南昌市洪都社区老年性痴呆流行现状及患者全血中多种化学元素分布特征探索
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摘要
目的:探讨南昌市洪都社区老年自然人群AD的分布规律和流行特征,通过检测人体血液中与老年性痴呆(AD)相关化学元素含量与分布特征等数据,筛选与AD相关的危险因素和保护因素,从而为AD早期预防或干预提供参考。
方法:采用整群抽样确定调查对象。以简易智能状态量表(MMSE)为测评工具筛查AD患者,并给合病史、临床表现等对AD患者作出最后评定;随机抽取52例AD病人和70例非AD为对照,进行病例对照研究,其中采集的血样本,用原子吸收分光光度仪检测其宏、微量元素含量并作分析;其他影响因素采用多因素分析。
结果:(1)南昌市洪都社区2408名≥60岁者调查,其AD总患病率为4.69%,其中女性为5.47%,男性为3.60%,女性显著高于男性(x~2=4.57,p＜0.05);在确诊的113例AD患者中,以中型为多,轻、中、重型分别占22.12%、44.25%和33.63%;AD发生与年龄、文化程度有关,即年龄越大文化程度越低者,AD患病率越高;(2)病例组与对照组的不同性别间各元素的含量均无显著性差异(p＞0.05);(3)AD组与对照组的全血中Ca、Fe两元素含量相近且差别均无显著性(p＞0.05);AD组人群的血Al、Cu、Mn、Cd含量均显著高于对照组(t值范围10.399～2.137之间,P＜0.05);AD患者血Zn、Se、Cr含量均显著低于对照组(t值范围4.306～2.865之间,P＜0.01);(4)部分元素含量比值结果显示,AD组均高于对照组且有显著性差异(P＜0.01);(5)多因素Logistic回归分析结果提示,Al(OR=3.327)、高血压史(OR=4.228)、一级亲属痴呆史(OR=3.349)是AD发病的危险因素,而文化程度高(OR=0.465)、Zn(OR=0.218)和Se(OR=0.253)是AD发病的保护性因素。
结论:(1)南昌市洪都社区老年自然人群AD患病率处于相对高的水平,对老年人的健康构成威胁,年龄分布提示75岁以上和低文化程度的人群应做为AD重点监控对象,与男性相比女性更易患AD,因此在社区卫生保健中对老年女性应予以更多的关注。(2)AD患者血Zn、Se、Cr含量普遍较低,而Al、Mn、Cu、Cd含量普遍较高,应引起重视,如调整膳食结构,注意营养均衡和改变不良生活习惯是十分必要的。(3)血Al含量高,有高血压史和一级亲属痴呆史等因素提示为AD患病的危险因素,而血Zn、Se含量高以及文化程度高等则提示为AD患驳谋；ば砸蛩亍Ｖ厥雍透纳粕缜巳河胫喙氐母鋈诵形吞卣?清除其体内有害元素补充人体必需元素对预防和控制AD有积极意义;且选择某些与AD发生关系密切的元素作为标志物对诊断该病也有重要参考价值。
Objective: To explore the distribution regularity and epidemiological characteristics of Alzheimer's disease (AD) among natural population in NanChang Hongdu community, by measuring the contents and distribution of chemical elements which related to AD in human blood , and screening related risk factors and protective factors, so as to provide reference for AD early prevention or intervention. Methods: Cluster sampling method was used to determine the target population. MMSE scale screening tool was performed for the evaluation of patients with AD, associated the medical history, clinical manifestation. A case-control study conducted with 52 cases diagnosed AD patients and 70 controls, by measuring their chemical elements and other factors, and conducted some related analysis. Results: The total prevalence rate of AD in Nanchang Hongdu community dwellers was 4.69%,and the prevalence rates of AD between males and females were 3.60% and 5.47% , there was significant difference between males and females (x~2 = 4.57, p<0.05);Among these 113 senile dementias, the proportion of mild, moderate, severe AD was 22.12%, 44.25% and 33.63% respectively. AD was related with age and education degree, the older of the age and the lower of education degree, the higher of the prevalence rate of AD. There were no significant difference (p> 0.05) between males and females in AD and between the control of males and females about all elements in blood respectively. There were no significant difference between AD cases and controls in blood calcium and ferri contents (P>0.05); Blood aluminium, copper, manganese and cadmium contents of AD patients were significantly higher than the control group(t: 10.399～2.137, P <0.05); Blood zinc, selenium and chromium levels of AD patients were lower than the control group, representing a significant difference (P<0.01). Multiple logistic regression analysis revealed that the first degree relatives of dementia (OR=3.349), hypertension (OR=4.228), and aluminum (OR=3.327) were the risk factors for AD; high levels of education (OR=0.465), zinc (OR=0.218), and selenium (OR=0.253) were protective factors for AD. Conclusion: The prevalence rate of AD was in a relatively high level among old natural population in Nanchang Hongdu community, and formed a threat to the health of the old people. Age distribution suggested the age groups above 75 years should be regarded as an important monitoring target of AD. Comared with male, female was prone to suffering from AD, so more attention should be paid to the older female in community healthcare. There were lower blood zinc, selenium, chromium contents and higher aluminum, manganese, copper, cadmium content in AD patients, and it should aroused the attention of AD patients, it is necessary to improve their diet, the balance of nutrition and change unhealthy life style, etc. The result revealed that high blood aluminum contents, the hypertension, and family history of dementia were risk factors of AD, while high contents of zinc, selenium in blood and high education levels were protective factors of AD. More attention should be paid to improving the personal behavior and characteristics of the community dwellers, it is important to prevent and control AD incidence. And selecting some elements closed to AD as a marker, which is also an important reference value to diagnosis of AD.
