發(fā)布時(shí)間：2018-10-30 14:51

【摘要】：研究背景:人口老齡化已成為當(dāng)今人類社會(huì)的共同趨勢(shì),引起高度重視。認(rèn)知功能的損害嚴(yán)重影響了老年人群的生活質(zhì)量,加重患者、家庭和社會(huì)負(fù)擔(dān),這已成為當(dāng)今社會(huì)面臨的一個(gè)重要的健康問(wèn)題。已有研究表明,認(rèn)知功能受損是致殘、致死的重要原因。國(guó)內(nèi)外已有研究報(bào)道,脈壓(pulse pressure,PP)、踝臂指數(shù)(ankle-brachial index,ABI)改變是心血管疾病的獨(dú)立危險(xiǎn)因素。近年來(lái)有關(guān)PP、ABI與認(rèn)知功能之間關(guān)系的研究越來(lái)越多。但由于研究方法、地域等因素限制,無(wú)法得出確切結(jié)論,需要深入分析和評(píng)價(jià)。目的:探討PP、ABI對(duì)認(rèn)知功能受損是否具有預(yù)測(cè)價(jià)值,為認(rèn)知功能障礙早期干預(yù)提供依據(jù)和方法。方法:以脈壓、踝臂指數(shù)、認(rèn)知功能障礙等作為關(guān)鍵詞檢索以下數(shù)據(jù)庫(kù)從建庫(kù)至2017年3月相關(guān)文獻(xiàn):Cochrane圖書(shū)館,Pub Med,EMBASE,中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM),萬(wàn)方數(shù)據(jù)庫(kù),中國(guó)知網(wǎng),維普及相關(guān)期刊論文(CNKI)。并手動(dòng)檢索了相關(guān)文章所引用的參考文獻(xiàn)。搜索相關(guān)文獻(xiàn),進(jìn)行文獻(xiàn)的閱讀、篩選、數(shù)據(jù)提取、統(tǒng)計(jì)分析。結(jié)果:有關(guān)PP與認(rèn)知功能關(guān)系的研究共檢索出文獻(xiàn)342篇,依據(jù)文獻(xiàn)納入及排除標(biāo)準(zhǔn),經(jīng)過(guò)篩選最終納入文獻(xiàn)5篇,總?cè)藬?shù)4897人,其中觀察組2481人,對(duì)照組2416人。研究類型均為病例對(duì)照研究,應(yīng)用NOS量表進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià),納入文獻(xiàn)的總體質(zhì)量較高,meta分析結(jié)果顯示:Chi2=43.37,df=4,P0.00001,結(jié)果存在統(tǒng)計(jì)學(xué)意義。這些研究在統(tǒng)計(jì)學(xué)上存在異質(zhì)性(I2=91%),應(yīng)用隨機(jī)效應(yīng)模型分析,I2仍為91%,說(shuō)明各組之間異質(zhì)性顯著。隨后我們進(jìn)行亞組分析及敏感性分析,以探索異質(zhì)性來(lái)源,最終考慮異質(zhì)性來(lái)源于臨床(性別、地區(qū)及入組人群是否為住院患者)。應(yīng)用Begg's test和Egger's test進(jìn)行發(fā)表偏倚分析,Begg秩相關(guān)法檢驗(yàn)結(jié)果顯示,u=z=-1.47,z=1.22(連續(xù)性校正值),Pr|z|=0.221(連續(xù)性校正值),統(tǒng)計(jì)量z小于1.96,P大于0.05,說(shuō)明無(wú)統(tǒng)計(jì)學(xué)意義,可認(rèn)為無(wú)發(fā)表偏倚。在Egger直線回歸法檢驗(yàn)中,P=0.1810.05,95%CI=-4.04~1.19包含0,說(shuō)明納入的研究不存在發(fā)表偏倚。同樣方法進(jìn)行ABI與認(rèn)知功能障礙的研究,共檢索出相關(guān)文獻(xiàn)398篇,最終納入不同類型研究8個(gè),其中橫斷面研究2個(gè),隊(duì)列研究4個(gè),病例對(duì)照研究1個(gè),隨機(jī)對(duì)照研究1個(gè)。仔細(xì)閱讀全文,分別采用相應(yīng)質(zhì)量評(píng)價(jià)工具對(duì)納入研究的方法學(xué)質(zhì)量進(jìn)行評(píng)價(jià),納入的8個(gè)研究總體質(zhì)量較高,分別對(duì)各研究進(jìn)行數(shù)據(jù)提取,采用敘述性的表格進(jìn)行定性分析。因研究類型不一致,僅予以系統(tǒng)評(píng)價(jià),未采用meta分析。結(jié)論:1、脈壓、踝臂指數(shù)與認(rèn)知功能障礙相關(guān);2、脈壓可能成為預(yù)測(cè)老年人認(rèn)知功能障礙的臨床指標(biāo);3、踝臂指數(shù)對(duì)認(rèn)知功能障礙可能有預(yù)測(cè)價(jià)值。因納入研究數(shù)量、類型不足等原因,尚不能得出確切結(jié)論,期待未來(lái)高質(zhì)量、大樣本的不同類型臨床研究來(lái)證實(shí)。
[Abstract]:Background: population aging has become a common trend of human society, and has attracted great attention. The impairment of cognitive function has seriously affected the quality of life of the elderly and increased the burden of patients, families and society, which has become an important health problem facing the society today. Research has shown that cognitive impairment is an important cause of disability and death. Changes in pulse pressure (pulse pressure,PP) and ankle brachial index (ankle-brachial index,ABI) have been reported as independent risk factors for cardiovascular disease. In recent years, there are more and more researches on the relationship between PP,ABI and cognitive function. However, due to the limitations of research methods, geographical factors and other factors, it is impossible to draw a definite conclusion, which needs in-depth analysis and evaluation. Objective: to explore the predictive value of PP,ABI for cognitive impairment and to provide evidence and methods for early intervention