【作者】 方静； 彭乐； 陈发秀； 陈燕； 魏群； 尹绢； 邱元芝； 胡坚；

【机构】 江西省人民医院；

【摘要】 目的研究老年高血压患者直立性低血压与认知功能障碍的关系。方法选取明确诊断为高血压的患者201例,其中男性99例(49.3%),年龄65～80 (71.6±8.8)岁。测量卧位、立位血压,以卧位转为立位3 min内收缩压下降≥20mmHg和(或)舒张压下降≥10mHg为直立性低血压(OH)的诊断标准。根据蒙特利尔认知功能评分量表(Montreal cognitiveassessment,MoCA)评分,分为认知功能障碍组(<26分)和正常组(≥26分);随访1年,同一患者MoCA量表评分相差4分,则为认知功能减退,分为认知功能减退组和无变化组,分析OH与知功能障碍及认知功能减退的关系。结果患者201例中MoCA得分<26分63例(31.3%),符合OH标准54例(26.9%)。OH组认知功能障碍发生率高于非OH组(51.9%比23.8%,P=0.001)。OH组MoCA得分低于非OH组(22.66±3.23比25.01±2.12,P=0.001)。MoCA得分与卧-立位收缩压降幅呈负相关(r=-0.321,P=0.021)。单因素及多因素分析显示,与认知功能障碍相关的因素有:OH、年龄和受教育年限[OR(95%CI)分别为3.59(1.53～7.99),1.07(1.03～1.16),0.99(0.78～0.99),均P<0.05]。结论OH可能是高血压患者认知功能障碍的独立危险因素。更多还原

【Abstract】 Objective To explore the relationship between orthostatic hypotension(OH) and cognitive dysfunction in elderly hypertensive patients.Methods A total of 201 elderly hypertension patients with mean age of 71.6 years(range 65～80 years) were enrolled.ninety-nine patients were male(49.3%).The blood pressure on both supine and standing position were measured.OH was defined as decreased in systolic blood pressure(SBP)≥20 mmHg and/or decreased in diastolic blood pressure(DBP)≥ 10 mmHg within 3 minutes after standing up.According to the Montreal cognitive assessment scale(MoCA) score,the patients were divided into cognitive dysfunction group(n=63) and normal cognitive function group(n=138).After one-year followup,the patients were divided into cognition decline group(difference of MMSE> 4 points) and cognition intact group.The relationship between OH and cognitive Dysfunction or cognitive decline was analysed.Results sixtythreepatients had cognitive dysfunction,the prevalence of cognitive dysfunction was 31.3%.There were 54 patients who met OH criteria(26.9%).The incidence of cognitive dysfunction in OH group was significantly higher than that in non-OH group(51.9% vs 23.8%,P=0.001).The MoCA score was lower in OH group than that in nonOH group(22.66±3.23 vs 25.01±2.12,P=0.001).The MoCA score was negatively correlated with SBP decline after standing up(r=-0.321,P=0.021).Univariate and mutivariable analyses showed that the factors associated with cognitive dysfunction include OH,age and education[OR(95%CI) was 3.59(1.53～7.99),1.07(1.03～1.16),0.99(0.78～0.99)respectively,all P <0.05].Conclusion OH may be an independent risk factor for cognitive dysfunction in elderly hypertentive patients.更多还原