社区人群钠钾摄入量与轻度认知障碍的关系

李梅; 木拉力别克·黑扎提; 孙乐; 王中蓉; 杨志康; 李靖; 李薇; 李南方

doi:10.16766/j.cnki.issn.1674-4152.003425

社区人群钠钾摄入量与轻度认知障碍的关系

doi: 10.16766/j.cnki.issn.1674-4152.003425

新疆维吾尔自治区人民医院高血压中心，新疆高血压研究所，国家卫生健康委高血压诊疗研究重点实验室，新疆维吾尔自治区重点实验室“新疆高血压病研究实验室”，新疆高血压 (心脑血管)疾病临床医学研究中心，新疆乌鲁木齐 830001

基金项目:

新疆维吾尔自治区人民医院院内项目 20190418

新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目 WJWY-202124

详细信息

通讯作者:
李南方，E-mail：lnanfang2016@sina.com

中图分类号: R741 R446
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出版历程
- 收稿日期: 2023-02-16
- 网络出版日期: 2024-05-27

The relationship between sodium and potassium intake and mild cognitive impairment in community population

Hypertension Center of People ' s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, Xinjiang 830001, China

摘要

摘要: 目的研究在社区人群中24小时尿钠钾排泄评估的钠钾摄入量与轻度认知功能障碍(MCI)之间的关系。方法于2019年3—6月在额敏县采用多级分层随机抽样进行横断面研究，在年龄≥35岁的561例社区人群中，使用简易认知功能状态检查问卷(MMSE)评估认知功能，按24小时尿钾、尿钠、盐摄入三分位分组，其中24小时尿钾三分位分为最低组(T1，187例)、中等组(T2, 187例)和最高组(T3, 187例)，采用多元线性回归模型分析及logistic回归模型分析研究MCI的患病风险。结果 24小时尿钾T1与T3相比MMSE总分下降[25.0(20.0, 28.0) vs. 27.0(24.0, 29.0)，P=0.009]，T3 MCI患病率明显低于T1组(9.1% vs. 24.6%，P < 0.001)。多元线性回归分析显示，24小时尿钾与MMSE呈正相关关系(β=0.027，95% CI：0.000~0.054, P=0.047)，24小时尿钠与MMSE呈负相关(β=-0.007，95% CI：-0.013~-0.001，P=0.025)。多变量logistic回归分析显示，24小时尿钾较低的T1、T2组较尿钾排泄较高的T3组均增加MCI患病风险，分别为3.222倍(95% CI: 1.577~6.562, P=0.001)和3.022倍(95% CI: 1.513~6.029, P=0.002)，24小时尿钠较高的T2相对尿钠较低的T1 MCI的风险是2.812倍(95% CI: 1.502~5.256, P=0.001)。结论较高的钠盐摄入及较低的钾盐摄入与MCI独立相关。
- 24小时尿钠 /
- 24小时尿钾 /
- 轻度认知障碍 /
- 简易认知功能评估表
Abstract: Objective To investigate the association between sodium and potassium intake, as assessed by 24-hour urinary sodium and potassium excretion, and mild cognitive impairment (MCI) in a community population. Methods A cross-sectional study was conducted in Emin County from March to June 2019 using multi-level stratified random sampling, a total of 561 community residents aged ≥ 35 years were included in this study. The mini-mental state examination (MMSE) was used to assess cognitive function. The subjects were divided into three groups according to 24-hour urinary potassium interquartile grouping: the lowest group (T1, n=187), the middle group (T2, n=187) and the highest group (T3, n=187). Multivariate linear regression model analysis and logistic regression model were used to analyze the risk of MCI. Results Twenty-four-hour urinary potassium total MMSE score was lower in the T1 group than in the T3 group [25.0 (20.0, 28.0) vs. 27.0 (24.0, 29.0), P=0.009], and the prevalence of MCI was significantly lower in the T3 group than in the T1 group (9.1% vs. 24.6%, P < 0.001). Multivariate linear regression analysis showed that 24-hour urinary potassium was positively correlated with MMSE (β=0.027, 95% CI: 0.000 to 0.054, P=0.047) and 24-hour urinary sodium was negatively correlated with MMSE (β=-0.007, 95% CI: -0.013 to -0.001, P=0.025). Multivariate logistic regression analysis showed that T1 and T2 groups with lower 24-hour urinary potassium increased the risk of MCI compared with T3 group with higher urinary potassium excretion by 3.222 times (95% CI: 1.577 to 6.562, P=0.001) and 3.022 times (95% CI: 1.513 to 6.029, P=0.002), respectively. The risk of MCI in the T2 group with higher 24-hour urinary sodium was 2.812 times (95% CI: 1.502 to 5.256, P=0.001) compared with the T1 group with lower urinary sodium. Conclusion Higher sodium intake and lower potassium intake were independently associated with MCI.
- 24-hour urinary sodium /
- 24-hour urinary potassium /
- Mild cognitive impairment /
- Simple cognitive function assessment form

