脉压、踝臂指数对认知功能障碍预测价值的系统评价

发布时间：2018-10-30 14:51

【摘要】：研究背景:人口老龄化已成为当今人类社会的共同趋势,引起高度重视。认知功能的损害严重影响了老年人群的生活质量,加重患者、家庭和社会负担,这已成为当今社会面临的一个重要的健康问题。已有研究表明,认知功能受损是致残、致死的重要原因。国内外已有研究报道,脉压(pulse pressure,PP)、踝臂指数(ankle-brachial index,ABI)改变是心血管疾病的独立危险因素。近年来有关PP、ABI与认知功能之间关系的研究越来越多。但由于研究方法、地域等因素限制,无法得出确切结论,需要深入分析和评价。目的:探讨PP、ABI对认知功能受损是否具有预测价值,为认知功能障碍早期干预提供依据和方法。方法:以脉压、踝臂指数、认知功能障碍等作为关键词检索以下数据库从建库至2017年3月相关文献:Cochrane图书馆,Pub Med,EMBASE,中国生物医学文献数据库(CBM),万方数据库,中国知网,维普及相关期刊论文(CNKI)。并手动检索了相关文章所引用的参考文献。搜索相关文献,进行文献的阅读、筛选、数据提取、统计分析。结果:有关PP与认知功能关系的研究共检索出文献342篇,依据文献纳入及排除标准,经过筛选最终纳入文献5篇,总人数4897人,其中观察组2481人,对照组2416人。研究类型均为病例对照研究,应用NOS量表进行文献质量评价,纳入文献的总体质量较高,meta分析结果显示:Chi2=43.37,df=4,P0.00001,结果存在统计学意义。这些研究在统计学上存在异质性(I2=91%),应用随机效应模型分析,I2仍为91%,说明各组之间异质性显著。随后我们进行亚组分析及敏感性分析,以探索异质性来源,最终考虑异质性来源于临床(性别、地区及入组人群是否为住院患者)。应用Begg's test和Egger's test进行发表偏倚分析,Begg秩相关法检验结果显示,u=z=-1.47,z=1.22(连续性校正值),Pr|z|=0.221(连续性校正值),统计量z小于1.96,P大于0.05,说明无统计学意义,可认为无发表偏倚。在Egger直线回归法检验中,P=0.1810.05,95%CI=-4.04~1.19包含0,说明纳入的研究不存在发表偏倚。同样方法进行ABI与认知功能障碍的研究,共检索出相关文献398篇,最终纳入不同类型研究8个,其中横断面研究2个,队列研究4个,病例对照研究1个,随机对照研究1个。仔细阅读全文,分别采用相应质量评价工具对纳入研究的方法学质量进行评价,纳入的8个研究总体质量较高,分别对各研究进行数据提取,采用叙述性的表格进行定性分析。因研究类型不一致,仅予以系统评价,未采用meta分析。结论:1、脉压、踝臂指数与认知功能障碍相关;2、脉压可能成为预测老年人认知功能障碍的临床指标;3、踝臂指数对认知功能障碍可能有预测价值。因纳入研究数量、类型不足等原因,尚不能得出确切结论,期待未来高质量、大样本的不同类型临床研究来证实。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1

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