Neurology:芬兰青年的心血管风险研究:持续高水平血清肌酐或与中年男性学习、记忆功能更佳相关!

2022-04-29 Naomi MedSci原创

血清肌酐通常用于评估肾功能,其升高会增加认知能力低下的风险。研究调查了中年时血清肌酐和认知表现之间的关系,发现在男性中,与低水平的血清肌酐相比,持续的高水平可能与中年时更好的记忆和学习功能有关。

随着痴呆症患病率的增加,在认知缺陷出现之前加强认知健康的有效手段至关重要。众所周知,导致认知缺陷的病理生理过程在出现临床症状之前几年或几十年就开始了。同时,在出现症状后,目前没有治愈方法,也很少有药物治疗来减缓疾病进程。因此,识别认知表现的早期决定因素在识别高危个体和减少认知缺陷负担方面都可能发挥关键作用。

血肌酐是肾功能的一项指标,可用来计算估计的肾小球滤过率(EGFR)。先前的研究表明,由于血清肌酐升高而导致的EGFR低,表明肾功能受损与认知能力低下、更高的全因死亡率有关。然而,EGFR的非线性相关性也已被报道,因为高EGFR(即低血清肌酐)与各种原因和心血管死亡率的风险增加有关。此外,一些研究表明,中年和老年的高EGFR与认知能力低下和痴呆症发病率增加有关。

低血肌酐和认知能力受损之间联系的机制尚不清楚。肌肉含量低或不良的饮食习惯可能是低血肌酐的原因,这两个因素也被证明与认知能力低下有关。低血肌酐可能表明肾小球高滤过,这在生理上发生在怀孕和高蛋白饮食后。此外,作为对肾单位丢失的适应性反应,滤过增加可导致肾小球高血压,继而导致肾小球硬化,导致进行性肾功能下降和肾小球损伤。重要的是,肾小球高滤过被认为是早期的危险因素的表现,如糖尿病、前驱糖尿病、血压升高、肥胖和吸烟,并与心血管终点(即死亡、充血性心力衰竭住院、心肌梗死、卒中)有关。此外,肾小球高滤过被认为与认知能力差有关。然而,先前缺乏关于中年纵向血清肌酐水平与认知表现之间关系的系统证据。

近日,有研究人员利用青年芬兰人心血管风险研究(YFS)的数据,试图研究中年时血清肌酐和认知表现之间的纵向联系。研究假设,在没有肾脏疾病的参与者中,成年和中年期间的低血肌酐是心血管健康不良的迹象,并与中年认知能力差有关。

自2001年以来,芬兰青年心血管风险研究的参与者接受了长达10年的跟踪调查。在2001年、2007年和2011年重复测定血清肌酐。用潜伏期生长混合模型确定了无肾脏疾病的参与者血清肌酐的性特异性纵向轨迹。整体认知功能和四个特定领域,如1)工作记忆,2)情景记忆和联想学习,3)反应时,4)信息处理通过计算机化的认知测验进行评估。

  • 在男性(N=973)和女性(N=1,204)中,确定了4个血肌酐轨迹组,均为临床血肌酐正常。经过10年的随访,对2026名年龄在34岁到49岁(平均41.8岁)的参与者进行了认知测试。
  • 在男性和女性中,持续的低血肌酐与儿童学习成绩差、成人教育程度低、成年后年收入低、体力活动少和吸烟有关。
  • 与低血肌酐轨迹组相比,高血肌酐组的总体认知表现(β=0.353 SD,95%CI 0.022~0.684)和工作记忆(β=0.351 SD,95%CI 0.034~0.668)较好,而中等血肌酐组(β=0.247 SD,95%CI 0.026~0.468)或正常血肌酐组(β=0.244 SD,95%CI 0.008~0.481)的情景记忆和联想学习能力较好。
  • 没有发现与女性有关的联系。

研究结果表明,在男性中,与低水平的血清肌酐相比,持续的高水平可能与中年时更好的记忆和学习功能有关。

文献来源:Hakala JO, Pahkala K, Juonala M, et al. Repeatedly Measured Serum Creatinine and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study [published online ahead of print, 2022 Apr 11]. Neurology. 2022;10.1212/WNL.0000000000200268. doi:10.1212/WNL.0000000000200268

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    2023-01-15 yinhl1978
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    2022-10-26 weiz
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    2022-04-29 123a22c1m04暂无昵称

    不应该比较认知功能的变化吗?

    0

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    2022-04-29 xulv123

    认真学习~~

    0

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    2022-04-29 1064510_1039
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    2022-04-27 俅侠

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