高龄人群痴呆患病率及危险因素的病例对照研究

发布时间：2019-05-24 07:18

【摘要】：目的：目前，痴呆已经成为导致60岁以上老人失能的首要原因，而目前我国有关于高龄人群痴呆患病情况及危险因素的流行病学资料较少。部队干休所离退休老干部具有完善的医疗保健体系，流行病学调查工作易于组织和实施，人群稳定性好，不仅可以确保流行病学调查工作高质量完成，而且可以获得更加真实可靠的数据。本实验基于对部队干休所离退休老干部这一高龄人群痴呆患病率及危险因素的调查研究，评估高龄老人痴呆患病情况，获得高龄老人罹患痴呆的危险因素，从而探索可能的早期干预治疗方案。方法： 1采用分层，整群抽样于2009年12月至2011年7月对北京市15个干休所80岁及80岁以上军队离退休老干部进行流行病学调查。 2所有调查员均为神经科医生或研究生，在研究方案实施前均经过系统的调查方法培训，对认知量表评分进行一致性检验，并由质控人员对调查表进行质量控制。 3采用二阶段调查方法，根据《全军离退休老干部神经系统健康状况抽样调查表》对被访者和知情人采取入户或在干休所门诊部进行面对面调查，第一阶段记录被访者人口社会学资料，既往病史，吸烟饮酒史等一般情况，采用简易智能状态检查(MMSE)量表和蒙特利尔认知量表(MOCA)，日常生活能力(ADL)量表和抑郁自评量表(CES-D)进行筛查，高于相应划界分为认知功能正常者，低于划界分者进入第二阶段进行更详细的认知功能量表检查并进行认知诊断评估。以认知功能正常者为对照组，痴呆者为病例组进行非匹配病例对照研究。 4应用Epidata3.0软件建立数据库，所有调查表数据行双录入并进行一致性检验，采用SPSS13.0进行统计学分析。对各个因素先进行单因素分析，P0.05认为差异有统计学意义，以痴呆为应变量，有统计学意义的变量为自变量进行多因素非条件Logistic回归分析。用OR和P值评价危险因素与痴呆的关联强度和独立性。 5主要观察指标为痴呆及其主要亚型粗患病率，各年龄段痴呆粗患病率，各可能为痴呆危险因素的OR值及P值。结果： 1597名老干部参加调查，应答率90.5%，男性569人，女性28人，年龄80~98岁，平均年龄83岁。认知功能正常者247人，痴呆者113人。 2痴呆类型分布：AD71人，VD31人，其他类型痴呆11人。痴呆总患病率为18.9%，其中AD患病率11.9%，VD患病率5.2%，其他类型痴呆患病率1.8%。 3痴呆危险因素：①人口社会学因素：单因素分析结果显示将年龄分层，痴呆组与对照组80~84岁，85~89岁，90岁以上三个年龄段OR为3.32(95%CI2.19，5.04)，P0.01，俩组年龄差别有统计学意义。将教育年限分层，痴呆组与对照组6年以下，6~12年，12年以上三组受教育年限OR为2.07(95%CI1.44，2.97)，P0.01，两组受教育年限有统计学意义。男女性别比较， P0.05，差别无统计学意义②血管性危险因素：单因素分析结果显示：与认知功能正常人相比，有糖尿病者患痴呆的OR为2.37(95%CI1.49，3.77)，P0.01；有高血压病史者患痴呆的OR为2.40(95%CI1.44，4.00)，P0.01；有脑卒中病史者患痴呆的OR为3.20(95%CI1.93，5.31) P0.01；痴呆组高脂血症，冠心病，心律失常比例略高于非痴呆组，但P0.05，差异无统计学意义。③其他可能的危险因素：病例组吸烟，饮酒，精神创伤及电磁暴露史比例均高于对照组，但无统计学意义。 4多因素分析：选用非条件logistic回归模型进行多因素分析，结果显示年龄，脑卒中，糖尿病，高血压及受教育年限短为痴呆发生的独立危险因素，其OR值及95%可信区间分别为2.87(1.83，4.50)，2.41(1.37，4.23)，2.05(1.23，3.44)，1.80(1.02，3.15)，1.86(1.26，2.75)。结论： 1高龄人群痴呆患病率较高，，且随年龄增加而增加，AD患病率高于VD。 2增龄，低教育年限，高血压，糖尿病，脑卒中为高龄人群发生痴呆的独立危险因素。 3吸烟，饮酒，精神创伤史，电磁场暴露，高血脂，冠心病，心律失常是否为高龄老人发生痴呆的危险因素尚需进一步研究。 4预防高血压，糖尿病，脑卒中，提高教育程度对降低痴呆发病率有重要意义。
[Abstract]:Objective: At present, dementia has become the first cause of failure of the old people over the age of 60, and there are few epidemiological data about the prevalence of dementia and the risk factors in the elderly. The retired veteran cadres of the unit have a perfect health care system. The epidemiological investigation is easy to organize and implement, and the stability of the population is good. It is not only possible to ensure the high quality of the epidemiological investigation, but also to obtain a more real and reliable number. This experiment is based on the study of the prevalence of dementia and the risk factors of the old-age group of retired veteran cadres in the army, and to evaluate the risk factors of the senile people's dementia, so as to explore the possible early intervention and treatment. therapy plan Methods:1 By stratified and cluster sampling from December 2009 to July 2011,15 retired cadres aged 80 and over 80 years of age and over 80 years of age were admitted to Beijing. Line epidemiological survey. All investigators are neurologists or postgraduates, trained in the system's investigative methods before the implementation of the study protocol, and the scores of the cognitive scales are tested for consistency and are made by the quality control personnel. The quality control of the questionnaire is carried out.3. The two-stage investigation method is adopted to conduct a face-to-face investigation of the respondent and the lover and the outpatient department in the dry place according to the sample survey of the health status of the nervous system of the retired cadres of the whole army. The first stage records the respondent. The general conditions such as the sociological information, the past medical history, the history of smoking and drinking, the simple and intelligent status check (MMSE) scale and the Montreal Cognitive Scale (MOCA), the daily living capacity (ADL) scale and the depression