【摘要】 目的·探索高血压和血脂异常对老年人认知功能的影响。方法·采用前瞻性队列研究方法建立动态人群队列，于2019年整群选取上海某社区65岁及以上自愿参与免费体检项目居民建立基线，2022年在队列源社区整群随机抽取2个社区卫生服务站512例67～93岁社区老年人进行随访。采集数据包括居民健康档案、各项体检测量结果、简明精神状态检查（Mini-mental State Examination,MMSE）量表评分。结果·512例随访者中，经数据清洗，有效样本量为495例。根据基线和随访认知判断和变化，分3个认知组：好转组、正常组、下降组。下降组高血压患病率超好转组43.14%，超正常组24.39%（下降组66.67%vs好转组23.53%,P=0.011；下降组66.67%vs正常组42.28%,P=0.040）。好转组总胆固醇（total cholesterol,TC）低于正常组[好转组（4.38±1.04） mmol/L vs正常组（5.11±1.12） mmol/L,P=0.009]，下降组2022年TC高于2019年[成对差值（0.46±0.87） mmol/L,95%CI 0.08～0.84,P=0.021]。好转组低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-Ch）低于正常组[好转组（2.51±0.92） mmol/L vs正常组（3.07±1.00） mmol/L,P=0.024]，且其2022年高密度脂蛋白胆固醇（high-density lipoprotein cholesterol,HDL-Ch）高于2019年[成对差值（0.16±0.20） mmol/L,95%CI0.06～0.26, P=0.005]。多项式Logistic回归分析显示：好转组TC低于正常组[β=4.12, OR=61.64, 95%CI1.52～2 494.07,P=0.029]和下降组[β=5.88,OR=357.35,95%CI 4.54～28 149.75,P=0.008]；下降组三酰甘油（triacylglycerol,TAG）[β=1.85, OR=6.34, 95%CI 1.05～38.43, P=0.045]、 LDL-Ch [β=5.61, OR=274.06, 95%CI 3.65～20 567.57, P=0.011]和高血压[β=1.90,OR=6.69,95%CI 1.53～29.16,P=0.011]均高于好转组；下降组年龄大于正常组[β=0.08,OR=1.08,95%CI 1.00～1.16, P=0.041]，受教育程度低于正常组[β=1.22, OR=3.39, 95%CI 1.28～8.94, P=0.014]。结论·低TC和LDL-Ch、高HDL-Ch有利于认知好转；高血压、高TC、高TAG、高LDL-Ch、受教育程度低、高年龄是认知下降的风险因素。更多还原

【Abstract】 Objective·To explore the effects of hypertension and dyslipidemia on cognitive function in the elderly. Methods·A dynamic population cohort was established by using prospective cohort study methods. In 2019, a complete cohort was selected from residents aged 65 and above who voluntarily participated in a free physical examination program in a community in Shanghai,serving as the baseline cohort. In 2022, 512 community-dwelling elderly aged 67 to 93 were randomly selected from the same community as the follow-up cohort for the study. The collected date included residents′ health records, various physical examination measurements, and Mini-mental State Examination(MMSE) scale scores. Results·Of the 512 cases that were followed up, the valid sample size was reduced to 495 after data cleaning. According to the baseline and follow-up cognitive assessments and changes, the cases were categorized into three cognitive groups: the improvement group, the normal group, and the decline group.The prevalence of hypertension in the decline group was 43.14% higher than that in the improvement group and 24.39% higher than that in the normal group(66.67% in the decline group vs 23.53% in the improvement group, P=0.011; 66.67% in the decline group vs 42.28% in the normal group, P=0.040). Total cholesterol(TC) in the improvement group was lower than that in the normal group [improvement group(4.38±1.04) mmol/L vs normal group(5.11±1.12) mmol/L, P=0.009]. Additionally, TC in the decline group in 2022 was higher than that in 2019 [paired difference(0.46±0.87) mmol/L, 95% CI 0.08-0.84, P=0.021]. LDL-Ch in the improvement group was lower than that in the normal group [improved group(2.51±0.92) mmol/L vs normal group(3.07±1.00)mmol/L, P=0.024], and their HDL-Ch in 2022 was higher than that in 2019 [paired difference(0.16±0.20) mmol/L, 95% CI 0.06-0.26,P=0.005]. The results of multinomial Logistic regression showed: TC in the improved group was lower than that in the normal group [β=4.12, OR=61.64, 95% CI 1.52-2494.07, P=0.029] and the decline group [β=5.88, OR=357.35, 95% CI 4.54-28149.75, P=0.008];the TAG [β=1.85, OR=6.34, 95% CI 1.05-38.43, P=0.045], LDL-Ch [β=5.61, OR=274.06, 95% CI 3.65-20567.57, P=0.011], and hypertension [β =1.90, OR=6.69, 95% CI 1.53-29.16, P=0.011] in the decline group were higher than those in the improvement group; the age of the decline group was greater than that of the normal group [β=0.08, OR=1.08, 95% CI 1.00-1.16, P=0.041], and the education level was lower than that of the normal group [β=1.22, OR=3.39, 95% CI 1.28-8.94, P=0.014]. Conclusion·Low TC and LDL-Ch and high HDL-Ch are beneficial to cognitive improvement. Conversely, hypertension, high TC, high TAG, high LDLCh, low education level, and advanced ages are risk factors for cognitive decline.更多还原