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表 1 24小时尿钾含量三分位研究人群一般特征

Table 1. General characteristics of the study population stratified by tertiles of 24-hour urinary potassium excretion

项目	T1:≤25.5(n=187)	T2:25.5~35.8(n=187)	T3:≥35.8(n=187)	统计量	P值
年龄(x±s，岁)	54.22±9.28	51.87±9.57	52.36±8.95	4.732^a	0.009
年龄段[例(%)]
35~44岁	29(15.5)	37(19.8)	36(19.3)	6.436^b	0.168
45~59岁	108(57.8)	119(63.6)	114(61.0)
≥60岁	50(26.7)	31(16.6)	37(19.8)
性别(男/女，例)	83/104	62/125	94/93	11.564^b	0.003
教育水平[例(%)]				41.401^b	< 0.001
小学及以下	103(55.1)	60(32.1)	50(26.7)
初中	45(24.1)	46(24.6)	56(29.9)
高中及以上	39(20.9)	81(43.3)	81(43.3)
工作分类[例(%)]
脑力劳动者	31(16.6)	62(33.2)	64(34.2)	19.387^b	0.001
体力劳动者	138(73.8)	111(59.4)	104(55.6)
无业或不能分类者	18(9.6)	14(7.5)	19(10.2)
吸烟[例(%)]	41(22.0)	31(16.6)	29(15.5)	2.858^b	0.239
饮酒[例(%)]	71(38.0)	66(35.3)	97(51.9)	12.953^b	0.002
BMI(x±s)	26.53±3.92	26.83±4.09	27.28±3.93	0.664^a	0.571
< 25	51(27.3)	50(26.7)	33(17.6)	7.061^b	0.133
25~30	73(39.0)	67(35.8)	84(44.9)
≥30	63(33.7)	70(37.4)	70(37.4)
腹围(x±s，cm)	91.13±11.21	93.15±10.78	82.58±9.68	1.440^a	0.237
腹型肥胖[例(%)]	102(54.5)	117(62.6)	121(64.7)	4.211^b	0.122
高血压[例(%)]	100(53.5)	88(47.1)	90(48.1)	1.766^b	0.413
高脂血症[例(%)]	61(32.6)	78(41.7)	72(38.5)	1.671^b	0.434
糖尿病[例(%)]	15(8.1)	22(11.8)	27(14.4)	3.778^b	0.151
脑卒中[例(%)]	19(10.1)	15(8.0)	14(7.5)	1.001^b	0.605
降压药物[例(%)]	42(22.5)	52(27.8)	39(20.9)	2.742^b	0.254
收缩压(x±s，mmHg)	132.53±18.24	131.80±18.49	131.16±16.39	0.573^a	0.568
舒张压(x±s，mmHg)	83.47±12.13	81.23±10.20	82.59±9.68	1.391^a	0.251
空腹血糖[M(P₂₅, P₇₅)，mmol/L]	5.23(4.60, 5.81)	5.20(4.73, 6.00)	5.49(4.81, 6.10)	6.320^c	0.042
血清总胆固醇[M(P₂₅, P₇₅)，mmol/L]	4.87(4.02, 5.52)	4.60(3.93, 5.22)	4.69(4.10, 5.55)	1.582^c	0.453
甘油三酯[M(P₂₅, P₇₅)，mmol/L]	1.05(0.70, 1.58)	1.20(0.80, 1.60)	1.31(0.90, 1.91)	15.958^c	< 0.001
血清肌酐[M(P₂₅, P₇₅)，mmol/L]	70.40(57.50, 91.00)	67.00(55.20, 85.70)	74.80(59.53, 94.10)	5.341^c	0.069
24小时尿钾[M(P₂₅, P₇₅)，mmol/L]	19.58(16.34, 25.88)	30.82(27.89, 33.22)	45.41(39.27, 59.82)	497.782^c	< 0.001
24小时尿肌酐[M(P₂₅, P₇₅)，mmol/L]	6.57(5.01, 8.60)	8.03(6.73, 10.10)	10.06(8.30, 12.96)	2.881^c	0.237
24小时尿蛋白[M(P₂₅, P₇₅)，mg]	40.00(25.00, 65.75)	39.00(23.00, 63.00)	44.50(28.00, 75.00)	5.774^c	0.056
肾小球滤过率[M(P₂₅, P₇₅)，mL/(min·1.73 m²)]	90.64(69.43, 103.39)	96.82(74.27, 107.97)	88.44(68.09, 104.18)	4.365^c	0.112
钾盐摄入[M(P₂₅, P₇₅)，g]	0.76(0.64, 0.89)	1.20(1.09, 1.30)	1.78(1.53, 2.10)	497.780^c	< 0.001
注：^a为F值，^b为χ²值, ^c为H值；1 mmHg=0.133 kPa。