方法:采用整群抽样确定调查对象。以简易智能状态量表(MMSE)为测评工具筛查AD患者,并给合病史、临床表现等对AD患者作出最后评定;随机抽取52例AD病人和70例非AD为对照,进行病例对照研究,其中采集的血样本,用原子吸收分光光度仪检测其宏、微量元素含量并作分析;其他影响因素采用多因素分析。
结果:(1)南昌市洪都社区2408名≥60岁者调查,其AD总患病率为4.69%,其中女性为5.47%,男性为3.60%,女性显著高于男性(x~2=4.57,p＜0.05);在确诊的113例AD患者中,以中型为多,轻、中、重型分别占22.12%、44.25%和33.63%;AD发生与年龄、文化程度有关,即年龄越大文化程度越低者,AD患病率越高;(2)病例组与对照组的不同性别间各元素的含量均无显著性差异(p＞0.05);(3)AD组与对照组的全血中Ca、Fe两元素含量相近且差别均无显著性(p＞0.05);AD组人群的血Al、Cu、Mn、Cd含量均显著高于对照组(t值范围10.399～2.137之间,P＜0.05);AD患者血Zn、Se、Cr含量均显著低于对照组(t值范围4.306～2.865之间,P＜0.01);(4)部分元素含量比值结果显示,AD组均高于对照组且有显著性差异(P＜0.01);(5)多因素Logistic回归分析结果提示,Al(OR=3.327)、高血压史(OR=4.228)、一级亲属痴呆史(OR=3.349)是AD发病的危险因素,而文化程度高(OR=0.465)、Zn(OR=0.218)和Se(OR=0.253)是AD发病的保护性因素。
结论:(1)南昌市洪都社区老年自然人群AD患病率处于相对高的水平,对老年人的健康构成威胁,年龄分布提示75岁以上和低文化程度的人群应做为AD重点监控对象,与男性相比女性更易患AD,因此在社区卫生保健中对老年女性应予以更多的关注。(2)AD患者血Zn、Se、Cr含量普遍较低,而Al、Mn、Cu、Cd含量普遍较高,应引起重视,如调整膳食结构,注意营养均衡和改变不良生活习惯是十分必要的。(3)血Al含量高,有高血压史和一级亲属痴呆史等因素提示为AD患病的危险因素,而血Zn、Se含量高以及文化程度高等则提示为AD患驳谋；ば砸蛩亍Ｖ厥雍透纳粕缜巳河胫喙氐母鋈诵形吞卣?清除其体内有害元素补充人体必需元素对预防和控制AD有积极意义;且选择某些与AD发生关系密切的元素作为标志物对诊断该病也有重要参考价值。
Objective: To explore the distribution regularity and epidemiological characteristics of Alzheimer's disease (AD) among natural population in NanChang Hongdu community, by measuring the contents and distribution of chemical elements which related to AD in human blood , and screening related risk factors and protective factors, so as to provide reference for AD early prevention or intervention. Methods: Cluster sampling method was used to determine the target population. MMSE scale screening tool was performed for the evaluation of patients with AD, associated the medical history, clinical manifestation. A case-control study conducted with 52 cases diagnosed AD patients and 70 controls, by measuring their chemical elements and other factors, and conducted some related analysis. Results: The total prevalence rate of AD in Nanchang Hongdu community dwellers was 4.69%,and the prevalence rates of AD between males and females were 3.60% and 5.47% , there was significant difference between males and females (x~2 = 4.57, p<0.05);Among these 113 senile dementias, the proportion of mild, moderate, severe AD was 22.12%, 44.25% and 33.63% respectively. AD was related with age and education degree, the older of the age and the lower of education degree, the higher of the prevalence rate of AD. There were no significant difference (p> 0.05) between males and females in AD and between the control of males and females about all elements in blood respectively. There were no significant difference between AD cases and controls in blood calcium and ferri contents (P>0.05); Blood aluminium, copper, manganese and cadmium contents of AD patients were significantly higher than the control group(t: 10.399～2.137, P <0.05); Blood zinc, selenium and chromium levels of AD patients were lower than the control group, representing a significant difference (P<0.01). Multiple logistic regression analysis revealed that the first degree relatives of dementia (OR=3.349), hypertension (OR=4.228), and aluminum (OR=3.327) were the risk factors for AD; high levels of education (OR=0.465), zinc (OR=0.218), and selenium (OR=0.253) were protective factors for AD. Conclusion: The prevalence rate of AD was in a relatively high level among old natural population