血清胱抑素C水平与老年人行为功能依赖的相关性研究
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摘要
目的探究社区老年人血清胱抑素C(Cys C)与行为功能依赖的关系,以期对老年人行为功能依赖的早期防治提供依据。方法于2010年6月至2011年7月选择兴隆庄煤矿社区年龄≥60岁的1 448名老人为研究对象,使用标准调查问卷搜集参与者的基本资料,采集清晨空腹静脉血检测Cys C等生化指标,使用日常基础行为能力量表(BADL)、工具性日常生活活动能力量表(IADL)来评估老年人的行为功能依赖状态,根据量表评分将受试人群分为无行为功能依赖组和有行为功能依赖组,分别为1 195名和253名。采用SPSS 17.0软件进行t检验、χ~2检验和多因素logistic回归分析。结果 1 448名老年人中有行为功能依赖253人(17.5%)。行为功能依赖组女性比例、年龄、高血压病史、脑卒中病史、高胆固醇血症、高甘油三酯血症、认知功能障碍和Cys C水平显著高于无行为功能依赖组,而受教育水平、HDL-C水平显著低于无行为功能依赖组,差异均有统计学意义(P<0.05,P<0.01)。多因素logistic回归结果显示,年龄(OR=1.094,95%CI:1.061~1.129)、脑卒中病史(OR=2.940,95%CI:1.787~4.837)和认知功能下降(OR=2.867,95%CI:2.037~4.036)是行为功能依赖的危险因素,而受教育年限(OR=0.885,95%CI:0.834~0.938)、HDL-C水平(OR=0.696,95%CI:0.519~0.934)是行为功能依赖的保护因素,较高浓度的Cys C水平(>1.25 mg/L)是行为功能依赖的独立危险因素(OR=2.022,95%CI:1.129~3.621)。结论较高浓度的Cys C水平可显著增加社区老年人行为功能依赖的发生风险,关注及控制Cys C水平的增高对行为功能依赖的防治有深远意义。
Objective To investigate the relationship between serum cystatin C(CysC) levels and behavioral functional dependence, and to provide the basis for the early prevention and control of behavioral dependence in the elderly. Methods From June of 2010 to July of 2011, 1 448 elder residents(≥60 years old) selected from Xinglong coal mine community as the subjects.The investigation was conducted with the questionnaire interview and blood biochemical test(such as CysC). The basic activities of daily living(BADL) score, instrumental ADL score were used to assess the behavioral functional dependence in the elderly.According to BADL scores and LADL scores, the subjects were divided into the behavioral functional dependence group(253 cases) and non-behavioral functional dependence(1 195 cases). The t test, χ~2 test and multiple factors logistic regression method were used to analyze the data, the used software was SPSS 17.0. Results There were 253 case with behavioral functional dependence(17.5%). The female proportion, age, hypertension history, stroke history, hypercholesterolemia, hypertriglyceridemia,cognitive dysfunction and CysC levels in behavioral functional dependence group were significantly higher than those in non-behavioral functional dependence group, but the educational levels and HDL-C levels in behavioral functional dependence group were significantly lower than those in non-behavioral functional dependence group(P<0.05 or P<0.01). The multivariate logistic regression showed that age(OR=1.094, 95%CI: 1.061-1.129), stroke history(OR=2.940, 95%CI: 1.787-4.837) and cognitive dysfunction(OR=2.867, 95%CI: 2.037-4.036) were the risk factors of behavioral functional dependence; the educational level(OR=0.885, 95%CI: 0.834-0.938) and HDL-C level(OR=0.696, 95%CI: 0.519-0.934) were the protection factors of behavioral functional dependence; the high concentration CysC level(>1.25 mg/L) was an independent risk factor(OR =2.022, 95% CI:1.129-3.621) of behavioral functional dependence. Conclusion Higher levels of CysC(>1.25 mg/L) significantly increased the risk of behavioral-functional dependence in the elderly population of the community. And it is important to observe and control the elevated levels of cystatin C for behavioral-functional dependence.