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表 2 24小时尿钾三分位分组间MMSE评分及MCI患病率比较

Table 2. Comparison of MMSE scores and MCI prevalence among tertiles of 24-hour urinary potassium excretion

项目	T1:≤25.5(n=187)	T2:25.5~35.8(n=187)	T3:≥35.8(n=187)	统计量	P值
总MMSE得分[M(P₂₅, P₇₅)，分]	25.0(20.0, 28.0)^a	26(22.3, 28.3)^a	27.0(24.0, 29.0)	19.341^c	< 0.001
定向力[M(P₂₅, P₇₅)，分]	9.0(8.1, 10.0)^b	10.0(9.0, 10.0)^a	10.0(9.0, 10.0)	10.884^c	0.004
记忆力[M(P₂₅, P₇₅)，分]	3.0(2.5, 3.0)^a	3.0(3.0, 3.0)^a	3.0(3.0, 3.0)	8.920^c	0.012
注意力及计算能力[M(P₂₅, P₇₅)，分]	3.0(1.0, 5.0)^a	4.0(2.0, 5.0)^a	4.0(3.0, 5.0)	18.544^c	< 0.001
回忆能力[M(P₂₅, P₇₅)，分]	2.0(1.0, 3.0)^a	2.0(1.0, 3.0)^a	2.0(2.0, 3.0)	10.881^c	0.004
语言和表达能力[M(P₂₅, P₇₅)，分]	8.5(6.8, 9.0)^b	9.0(7.0, 9.0)^a	9.0(8.0, 9.0)	10.890^c	0.004
MCI患病[例(%)]	46(24.6)^a	44(23.5)^a	17(9.1)	18.183^d	< 0.001
年龄≥45岁人群[例(%)]	155(82.9)	144(77.0)	144(77.0)	-
总MMSE得分[M(P₂₅, P₇₅)，分]	24.0(20.0, 28.0)	25.7(21.8, 28.0)	26.0(23.0, 29.0)	8.172^c	< 0.001
定向力[M(P₂₅, P₇₅)，分]	9.0(8.0, 10.0)	10.0(8.0, 10.0)	10.0(8.0, 10.0)	1.841^c	0.161
记忆力[M(P₂₅, P₇₅)，分]	3.0(2.0, 3.0)	3.0(3.0, 3.0)^a	3.0(3.0, 3.0)	3.882^c	0.021
注意力及计算能力[M(P₂₅, P₇₅)，分]	3.0(1.0, 4.0)^b	4.0(2.0, 5.0)^a	4.0(2.0, 5.0)	7.251^c	0.001
回忆能力[M(P₂₅, P₇₅)，分]	2.0(1.0, 3.0)^a	2.0(1.0, 3.0)^a	2.0(2.0, 3.0)	5.538^c	0.004
语言和表达能力[M(P₂₅, P₇₅)，分]	8.0(6.0, 9.0)	9.0(7.0, 9.0)^a	9.0(7.0, 9.0)	4.176^c	0.016
MCI患病[例(%)]	44(28.4)^a	37(25.7)^a	16(11.1)	14.830^d	0.001
注：与T3比较，^aP < 0.05；与T2比较，^bP < 0.05；“-”为未比较。^c为H值，^d为χ²值。

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表 3 24小时尿钠、尿钾及盐摄入与MMSE评分相关性的多元线性回归分析

Table 3. Multivariate linear regression analysis of the correlation between 24-hour urinary sodium, potassium, salt intake and MMSE score