in Nanchang Hongdu community, and formed a threat to the health of the old people. Age distribution suggested the age groups above 75 years should be regarded as an important monitoring target of AD. Comared with male, female was prone to suffering from AD, so more attention should be paid to the older female in community healthcare. There were lower blood zinc, selenium, chromium contents and higher aluminum, manganese, copper, cadmium content in AD patients, and it should aroused the attention of AD patients, it is necessary to improve their diet, the balance of nutrition and change unhealthy life style, etc. The result revealed that high blood aluminum contents, the hypertension, and family history of dementia were risk factors of AD, while high contents of zinc, selenium in blood and high education levels were protective factors of AD. More attention should be paid to improving the personal behavior and characteristics of the community dwellers, it is important to prevent and control AD incidence. And selecting some elements closed to AD as a marker, which is also an important reference value to diagnosis of AD.
引文
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[17]马催,唐牟尼,郭扬波,等.广州市城乡65岁及其以上人群痴呆患病率调查.中华神经科杂志,2005,38(4):227-230
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[2]韩恩吉.老年期痴呆.山东医药,2003,43(25):48-49
[3]汤哲,孟琛.北京地区老年痴呆流行病研究.中华流行病学杂志,2003,8(24):734-736
[4]胡祥炬.南昌九江城乡社区养老机构AD流行特征和影响因素研究(硕士毕业论文)
[5]Evans DA,Funkenstein HH,Albert MS,et al.Prevalence of Alzheimer's disease in a community population of older persons.JAMA,1989,262(18):2551-2556
[6]Flaten TP.Aluminium as a risk factor in Alzheimer's disease,with emphasis on drinkingwater.Brain Res Bull,2001,55:187-196
[7]Bush AI,Moir RD,Rosenkranz KM,etal.Zinc and Alzheimer's disease[J].Science,1995,268:1921-1923
[8]Beka S,.Rela K,Jossiphov J.Immunostaining of calmodulin and aluminium in Alzheimer's disease-affectde brains[J].Brain Beasearch Bulletin,2001,55:253-256
[9]方宾,赵广超,金家英,等.老年痴呆患者血清中7种微量元素的测量与评价.营养学报,1997,19(1):88-90
[10]楚晋,李林.微量元素与Alzheimer病的关系.中国老年学杂志,2001,21(1):76-77
[11]Mirra SS,Heyman A,McKeel D,et al.The consortium to establish a registry for Alzheimer's disease(Part Ⅱ).Neurology,1991,41:479-486
[12]Cummings JL,Vinter HV,Cole GM,et al.Alzheimer's disease.Etiologies,pathophysiology,cognitive reserve,and treatment opportunities.Neurology,1998,51(Suppl 1):S2-S17.
[13]黄河浪,吴磊.南昌九江两市福利院老年痴呆患病率调查分析.江西医学院报,2005,45(2):73-78
[14]Lee DY,Lee JH,Ju YS,et al.The p revalence of dementia in older people in an urban population of Korea:the Seoul study J Am Geriatr Soc,2002,50:1233-1239.
[15]范俭雄.南京地区老年期痴呆流行病学调查.临床精神医学杂志,2000,10(3):137-138.
[16]周玢,洪震,黄茂盛,等.上海市城乡人群痴呆患病率调查.中华流行病学杂志,2001,22(5):368-371
[17]马催,唐牟尼,郭扬波,等.广州市城乡65岁及其以上人群痴呆患病率调查.中华神经科杂志,2005,38(4):227-230
[18]屈秋民,乔晋,杨剑波,等.西安地区中老年人的痴呆患病率调查.中华老年医学杂志.2001,20(4):283-286
[19]Bachman DL,Wolf PA,Linn R,et al.Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham study.Neurol,1992,42:115-119
[20]Breteler MMB,Claus JJ,van Duijin CM.Epidemiology of Alzheimer's disease.Epidemiol Reviews,1992,14:58-82.
[21]Zhang MY,Katzman R,Salmon D,et al.Prevalence of dementia and Alzheimer's disease in Shanghai,China:impact of age,gender and education.Ann Neuro,1990,27:428-437
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