老年人血压昼夜节律与认知功能障碍的相关性分析

史静静; 郭航远

doi:10.13201/j.issn.1001-1439.2018.10.010

老年人血压昼夜节律与认知功能障碍的相关性分析

史静静,
郭航远^,

- 温州医科大学(浙江温州, 325000)

详细信息

通讯作者: 郭航远,E-mail:ghangyuan@hotmail.com

中图分类号: R544.1

收稿日期: 2018-05-20

Relationship between blood pressure rhythm and cognitive impairments in the elderly

SHI Jingjing,
GUO Hangyuan^,

- Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China

More Information

Corresponding author: GUO Hangyuan, E-mail: ghangyuan@hotmail.com

Received Date: 20 May 2018

摘要

摘要: 目的:探讨老年人群中血压昼夜节律与认知功能障碍之间的相关性。方法:随机纳入2016-01-2017-01在我院体检的老年人366例, 根据蒙特利尔认知评估 (MoCA) 量表评分, 分为认知正常组与认知障碍组, 比较两组一般情况, 合并症以及24h动态血压监测。结果:① 认知正常组夜间血压下降 (△MBP) 与认知障碍组比较差异有统计学意义 (0.07±0.07:0.09±0.10, P＜0.05); ② 杓型组老年人MoCA总分高于非杓型组 (25.15±3.68:23.91±5.22, P＜0.05)、超杓型组 (25.15±3.68:22.55±2.54, P＜0.05)、反杓型组 (25.15±3.68:21.97±5.18, P＜0.05), 非杓型组老年人MoCA总分则高于超杓型组 (23.91±5.22:22.55±2.54, P＜0.05)、反杓型组 (23.91±5.22:22.55±2.54, P＜0.05), 超杓型组老年人MoCA总分高于反杓型组 (22.55±2.54:21.97±5.18, P＜0.05)。③ 血压昼夜节律异常是引起老年人群认知功能障碍的危险因素 (OR=2.437, 95%CI:1.48~4.012, P＜0.05), 其中反杓型高血压老年人相对影响较大 (OR=5.305, 95%CI:1.814~15.514, P＜0.05)。④ 高血压组中血压昼夜节律消失占77.0%, 对照组占76.4%。两组△MBP比较差异无统计学意义 (8.33±0.08:7.58±0.09, P＞0.05)。结论:老年高血压患者和非高血压患者均会出现血压昼夜节律减弱或消失, 且血压节律异常是引起老年人群认知功能障碍的危险因素。
- 老年人群 /
- 24h动态血压 /
- 昼夜节律 /
- 认知功能障碍
Abstract: Objective: To evaluate the relationship between blood pressure rhythm and mild cognitive impairments.Method: The 24 hambulatory blood pressure monitoring and cognitive function were tested in 366 elderly in our hospital in January 2016-2017 January by the Montreal cognitive assessment (MoCA) scale.According to the results we analyzed the relationship between blood pressure rhythm and mild cognitive impairments.Result: ① There was a significantly difference between control group (Moca ≥ 26) and MCI group in △MBP% (0.07±0.07 vs 0.09±0.10, P＜0.05); ② The total score of MoCA in the dipper group was higher than that in the non dipper group (25.15±3.68 vs 23.91±5.22, P＜0.05), the super dipper group (25.15±3.68 vs 22.55±2.54, P＜0.05), the anti dipper group (25.15±3.68 vs 21.97±5.18, P＜0.05), and the total MoCA of the non dipper group was higher than that of the super dipper group (23.91±5.22 vs 22.55±2.54, P＜0.05), and the anti dipper group.The total score of MoCA in the elderly dipper group was higher than that in the reverse dipper group (22.55±2.54 vs 21.97±5.18, P＜0.05); ③ Abnormal blood pressure rhythm was a risk factor for mild cognitive impairments in the elderly (OR=2.437), and reverse-dipper blood pressure was relatively influential (OR=5.305) (P＜0.05); ④ The blood pressure rhythm in the hypertension group was 77.0% and 76.4% in the control group.There was no significant difference between the two groups of△MBP%.Conclusion: hypertensive patients and non-hypertensive elderly both have a reduced or disappearance of 24 hambulatory blood pressure circadian rhythm, and abnormal blood pressure rhythm is a risk factor for mild cognitive impairments in the elderly.
- elderly /
- 24 h ambulatory blood pressure /
- blood pressure rhythm /
- cognitive impairment

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参考文献(28)

