UAER 20～200ug/min定义为微量白蛋白尿。用UAER作为微量白蛋白尿评价指标,并进行统计学处理。结果:1对认知功能正常组及认知功能障碍组进行单因素分析结果显示,年龄、文化程度、婚姻、60岁前体脑力劳动,饮酒,收入,高血压分级,胆固醇,24小时尿白蛋白排泄率等因素在认知功能障碍组(N=38)及认知功能正常组(N=159)之间的差异有统计学意义(均P<0.05);而性别、吸烟史、体重指数、高血压病程及冠心病病史在两组间差异无统计学意义(P>0.05)。2认知功能障碍组的年龄、胆固醇、24小时尿白蛋白排泄率三项指标值均明显高于认知功能正常组,分别是年龄(74.47±6.73) vs (66.55±5.72)岁;胆固醇(5.09±1.20) vs (4.61±1.20)mmol/L及24小时尿白蛋白排泄率(42.52±36.61) vs (16.55±14.38)ug/min,(P < 0.05)。3被调查的197名老年人中有38人存在认知障碍,占19.3%。其中文盲20人,认知障碍14人,占65.0%;小学67人,认知障碍18人,占26.9%;初中65人,认知障碍7人,占10.8%;高中及以上学历者45人,认知障碍0人,占0.0% (χ2=44.923,P=0.000)。4对入选的老年高血压患者进行Logistic多因素回归分析显示,年龄、UAER及文化程度与老年人高血压认知功能损害呈独立相关。分别为年龄(OR = 2.990,95% CI : 1.119-7.987, P<0.05),UAER (OR = 3.016,95%CI : 1.032-8.816, P<0.05)及文化程度(OR = 0.324,95%CI : 0.141-0.747, P<0.05)。结论:认知功能障碍组UAER水平明显高于认知功能正常组(P<0.05),老年高血压病患者除文化程度和年龄因素外,微量白蛋白尿与认知功能降低密切相关,微量白蛋白尿作为内皮细胞损伤的标志是老年高血压病患者认知功能障碍独立的危险因素。更多还原

【Abstract】 Objective: Currently, with the constant increasing of aging process in China, Alzheimer’s Disease(AD) has become a serious public health problem which threatened to the physical and mental health of the old people. It mainly characterized as cognitive decline, behavioral problems and recess in activities of daily living. Therefore,great attention has been paid to the family and social burden generated by dementia. Cognition is an ability in the human body to know about the outside world, and also is one of the important functions of the senior center of f the brain, cognitive impairment is a major clinical features of early dementia. It is well known that hypertension is a major risk factors of cerebrovascular diseases and is closely related to cognitive decline and dementia. Microalbuminuria (MAU) not only represents the glomerular endothelial function impairment, but also as a sign of systemic vascular endothelial cell damage. It has important reference value for predicting and evaluating the progression and treatment of hypertension and cardiovascular disease and blood vessel-related diseases. This study was designed to detect the relationship between microalbuminuria and cognitive impairment in the aged patients with primary hypertension and to explore the risk factors impacting the cognitive function, thus providing a more sensitive, specific, cheap and practical indicator and monitoring measure.Methods: Totally 197 elderly hypertensive patients, male 98 cases , female 99 cases ,average (68.08±6.69) years old, who were hospitalized in the second Hosptital of Hebei Medical University from January 2009 to November 2009 were enrolled. All the patients were in accordance with the Guideline for the prevention and treatment of hypertension in China (2005), Excepting for secondary hypertension, diabetes, kidney disease, macroalbuminuria (UAER> 200 ug / min), cerebral vascular disease, mental disease, severe audiovisual and language disorder, and malignant tumors. By making use of the Mini Mental State Examination(MMSE) to evaluate the cognitive function, the patients were divided into two groups: impaired cognition group(n=38) and normal cognition group(n=159). Clinical information Including sex, age, marital status, profession , education labor nature before 60 years old,income, living behavior (smoking, drinking),chronic diseases and risk factors, associated complications, etc were collected, body height and weight were measured, blood pressure was classified into 3 levels. Total cholesterol, triglyceride,fasting plasma glucose, uric acid and urinary albumin excretion rate (UAER) were tested. UAER was applied to estimate microalbuminuria. And then to analyze the statistical results.Results:1 Univariant correlation analysis between the two groups showed that significant difference existed in age,culture,marital status, labor nature before 60 years old, drinking ,income, blood pressure classification, cholesterol and UAER in the two groups(P<0.05). There was no relationship of the other factors between the two groups(P>0.05).2 Age, cholesterol and UAER in impaired cognition group are all significantly higher than the value of the three indicators of normal cognition group, age (74.47±6.73) vs (66.55±5.72) years; cholesterol (5.09±1.20) vs (4.61±1.20) mmol / L and 24-hour urinary albumin excretion rate (42.52±36.61) vs (16.55±14.38) ug / min,),respectively(P < 0.05).3 In the surveyed 197 elderly people, there were 38 patients have cognitive disorder. 13 of them were illiterate(65%), 18 of them had primary school education(26.9%), 7 of them got middle school education(10.8%), none of the high school and above education group occured cognitive impairment (χ2 = 44.923, P = 0.000).4 Multiple logistic regression analysis demonstrated that age(OR = 2.990, 95% CI : 1.119-7.987, P<0.05), UAER (OR = 3.016, 95%CI : 1.032-8.816, P<0.05) and culture (OR = 0.324, 95%CI :0.141-0.747, P<0.05) were related to cognitive impairment. Conclusion: UAER levels of cognitive dysfunction group was significantly higher than normal cognitive function group (P<0.05),Microalbuminuria as a sign of endothelial cell damage is an important risk factor for the cognitive impairment in aged patients with hypertension(P<0.05).更多还原