self-rating scale (CES-D) were used for screening, higher than the corresponding Demarcation is divided into a more detailed cognitive function scale for the normal person with the normal cognitive function and lower than the boundary of the boundary. In the control group, the dementia was the case group. A non-matched case-control study was conducted.4. The database was established using the Epidata3.0 software. All the questionnaire data lines were double-entered and the consistency check was performed. SP The statistical analysis of SS13.0 was carried out. The single-factor analysis was carried out for each factor, and the difference was considered to be statistical significance. Logistic regression analysis. The risk factors were evaluated with OR and P the correlation intensity and independence of the dementia with the main observation index is the coarse prevalence of the dementia and its main subtypes, the coarse prevalence of dementia in all ages, can be The OR value of the risk factors and the value of P. Results:1597 old cadres participated in the survey, the response rate was 90.5%, the male was 569, and the female 2 8 persons,80 to 98 years old, with an average age of 83 years. 247 people with normal cognitive function,113 people with dementia. type of dementia: The overall prevalence of dementia was 18.9% in the AD71, VD31 and other types of dementia. The prevalence of AD was 11.9%. The prevalence of dementia was 5.2% and the prevalence of other type of dementia was 1.8%. The risk factors of dementia were: the age stratification, the dementia group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, the age group, the dementia group, the control group, the control group, the control group, (4) The age difference between the two groups was statistically significant, P 0.01, and the age difference of the two groups was statistically significant. The education years were stratified, the dementia group and the control group were lower than 6 years, and in the period of 6 to 12 years, the OR of the three groups was 2.07 (95% CI 1.44,2). The results of single factor analysis showed that the OR of the patients with diabetes was 2.37 (95% CI 1.49, 3.77), P 0.01, and the OR of the patients with hypertension with dementia was 2.4. 0 (95% CI 1.44, 4.00), P0.01; OR of the patients with a history of stroke was 3.20 (95% CI 1.93, 5.31), P0.01; and the proportion of hyperlipidemia, coronary heart disease and arrhythmia in the dementia group. It was slightly higher than that of non-dementia group, but P 0.05, there was no significant difference in the difference. Other possible risk factors: smoking, drinking and spirit creation in the case group The proportion of the history of injury to the electromagnetic exposure was higher than that of the control group, but there was no statistical significance.4-factor analysis: The non-conditional logistic regression model was selected for multi-factor analysis. The results showed that the OR value and the 95% confidence interval of age, stroke, diabetes, hypertension and short-term dementia were 2.87 (1.83, 4.50), 2.41 (1.37, 4.23), 2.05 (1.23, 3.44) and 1.80 (1), respectively. .02 , 3.15), 1.86 (1.26, 2.75). Conclusion:1 The prevalence of dementia in the population was high, and with the increase of age, the prevalence of AD was higher than that of VD. an independent risk factor for dementia in the elderly population, such as age, hypertension, diabetes, and stroke. Smoking, drinking, history of mental trauma, exposure to electromagnetic fields, high blood The risk factors of fat, coronary heart disease and arrhythmia for senile patients with dementia need to be further studied.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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