[1]	中国防治认知功能障碍专家共识专家组.中国防治认知功能障碍专家共识[J].中华内科杂志, 2006, 45 (2):171-173.
[2]	O'Donnell MJ, Xavier D, Liu L, et al.Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22countries (the INTERSTROKE study):a case-control study[J].Lancet, 2010, 376 (9735):112-123.
[3]	Molander L, Gustafson Y, Lovheim H.Low blood pressure is associated with cognitive impairment in very old people[J].Dement Geriatr Cogn Disord, 2010, 29 (4):335-341.
[4]	Pearce LA, McClure LA, Anderson DC, et al.Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke:a secondary analysis from the SPS3 randomised trial[J].Lancet Neurol, 2014, 13 (12):1177-1185.
[5]	Yano Y, Ning H, Allen N, et al.Long-term blood pressure variability throughout young adulthood and cognitive function in midlife:the Coronary Artery Risk Development in Young Adults (CARDIA) study[J].Hypertension, 2014, 64 (5):983-988.
[6]	邢云利, 周震, 黄辛, 等.血压昼夜节律及晨峰血压对老年认知功能的影响[J].中华老年多器官疾病杂志, 2015, 14 (8):593-597.
[7]	袁艳敏, 郭艺芳.人体血压昼夜节律特征及其调节机制[J].中华高血压杂志, 2008, 16 (6):483-485.
[8]	中华医学会神经病学分会痴呆与认知障碍学组写作组.中国痴呆与认知障碍诊治指南:轻度认知障碍的诊断和治疗[J].中华医学杂志, 2010, 90 (41):2887-2893.
[9]	Nasreddine ZS, Phillips NA, Bedirian V, et al.The montreal cognitive assessment, MoCA:a brief screening tool for mild cognitive impairment[J].Am Geriatr Soc, 2005, 53 (6):695-699.
[10]	Tervo S, Kivipchs M, Hanninen T, et al.Incidence and risk factors for mild cognitive impairment:apopulation-based three-year follow-up study of cognitively healthy elderly subjects[J].Dement Geriatr Cogn Disord, 2004;17 (3):196-203.
[11]	Spence JD.Prevening dementia by treating hypertension and preventing stroke.Hypertension[J], 2004, 44 (1):29-34.
[12]	Hebert LE, Seherr PA, Bennet t DA, et al.Blood pressure and late life cognitive function change:a biracial longitudinal population study[J].Neurology, 2004, 62 (14):2021-2024.
[13]	Costantino I, Kristine Y, Jose B, et al.Impact of hypertension on cognitive function[J].Hypertension, 2016, 68:e67-e94.
[14]	吴寿岭, 王玉珍, 李冬青, 等.血压参数与老年人认知功能障碍的关系[J].中华高血压杂志, 2007, 15 (8):661-664.
[15]	常霞.血压节律变化对血管性认知功能障碍的影响[J].中国实用神经疾病杂志, 2016, 19 (1):55-56.
[16]	Yamamoto I, Akiguchi K, Oiwa M, et al.The Relationship between 24-Hour Blood Pressure Readings, Subcortical Ischemic Lesions and Vascular Dementia[J].Cerebrovasc Dis, 2005, 19 (3):302-308.
[17]	Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J].Lancet Neurol, 2010, 9 (6):689-701.
[18]	路超, 刘松岩, 国琦, 等, 血压节律变化对血管性认知功能障碍的影响[J].中国实验诊断学, 2014, 18 (9):1485-1488.
[19]	祝艳秋, 郭立苹, 姜一农, 等.原发性高血压患者颈动脉内中膜厚度与血流介导的血管舒张功能的关系[J].临床心血管病杂志, 2017, 33 (12):1215-1217.
[20]	Seshadri S, Wolf PA, Beiser A, et al.Stroke risk profile, brain volume, and cognitive function[J].Neurology, 2004, 63 (15):1591-1599.
[21]	Ding B, Ling HW, Zhang Y, et al.Pattern of cerebral hyperperfusion in Alzheimer's disease and amnestic mild cognitive impairment using voxel-based analysis of 3D arterial spin-labeling imaging:initial experience[J].Clin Interv Aging, 2014, 9 (4):493-500.
[22]	杨静, 余朝萍, 陈蓉.24h动态血压和脑卒中、认知功能的关系[J].中外医学研究, 2017, 12 (24):154-156.
[23]	Girard A.Blood pressure variability in the elderly[J].Ann Cardiol Angeiol, 1999, 48 (7):495-499.
[24]	刘群威, 韩丽敏, 常凤, 等.老年轻暍中度高血压患者自主神经功能与早期肾损害的关系[J].临床心血管病杂志, 2017, 33 (7):671-674.
[25]	于逢春, 周正宗, 睡眠障碍于认知功能障碍研究进展[J].中国卒中杂志, 2016, 11 (11):966-972.
[26]	柯将琼, 郑园园, 邵胜敏, 等, 阻塞性呼吸睡眠暂停综合征患者的认知功能障碍研究进展[J].中华医学杂志, 2016, 96 (13):1069-1072.
[27]	Takahiro K, Kazuo E, Toshinobu S, et al.Riser blood pressure pattern is associated with Mild Cognitive Impairment in Heart Failure Patients[J].American Journal of Hypertension, 2015, 5 (14):1-8.
[28]	Teive HA, Pioveasan MR, Wet'neck LC.Dementia and mild cognitive impairment inpatients with Parkinsons disease[J].Arq Neuropsiquiatr, 2009, 67 (2B):423-427.