上海市某社区老年人高血压与认知功能相关性及估算肾小球滤过率的中介作用初探OA
Preliminary study on correlation between hypertension and cognitive function in the older adults from communities in Shanghai and mediating effects of glomerular filtration rate
目的 分析上海市老年群体中高血压与认知功能障碍的关联,并评估估算肾小球滤过率(eGFR)在其中的潜在中介效应.方法 2016 年7 月至2019 年12 月,采用横断面调查上海市徐汇区2 个街道社区的1 380 名≥60 岁的老年人.通过收集一般人口学资料、进行蒙特利尔认知功能评估(MoCA),评定所有纳入者的认知功能状况,通过独立样本t检验比较不同特征群体的MoCA得分差异.采用多元线性回归模型分析认知功能的独立影响因素.进一步构建中介效应模型,采用Bootstrap法检验eGFR在高血压与认知功能之间的中介效应.结果 单因素分析显示,高血压病史人群MoCA得分显著低于无高血压病史人群[(21.33±4.51)分比(22.26±4.18)分,P＜0.001],心脑血管病史者的MoCA得分显著低于无病史者[(20.81±4.71)分比(22.07±4.21)分,P＜0.001].在校正年龄、性别、文化程度、婚姻状况、吸烟史、饮酒史等混杂因素后,多元线性回归分析显示,高血压史(β=-0.055,95%CI:-0.961～-0.047,P=0.031)、心脑血管病史(β=-0.077,95%CI:-1.204～-0.261,P=0.002)是认知功能的独立危险因素,eGFR(β=0.090,95%CI:0.013～0.058,P=0.002)是其独立保护因素.中介效应分析表明,eGFR在高血压与认知功能关系中存在显著的部分中介效应(间接效应值为-0.062,95%CI:-0.126～-0.016,中介效应占总效应的比例为10.95%.结论 高血压是认知功能受损的重要危险因素,且可能通过降低肾小球滤过率对认知功能产生负面影响,应加强高血压和肾功能筛查,早期诊断及干预老年人认知功能下降.
Objective To investigate the correlation between hypertension and cognitive impairment among the older adults in Shanghai,and evaluate the potential mediating effects of estimated glomerular filtration rate(eGFR).Methods From July 2016 to December 2019,a cross-sectional survey was conducted among 1 380 older adults aged≥60 years from two sub-district communities of Xuhui District,Shanghai.Their general demographic data were collected.The Montreal cognitive assessment(MoCA)was used to evaluate the cognitive function.Independent sample t-tests were used to compare differences in MoCA scores across groups with different characteristics.Multivariate linear regression models were applied to analyze independent influencing factors of cognitive function.Furthermore,a mediation model was constructed,and the Bootstrap method was employed to test the mediating effect of eGFR on the correlation between hypertension and cognitive function.Results Univariate analysis showed that the MoCA scores of the hypertensive population were significantly lower than those of the non-hypertensive population(21.33±4.51 vs.22.26±4.18,P＜0.001),and people with a history of cardiovascular and cerebrovascular diseases had significantly lower MoCA scores than those without(20.81±4.71 vs.22.07±4.21,P＜0.001).After adjusting for confounding factors such as age,sex,education level,marital status,smoking history,and alcohol consumption history,multivariate linear regression analysis revealed that hypertension(β=-0.055,95%CI:-0.961--0.047,P=0.031)and cardiovascular and cerebrovascular diseases(β=-0.077,95%CI:-1.204--0.261,P=0.002)were independent risk factors for cognitive function,while eGFR(β=0.090,95%CI:0.013-0.058,P=0.002)were an independent protective factor.Mediation analysis indicated that eGFR exerted a significant partial mediating effect on the correlation between hypertension and cognitive function(indirect effect value=-0.062,95%CI:-0.126--0.016),accounting for 10.95%of the total effect.Conclusion Hypertension is a significant risk factor for cognitive impairment and may exert a negative effect on cognitive function by reducing glomerular filtration rate.Screening for hypertension and renal function should be strengthened to facilitate early diagnosis and intervention of cognitive decline in the older adults.
张雨欣;肖世富;戴宁玲;汪海娅
上海交通大学医学院附属第九人民医院老年病科,上海 200011上海交通大学医学院附属精神卫生中心老年精神科,上海 200030||上海交通大学阿尔茨海默病诊疗中心,上海 200030上海市宝山区顾村镇社区卫生服务中心全科医学科,上海 201906上海交通大学医学院附属第九人民医院老年病科,上海 200011
高血压肾小球滤过率认知功能社区老年人
hypertensionglomerular filtration ratecognitive functioncommunity-dwelling older adults
《老年医学与保健》 2026 (4)
536-539,4
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