摘要
目的探讨中国老年人低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)及其比值LDL-C/HDL-C与认知功能下降的关系。方法数据来自中国老年人健康长寿影响因素调查队列,纳入2008年11月至2018年9月接受追踪调查的1081例老年人。采用简明精神状态量表(Mini-Mental State Examination,MMSE)评估认知功能,并将参与者分为加速认知下降组(参与者首次出现MMSE评分在随访与基线之间下降幅度>2分,125例)与认知稳定组(956例)。检测基线血清LDL-C和HDL-C水平,计算LDL-C/HDL-C比值。随访结束后,采用限制性立方样条描述剂量反应关系,使用Cox比例风险回归模型评估LDL-C、HDL-C及LDL-C/HDL-C对加速认知下降风险的影响。敏感性分析用以评估模型的稳健性。结果与认知稳定组比较,加速认知下降组基线年龄更高,受教育年限、男性、吸烟比例明显降低,差异有统计学意义(P<0.05,P<0.01)。末次随访发现,加速认知下降组一般能力、反应能力、注意力及计算能力、回忆、语言理解与自我协调能力评分显著低于认知稳定组(P<0.01)。限制性立方样条结果显示,LDL-C/HDL-C水平与加速认知下降风险呈正相关,HDL-C水平与加速认知下降风险呈负相关。调整相关因素后,Cox比例风险回归模型分析显示,LDL-C/HDL-C是加速认知下降的风险因素(HR=1.18,95%CI:1.04~1.34),HDL-C是认知功能的保护因素(HR=0.58,95%CI:0.42~0.80)。敏感性分析结果与主分析Cox回归模型结果保持高度一致性,且存在显著性关联(P<0.05)。结论LDL-C/HDL-C升高是老年人加速认知下降的风险因素,而高水平HDL-C具有保护作用。
Objective To investigate the influence of low-density lipoprotein cholesterol(LDL-C)and highdensity lipoprotein cholesterol(HDL-C)and the ratio(LDL-C/HDL-C)on cognitive function in elderly Chinese individuals.Methods Chinese Longitudinal Healthy Longevity Survey(CLHLS)cohort was subjected to derive the data from 4 waves of survey during November 2008 and September 2018.Finally,1081 individuals were enrolled in this study.Cognitive function was assessed using Mini-Mental State Examination(MMSE),and all the participants were divided into an accelerated cognitive decline group(participants who initially exhibited a decline in MMSE score by>2 between a follow-up and baseline,125 cases)and cognitive stability group(956 cases).At baseline,serum levels of LDL-C and HDL-C were measured,and the LDL-C/HDL-C ratio was calculated.After the last follow-up,restricted cubic splines were used to describe the dose-response relationships,Cox proportional hazards regression models were employed to determine the effects of LDL-C,HDL-C,and the LDL-C/HDL-C ratio on the risk of accelerated cognitive decline,and sensitivity analysis was performed to evaluate the robustness of the model.Results The accelerated cognitive decline group exhibited significantly older baseline age,lower male ratio,shorter years of education,and fewer smokers at baseline when compared with the cognitive stability group(P<0.05,P<0.01).At the last follow-up,the scores in the dimensions of general capacity,response,attention and calculation,memory,language,and self-coordination were obviously lower in the accelerated cognitive decline group than the cognitive stability group(P<0.01).The results of restricted cubic spline analysis showed a positive correlation between LDL-C and HDL-C ratio and risk of accelerated cognitive decline,while HDL-C level was negatively correlated with the risk of accelerated cognitive decline.After adjusting for relevant factors,Cox proportional hazards regression analysis indicated that LDL-C/HDL-C ratio was a risk factors for accelerated cognitive decline(HR=1.18,95%CI:1.04~1.34),and HDL-C level was a protective factor for cognitive function(HR=0.58,95%CI:0.42~0.80).The results of sensitivity analyses were consistent with the main findings,indicating the robustness of the model(P<0.05).Conclusion An elevated LDL-C/HDL-C ratio is a risk factor for accelerated cognitive decline in the elderly,while higher HDL-C level has protective effect.
作者
张子涵
秦彦文
ZHANG Zihan;QIN Yanwen(Beijing Anzhen Hospital·Beijing Institute of Heart Lung and Blood Vessel Disease,Capital Medical University,Beijing 100029,China)
出处
《中华老年心脑血管病杂志》
北大核心
2026年第2期219-223,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家自然科学基金(82470902,82401000)
2030“四大慢病国家重大专项”课题《新型脂蛋白及亚组分对心脑血管疾病的预警作用研究》(2023ZD0503403)
国家重点研发计划(2021YFC2500603)。