of cognitive dysfunction. Methods: pulse pressure, ankle-brachial index and cognitive dysfunction were used as keywords to search the following databases: Cochrane Library, Pub Med,EMBASE, Chinese Biomedical Literature Database (CBM), Wanfang database. (CNKI)., WIP and full text Database of Chinese Journals The references cited in related articles were searched manually. Search related documents, read, screen, data extraction, statistical analysis. Results: a total of 342 articles were retrieved from the study on the relationship between PP and cognitive function. According to the criteria of inclusion and exclusion, 5 articles were selected and finally included in the literature. The total number of papers was 4897, including 2481 in the observation group and 2416 in the control group. The types of study were all case-control studies. The quality of literature was evaluated by NOS scale. The results of meta analysis showed that the results of Chi2=43.37,df=4,P0.00001, were statistically significant. There was statistical heterogeneity in these studies (I _ 2o _ (91%). By using the random effect model, I _ 2 was still 91, indicating that the heterogeneity was significant among the groups. Then we conducted subgroup analysis and sensitivity analysis to explore the source of heterogeneity, and finally to consider whether the heterogeneity originated from clinical (sex, region and group of inpatients). Begg's test and Egger's test were used to analyze the bias of publication. The results of Begg rank correlation test showed that the value of continuity correction), Pr z = 0.221, the statistic z was less than 1.96, the result of Begg rank correlation test showed that the value of continuity correction was 1.22 (continuity correction value), Pr z = 0.221), and the statistical value was less than 1.96. P > 0.05, indicating that there was no statistical significance and that there was no publication bias. In the Egger linear regression test, there was no publication bias in the included study. Methods ABI and cognitive dysfunction were studied. A total of 398 papers were retrieved, and 8 studies were included in different types of studies, including 2 cross-sectional studies, 4 cohort studies, 1 case-control study and 1 randomized control study. Read the full text carefully and use the corresponding quality evaluation tools to evaluate the methodological quality of the study. The overall quality of the eight studies included is relatively high. The data of each study are extracted and qualitative analysis is carried out using narrative tables. Because of the inconsistency of the research type, only the systematic evaluation was given, and the meta analysis was not used. Conclusion: 1, pulse pressure and ankle brachial index are related to cognitive dysfunction; 2, pulse pressure may be a clinical index to predict cognitive dysfunction in the elderly; 3, ankle brachial index may have predictive value for cognitive dysfunction. Due to the insufficient number and type of research, it is not possible to draw a definite conclusion, which is expected to be confirmed by different types of clinical studies of high quality and large sample in the future.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.1

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