变量	未调整的β(95% CI)	P值	调整后的^a β(95% CI)	P值
总人群
24小时尿钠(mmol)	0.002(-0.003~0.008)	0.405	-0.007(-0.013~-0.001)	0.030
24小时尿钾(mmol)	0.049(0.023~0.074)	< 0.001	0.027(0.000~0.054)	0.047
盐摄入(g/d)	0.040(-0.055~0.136)	0.405	-0.116(-0.222~-0.011)	0.030
年龄≥45岁人群
24小时尿钠(mmol)	0.002(-0.004~0.009)	0.498	-0.006(-0.013~0.001)	0.096
24小时尿钾(mmol)	0.047(0.020~0.075)	0.001	0.026(-0.004~0.056)	0.085
盐摄入(g/d)	0.038(-0.071~0.147)	0.498	-0.102(-0.223~0.018)	0.096
注：^a根据年龄、性别、教育状况、职业、吸烟状况、饮酒假设、收缩压、中风、血脂异常、糖尿病、估计肾小球滤过率进行调整，24小时尿钠、24小时尿钾和盐摄入量，分析时分别调整另外2项。

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表 4 24小时尿钠、尿钾和盐摄入三分位数相对MCI风险简单或多元logistic回归分析

Table 4. Univariate analysis or multivariate logistic regression analysis of the association between tertiles of 24-hour urinary sodium, potassium, salt intake, and the relative risk of MCI

变量	简单logistic回归OR(95% CI)	P值	多元logistic^aOR(95% CI)	P值	多元logistic^bOR(95% CI)	P值
总人群
24小时尿钠^c
T2	1.692 (1.023~2.812)	0.043	2.277 (1.219~4.242)	0.009	2.812 (1.502~5.256)	0.001
T3	0.923 (0.527~1.611)	0.778	1.191 (0.603~2.342)	0.620	1.856 (0.932~3.753)	0.081
24小时尿钾^d
T1	3.265 (1.786~5.942)	< 0.001	2.703(1.366~5.333)	0.004	3.222(1.577~6.562)	0.001
T2	3.082 (1.688~5.623)	< 0.001	2.812(1.422~5.583)	0.003	3.022(1.513~6.029)	0.002
盐摄入^c
T2	1.691(1.023~2.814)	0.043	2.284 (1.216~4.245)	0.009	2.813 (1.502~5.264)	0.001
T3	0.923(0.532~1.614)	0.778	1.192 (0.604~2.337)	0.620	1.865 (0.931~3.748)	0.081
年龄≥45岁人群
24小时尿钠^c
T2	1.647(0.858~3.213)	0.137	2.113(0.927~4.771)	0.073	3.069(1.276~7.341)	0.012
T3	1.020 (0.502~2.073)	0.964	1.103(0.442~2.733)	0.846	2.162 (0.793~5.849)	0.132
24小时尿钾^d
T1	4.122(1.873~9.064)	< 0.001	4.101(1.634~10.302)	0.003	5.501 (2.029~14.893)	0.001
T2	3.214(1.427~7.213)	0.005	2.512(0.977~6.429)	0.056	2.652 (1.024~6.913)	0.046
盐摄入^c
T2	1.652(0.853~3.212)	0.137	2.111(0.932~4.767)	0.073	3.069 (1.281~7.342)	0.012
T3	1.024(0.501~2.072)	0.964	1.103(0.442~2.732)	0.846	2.162 (0.791~5.853)	0.132
注：^a为整年龄、性别、教育程度、职业、吸烟状况、饮酒情况、体重指数类别、收缩压、估计肾小球滤过率、中风、血脂异常、糖尿病。^b为当24小时尿钾、24小时尿钠或盐摄入量是预测变量时，调整其他两因素。^c为均以T1为参照；^d为均以T3为参照。

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参考文献(17)