Objective To investigate the relationship between serum cystatin C(CysC) levels and behavioral functional dependence, and to provide the basis for the early prevention and control of behavioral dependence in the elderly. Methods From June of 2010 to July of 2011, 1 448 elder residents(≥60 years old) selected from Xinglong coal mine community as the subjects.The investigation was conducted with the questionnaire interview and blood biochemical test(such as CysC). The basic activities of daily living(BADL) score, instrumental ADL score were used to assess the behavioral functional dependence in the elderly.According to BADL scores and LADL scores, the subjects were divided into the behavioral functional dependence group(253 cases) and non-behavioral functional dependence(1 195 cases). The t test, χ~2 test and multiple factors logistic regression method were used to analyze the data, the used software was SPSS 17.0. Results There were 253 case with behavioral functional dependence(17.5%). The female proportion, age, hypertension history, stroke history, hypercholesterolemia, hypertriglyceridemia,cognitive dysfunction and CysC levels in behavioral functional dependence group were significantly higher than those in non-behavioral functional dependence group, but the educational levels and HDL-C levels in behavioral functional dependence group were significantly lower than those in non-behavioral functional dependence group(P<0.05 or P<0.01). The multivariate logistic regression showed that age(OR=1.094, 95%CI: 1.061-1.129), stroke history(OR=2.940, 95%CI: 1.787-4.837) and cognitive dysfunction(OR=2.867, 95%CI: 2.037-4.036) were the risk factors of behavioral functional dependence; the educational level(OR=0.885, 95%CI: 0.834-0.938) and HDL-C level(OR=0.696, 95%CI: 0.519-0.934) were the protection factors of behavioral functional dependence; the high concentration CysC level(>1.25 mg/L) was an independent risk factor(OR =2.022, 95% CI:1.129-3.621) of behavioral functional dependence. Conclusion Higher levels of CysC(>1.25 mg/L) significantly increased the risk of behavioral-functional dependence in the elderly population of the community. And it is important to observe and control the elevated levels of cystatin C for behavioral-functional dependence.
引文
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[14]Welmer AK,Liang Y,Angleman S,et al.Vascular risk factor burden,atherosclerosis,and functional dependence in old age:a populationbased study[J].Int J Behav Med,2014,21(4):597-604.
[15]Mathews PM,Levy E.Cystatin C in aging and in Alzheimer’s disease[J].Ageing Res Rev,2016,32:38-50.DOI:10.1016/j.arr.2016.06.003.
[16]Slinin Y,Peters KW,Ishani A,et al.Cystatin C and cognitive impairment 10 years later in older women[J].J Gerontol A Biol Sci Med Sci,2015,70(6):771-778.
[17]赵坤,蔡双兵,肖丹,等.老年糖尿病患者血清胱抑素C水平与原发性高血压相关性研究[J].中华老年心脑血管病杂志,2015,17(4):357-360.
[18]Yang B,Zhu J,Miao Z,et al.Cystatin C is an independent risk factor and therapeutic target for acute ischemic stroke[J].Neurotox Res,2015,28(1):1-7.
[19]Kobayashi T,Yokokawa H,Fujibayashi K,et al.Association between high cystatin C levels and carotid atherosclerosis[J].World J Cardiol,2017,9(2):174-181.
[20]Yaffe K,Lindquist K,Shlipak MG,et al.Cystatin-C as a marker of cognitive function in elders:findings from the health ABC study[J].Ann Neurol,2008,63(6):798-802.
[21]Arpegard J,Ostergren J,de Faire U,et al.Cystatin C-a marker of peripheral atherosclerotic disease?[J].Atherosclerosis,2008,199(2):397-401.
[22]Ferrucci L,Penninx BW,Volpato S,et al.Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels[J].J Am Geriatr Soc,2002,50(12):1947-1954.
[23]Sun B,Zhou Y,Halabisky B,et al.Cys-C cathepsin B axis regulates amyloid beta levels and associated neuronal deficits in an animal model of Alzheimer’s disease[J].Neuron,2008,60(2):247-257.
[2]Yaffe K,Lindquist K,Shlipak MG,et al.Cystatin-C as a marker of cognitive function in elders:findings from the health ABC study[J].J Ann Neurol,2008,63(6):798-802.
