微量白蛋白尿与患有外周动脉疾病的老年人的认知功能呈负相关：1999 - 2002年美国国家健康与营养检查调查结果

Microalbuminuria is a negative correlate for cognitive function in older adults with peripheral arterial disease: results from the U.S. National Health and Nutrition Examination Survey 1999-2002.

作者信息

Kuo H-K, Lin L-Y, Yu Y-H

机构信息

Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

J Intern Med. 2007 Nov;262(5):562-70. doi: 10.1111/j.1365-2796.2007.01847.x.

DOI:10.1111/j.1365-2796.2007.01847.x

PMID:17949365

Abstract

OBJECTIVES

Microalbuminuria (MA) has been increasingly identified as a marker of cardiovascular risk. Although poor cognitive function has been implicated as a sequelae of increased cardiovascular burden, little is known about the association between MA and cognitive function.

DESIGN

Population-based cross-sectional study.

SETTINGS

National Health and Nutrition Examination Survey 1999-2002 in the USA.

SUBJECTS

2049 noninstitutionalized adults (>/=60 years) with nonmissing values in cognitive test, urinary albumin-to-creatinine ratio (UACR) and ankle-brachial blood pressure index (ABPI) was analysed. Participants with UACR >300 microg mg(-1) were excluded.

MAIN OUTCOME MEASURES

The UACR, in the unit of microg mg(-1), was calculated by dividing the urinary albumin value by the urinary creatinine concentration. MA was defined as UACR between 30 and 300 microg mg(-1). Cognitive function was measured by a 2-min Digit Symbol Substitution Test (DSST). Peripheral artery disease (PAD) was defined as an ABPI <0.9 in either leg.

RESULTS

Overall speaking, MA was inversely associated with DSST score after controlling for age, sex, race, body mass index and educational level (regression coefficient = -2.8, P = 0.002). There was an effect modification of PAD on the association between MA and the DSST score. Amongst participants with PAD, the DSST score for those with MA was lower than those without MA (beta = -6.3, P = 0.003) after multivariate adjustment. Moreover, participants with PAD in the highest quartile of UACR had significantly lower DSST score compared to those in the lowest quartile (beta = -8.7, P = 0.001). There was no association between MA and cognitive function amongst participants without PAD. We observed an additive effect of MA and PAD on DSST score. Participants with both MA and PAD had a lower mean DSST score compared to those without both conditions (beta = -6.2, P = 0.003).

CONCLUSIONS

The presence of MA or a higher level of urinary albumin excretion was inversely associated with cognitive function in participants with PAD.

摘要

目的

微量白蛋白尿（MA）越来越多地被认为是心血管风险的标志物。尽管认知功能差被认为是心血管负担增加的后遗症，但关于MA与认知功能之间的关联却知之甚少。

设计

基于人群的横断面研究。

背景

美国1999 - 2002年国家健康与营养检查调查。

研究对象

分析了2049名非机构化成年人（≥60岁），这些人在认知测试、尿白蛋白与肌酐比值（UACR）和踝臂血压指数（ABPI）方面无缺失值。UACR>300μg mg⁻¹的参与者被排除。

主要观察指标

UACR以μg mg⁻¹为单位，通过将尿白蛋白值除以尿肌酐浓度来计算。MA定义为UACR在30至300μg mg⁻¹之间。认知功能通过2分钟数字符号替换测试（DSST）进行测量。外周动脉疾病（PAD）定义为任一腿部的ABPI<0.9。

结果

总体而言，在控制年龄、性别、种族、体重指数和教育水平后，MA与DSST评分呈负相关（回归系数=-2.8，P = 0.002）。PAD对MA与DSST评分之间的关联存在效应修正。在患有PAD的参与者中，多因素调整后，患有MA的参与者的DSST评分低于未患有MA的参与者（β=-6.3，P = 0.003）。此外，UACR处于最高四分位数的患有PAD的参与者的DSST评分显著低于处于最低四分位数的参与者（β=-8.7，P = 0.001）。在没有PAD的参与者中，MA与认知功能之间无关联。我们观察到MA和PAD对DSST评分有相加作用。与既没有MA也没有PAD的参与者相比，同时患有MA和PAD的参与者的平均DSST评分更低（β=-6.2，P = 0.003）。