[1]	胡寅田, 胡希文. 老年住院患者衰弱综合征与认知功能障碍和抑郁的相关性分析[J]. 中华全科医学, 2022, 20(11): 1913-1915, 1986. doi: 10.16766/j.cnki.issn.1674-4152.002734 HU Y T, HU X W. Correlation analysis of frailty syndrome with cognitive dysfunction and depression among elderly inpatients[J]. Chinese Journal of General Practice, 2022, 20(11): 1913-1915, 1986. doi: 10.16766/j.cnki.issn.1674-4152.002734
[2]	2023 Alzheimer ' s Association. Alzheimer ' s disease facts and figures[J]. Alzheimers Dement, 2023, 19(4): 1598-1695. doi: 10.1002/alz.13016
[3]	SAMSON A D, SHEN K, GRADY C L, et al. Alzheimer ' s disease neuroimaging initiative. exploration of salient risk factors involved in mild cognitive impairment[J]. Eur J Neurosci, 2022, 56(9): 5368-5383. doi: 10.1111/ejn.15665
[4]	JAYEDI A, GHOMASHI F, ZARGAR M S, et al. Dietary sodium, sodium-to-potassium ratio, and risk of stroke: a systematic review and nonlinear dose-response meta-analysis[J]. Clin Nutr, 2019, 38: 1092-1100. doi: 10.1016/j.clnu.2018.05.017
[5]	FARACO G, BREA D, GARCIA-BONILLA L, et al. Dietary salt promotes neurovascular and cognitive dysfunction through a gut-initiated TH17 response[J]. Nat Neurosci, 2018, 21: 240-249. doi: 10.1038/s41593-017-0059-z
[6]	KENDING M D, MORRIS M J. Reviewing the effects of dietary salt on cognition: mechanisms and future directions[J]. Asia Pac J Clin Nutr, 2019, 28: 6-14.
[7]	马月玲, 石红霞, 郭蕾, 等. 围绝经期女性轻度认知功能损害的影响因素研究[J]. 中华全科医学, 2020, 18(4): 577-580. doi: 10.16766/j.cnki.issn.1674-4152.001302 MA Y L, SHI H X, GUO L, et al. A study of the influencing factors of mild cognitive impairment in perimenopausal women[J]. Chinese Journal of General Practice, 2020, 18(4): 577-580. doi: 10.16766/j.cnki.issn.1674-4152.001302
[8]	OVERWYK K J, QUADER Z S, MAALOUF J, et al. Dietary sodium intake and health indicators: a systematic review of published literature between January 2015 and December 2019[J]. Adv Nutr, 2020, 11(5): 1174-1200. doi: 10.1093/advances/nmaa049
[9]	LI M, HEIZHATI M, WANG L, et al. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing[J]. J Clin Sleep Med, 2022, 18(11): 2589-2596. doi: 10.5664/jcsm.10168
[10]	MOHAMMSDIFARD N, KHOSARHOSRAVI A, SALAS-SALVAD J, et al. Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: the Isfahan salt study[J]. Nutr Metab Cardiovasc Dis, 2019, 29: 1323-1329. doi: 10.1016/j.numecd.2019.07.019
[11]	SUN N, MU J, LI Y. An expert recommendation on salt intake and blood pressure management in Chinese patients with hypertension: a statement of the chinese medical association hypertension professional committee[J]. J Clin Hypertens (Greenwich), 2019, 21: 446-450. doi: 10.1111/jch.13501
[12]	MEYER H E, JOHANSSON L, EGGEN A E, et al. Sodium and potassium intake assessed by spot and 24-h urine in the population-based Tromsø study 2015-2016[J]. Nutrients, 2019, 11: 1619. doi: 10.3390/nu11071619
[13]	FOLSTEIN M F, FOLSTRIN S E, MCHUGF P R. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res, 1975, 12(3): 189-198. doi: 10.1016/0022-3956(75)90026-6
[14]	NOWAK K, FRIED L, JOVANOVICH A, et al. Dietary sodium/potassium intake does not affect cognitive function or brain imaging indices[J]. Am J Nephrol, 2018, 47: 57-65. doi: 10.1159/000486580
[15]	TAN M, HE F J, WANG C, et al. Twenty-four-hour urinary sodium and potassium excretion in China: a systematic review and meta-analysis[J]. J Am Heart Assoc, 2019, 8(14): e012923. DOI: 10.1161/JAHA.119.012923.
[16]	HAN W, HU Y, TANG Y, et al. Relationship between urinary sodium with blood pressure and hypertension among a Kazakh community population in Xinjiang, China[J]. J Hum Hypertens, 2017, 31(5): 333-340. doi: 10.1038/jhh.2016.83
[17]	ZHOU L, ZHAO X, HEIZHATI M, et al. Trends in lipids and lipoproteins among adults in Northwestern Xinjiang, China, from 1998 through 2015[J]. J Epidemiol, 2019, 29: 257-263. doi: 10.2188/jea.JE20180018