老年患者高血压合并认知功能障碍与血清25-羟维生素D3水平的关系研究

摘要

目的 探讨老年患者高血压合并认知功能障碍与血清25-羟维生素D3[25-(OH) D3]水平的关系.方法 选取2013年10月-2015年7月在北京大学人民医院老年科住院治疗的老年患者117例.根据血压测量结果和简易精神状态量表(MMSE)评定的认知功能状态,将纳入患者分为两组:以高血压合并认知功能障碍为观察组(n=30);以高血压未合并认知功能障碍、非高血压合并认知功能障碍、非高血压且未合并认知功能障碍为对照组(n=87).收集两组患者的临床资料,采用多因素Logistic回归分析、受试者工作特征(ROC)曲线探讨老年患者高血压合并认知功能障碍与血清25-(OH)D3水平的关系.结果 两组患者性别、受教育年限、吸烟率、饮酒率、合并糖尿病发生率、合并冠心病发生率、补充维生素D率、BMI、血红蛋白(Hb)、糖化血红蛋白(HbA1c)及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、游离三碘甲状腺原氨酸(fT3)、游离甲状腺素(fT4)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、促甲状腺素(TSH)、钙离子、尿素氮(BUN)、尿酸(UA)、肌酐(Cr)水平比较,差异无统计学意义(P＞0.05);观察组患者年龄高于对照组,高血压病程长于对照组,血清25-(OH) D3水平低于对照组,差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,年龄、高血压病程、Hb及血清fT3、25-(OH) D3水平是老年患者高血压合并认知功能障碍的影响因素(P＜0.05).血清25-(OH) D3水平对老年患者高血压合并认知功能障碍预测价值的ROC曲线下面积(AUC)为0.675(P＜0.05).结论 血清25-(OH) D3水平降低是老年患者高血压合并认知功能障碍的重要危险因素.%Objective To investigate the correlation of hypertension and cognitive dysfunction with serum 25-hydroxyvitamin D3 [25-(OH) D3] level in aged patients.Methods The enrolled participants were 117 inpatients who received treatment in Department of Geriatrics,Peking University People's Hospital from October 2013 to July 2015.Based on the status of cognitive function evaluated with the Mini-mental State Examination (MMSE) and the measured blood pressure level,we assigned 30 of them with both hypertension and cognitive dysfunction to the observation group,and other 87 cases,including the cases with hypertension but without cognitive dysfunction,those with cognitive dysfunction but without hypertension and those without hypertension and cognitive dysfunction,were assigned to the control group.We obtained the clinical data of the participants.Multivariate Logistic regression analysis and ROC curve of serum 25-(OH) D3 level were used to investigate the correlation of 25-(OH) D3 level with hypertension and cognitive dysfunction in aged patients.Results Two groups had no significant differences in terms of sex distribution,years of education,ratios in smoking prevalence,alcohol consumption prevalence,diabetes prevalence,coronary heart disease prevalence and treatment with vitamin D supplementation,BMI,levels of hemoglobin (Hb),glycosylated hemoglobin (HbA1c),and serum levels of total cholesterol (TC),triacylglycerol (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),free triiodothyronine (fT3),free thyroxine (fT4),total triiodothyronine (TT3),total thyroxine (TT4),thyroid-stimulating hormone (TSH),concentrations of calcium,urea nitrogen (BUN),uric acid (UA) and creatinine (Cr) (P ＞ 0.05).Compared with the control group,patients in the observation group were much older,and they had obviously longer duration of hypertension and lower serum 25-(OH) D3 level (P ＜ 0.05).Multivariate Logistic regression analysis found that,age,duration of hypertension,levels of serum Hb,fT3 and 25-(OH) D3 were the factors associated with hypertension and cognitive dysfunction in aged patients (P ＜0.05).The area under the ROC curve (AUC) of serum 25-(OH) D3 level showed that it had moderate value in predicting the occurrence of both hypertension and cognitive dysfunction in aged patients (AUC =0.675,P ＜ 0.05).Conclusion The decreased serum 25-(OH) Ds level may play an important role in the development of hypertension and cognitive dysfunction in aged patients.