[3]Yalcin S,Ulas T,Eren MA,et al.Relationship between oxidative stress parameters and cystatin C levels in patients with severe preeclampsia[J].J Medicina(Kaunas),2013,49(3):118-123.
[4]Lertnawapan R,Bian A,Rho YH,et al.Cystatin C is associated with inflammation but not atherosclerosis in systemic lupus erythematosus[J].J Lupus,2012,21(3):279-287.
[5]Wada M,Nagasawa H,Kawanami T,et al.Cystatin C as an index of cerebral small vessel disease:results of a cross-sectional study in community-based Japanese elderly[J].Eur J Neurol,2010,17(3):383-390.
[6]Song A,Liang Y,Yan Z,et al.Highly prevalent and poorly controlled cardiovascular risk factors among Chinese elderly people living in the rural community[J].Eur J Prev Cardiol,2014,21(10):1267-1274..
[7]中国成人血脂异常防治指南指定联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390-409.
[8]Cui GH,Yao YH,Xu RF,et al.Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China[J].J Acta Neurol Scand,2011,124(6):361-367.
[9]Spector WD,Fleishman JA.Combining activities of daily livingwith instrumental activities of daily living tomeasure functional disability[J].J Gerontol B Psychol Sci Soc Sci,1998,53(1):S46-57.
[10]La Plante MP.The classic measure of disability in activities of daily living is biased by age but an expanded IADL/ADL measure is not[J].J Gerontol B Psychol Sci Soc Sci,2010,65(6):720-732.
[11]Dumurgier J,Elbaz A,Dufouil C,et al.Hypertension and lower walking speed in the elderly:the Three-City study[J].J Hypertens,2010,28(7):1506-1514.
[12]Fernandes TG,Goulart AC,Santos-Junior WR.Educational levels and the functional dependence of ischemic stroke survivors[J].J Cad Saude Publica,2012,28(8):1581-1590.
[13]Zeng Y,Feng Q,Hesketh T.Survival,disabilities in activities of daily living,and physical and cognitive functioning among the oldest-old in China:a cohort study[J].Lancet,2017,389(10079):1619-1629.
[14]Welmer AK,Liang Y,Angleman S,et al.Vascular risk factor burden,atherosclerosis,and functional dependence in old age:a populationbased study[J].Int J Behav Med,2014,21(4):597-604.
[15]Mathews PM,Levy E.Cystatin C in aging and in Alzheimer’s disease[J].Ageing Res Rev,2016,32:38-50.DOI:10.1016/j.arr.2016.06.003.
[16]Slinin Y,Peters KW,Ishani A,et al.Cystatin C and cognitive impairment 10 years later in older women[J].J Gerontol A Biol Sci Med Sci,2015,70(6):771-778.
[17]赵坤,蔡双兵,肖丹,等.老年糖尿病患者血清胱抑素C水平与原发性高血压相关性研究[J].中华老年心脑血管病杂志,2015,17(4):357-360.
[18]Yang B,Zhu J,Miao Z,et al.Cystatin C is an independent risk factor and therapeutic target for acute ischemic stroke[J].Neurotox Res,2015,28(1):1-7.
[19]Kobayashi T,Yokokawa H,Fujibayashi K,et al.Association between high cystatin C levels and carotid atherosclerosis[J].World J Cardiol,2017,9(2):174-181.
[20]Yaffe K,Lindquist K,Shlipak MG,et al.Cystatin-C as a marker of cognitive function in elders:findings from the health ABC study[J].Ann Neurol,2008,63(6):798-802.
[21]Arpegard J,Ostergren J,de Faire U,et al.Cystatin C-a marker of peripheral atherosclerotic disease?[J].Atherosclerosis,2008,199(2):397-401.
[22]Ferrucci L,Penninx BW,Volpato S,et al.Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels[J].J Am Geriatr Soc,2002,50(12):1947-1954.
[23]Sun B,Zhou Y,Halabisky B,et al.Cys-C cathepsin B axis regulates amyloid beta levels and associated neuronal deficits in an animal model of Alzheimer’s disease[J].Neuron,2008,60(2):247-257.