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Article(id=1240730059519087260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410224, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729008000000, receivedDateStr=2024-10-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773742697839, onlineDateStr=2026-03-17, pubDate=1745510400000, pubDateStr=2025-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773742697839, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773742697839, creator=13701087609, updateTime=1773742697839, updator=13701087609, issue=Issue{id=1240730050669113883, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773742695728, creator=13701087609, updateTime=1773742807836, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240730520988995837, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240730520988995838, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1509, endPage=1516, ext={EN=ArticleExt(id=1240730059875603127, articleId=1240730059519087260, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Meta-analysis of risk factors for cognitive impairment in patients with multimorbidity, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the risk factors for cognitive impairment in patients with multimorbidity.

Methods

Studies on the occurrence of cognitive impairment in patients with multimorbidity were identified by searching Chinese and foreign databases: PubMed, Web of Science, Embase, Cochrane library, CNKI, Wan Fang Data, VIP, SinoMed. The search period was from database inception to July 1, 2024, meta-analysis was performed using RevMan5.4 and Stata18.0 software.

Results

A total of 12 studies were included, comprising 1 137 737 patients. The meta-analysis indicated that smoking (OR=1.11，95% CI=1.05-1.18), low social activity (OR=1.52，95% CI=1.06-2.17), having two chronic diseases (OR=1.15，95% CI=1.05-1.26), having three chronic diseases (OR=1.37，95% CI=0.96-1.94), having four or more chronic diseases (OR=1.67，95% CI=1.49-1.87), having two cardiovascular metabolic diseases (OR=1.72，95% CI=1.42-2.07), having three or more cardiovascular metabolic diseases (OR=2.53，95% CI=1.41-4.54), and eight multimorbidity models were the neuropsychiatric (OR=2.05，95% CI=1.83-2.29), cancer/sensory impairment (OR=1.32，95% CI=1.18-1.47) diabetes/heart disease (OR=2.17，95% CI=1.68-2.08) diabetes/stroke (OR=2.92，95% CI=1.49-5.71), diabetes/hypertension (OR=1.93，95% CI=1.72-2.17), hypertension/heart disease (OR=1.56，95% CI=1.40-1.74), stroke/heart disease (OR=2.65，95% CI=1.89-3.71), and stroke/diabetes-heart disease (OR=3.95，95% CI=2.81-5.56) showed statistically significant differences (all P<0.05).

Conclusion

Current evidence suggests that smoking, low social activity, number of chronic diseases, and different patterns of multimorbidity are all risk factors for cognitive impairment in patients with multimorbidity, and that early clinical screening and intervention is warranted to reduce the progression of cognitive impairment in patients with multimorbidity.

, correspAuthors=Hui WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Li YANG, Qi LI, Xing-xing CHEN, Zong-ze LYU, Yun-qing GU, Li-mei SU, Hui WANG), CN=ArticleExt(id=1240730061389747003, articleId=1240730059519087260, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=慢性病共病患者认知障碍危险因素的Meta分析, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

分析慢性病共病患者发生认知障碍的危险因素。

方法

通过检索中、外数据库：PubMed、Web of Science、Embase、Cochrane library、CNKI、Wan Fang Data、VIP、SinoMed。检索慢性病共病患者发生认知障碍的研究。检索建库至2024年7月1日，使用RevMan 5.4和Stata 18.0软件进行Meta分析。

结果

共纳入12篇文献，共1 137 737例患者。结果显示吸烟（OR=1.11，95% CI=1.05~1.18）、低社交活动(OR=1.52，95% CI=1.06~2.17）、患2种慢性病（OR=1.15，95% CI=1.05~1.26）、患3种慢性病（OR=1.37，95% CI=0.96~1.94）、患4种及以上慢性病（OR=1.67，95% CI=1.49~1.87）、患2种心血管代谢性疾病（OR=1.72，95% CI=1.42~2.07）、患3种及以上心血管代谢性疾病（OR=2.53，95% CI=1.41~4.54）及8种共病模式分别为神经精神类（OR=2.05，95% CI=1.83~2.29）、癌症/感觉障碍（OR=1.32，95% CI=1.18~1.47）、糖尿病/心脏病（OR=2.17，95% CI=1.68~2.08）、糖尿病/中风（OR=2.92，95% CI=1.49~5.71）、糖尿病/高血压（OR=1.93，95% CI=1.72~2.17）、高血压/心脏病（OR=1.56，95% CI=1.40~1.74）、中风/心脏病（OR=2.65，95% CI=1.89~3.71）、中风/糖尿病/心脏病（OR=3.95，95% CI=2.81~5.56）差异均有统计学意义(均P<0. 05)。

结论

当前证据显示吸烟、低社交活动、慢病数量、不同共病模式均是慢性病共病患者发生认知障碍的危险因素，临床应早期筛查并干预，降低慢性病共病患者认知障碍的进展。

, correspAuthors=王慧, authorNote=null, correspAuthorsNote=
王慧，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=N/xxp9q1Jup/0cMvAkB3/Q==, magXml=sUoh8k3qw3VcseRy76+wBA==, pdfUrl=null, pdf=SPi3TaoJi5skJG0EUbqrFA==, pdfFileSize=2182426, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=BGO0Sv28j5d5ZqZCbKGg+w==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=yQ+cPpFLVGx9L61TPyniow==, mapNumber=null, authorCompany=null, fund=null, authors=

杨丽 (2000— )，女，硕士在读，研究方向：老年护理

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杨丽 (2000— )，女，硕士在读，研究方向：老年护理

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杨丽 (2000— )，女，硕士在读，研究方向：老年护理

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Characteristics of the studies included in the Meta-analysis

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作者发表年份（年）研究类型研究地区年龄总样本量评估工具危险因素质量评分
Koyanagi[10]2018横断面研究中国、加纳、印度、墨西哥、俄罗斯、南非62.1±15.632 715WAIS量表1、2、3、158
Grande[11]2020队列研究瑞典75±10.42 478MMSE量表6、7、88
Hu[12]2022队列研究英国62.32±4.08245 483ICD9、ICD10代码1、2、39
Wang[13]2019队列研究瑞典73.6±10.52 648MMSE量表4、5、9、10、12、14、168
Valletta[14]2023队列研究瑞典73.6±10.73 122认知功能亚领域测试（执行功能、情景记忆、知觉速度、语言、视觉空间能力）6、7、89
Dove[15]2023队列研究瑞典72.4±10.02 577认知功能亚领域测试（情景记忆、知觉速度、语言流畅性等）4、9、10、12、149
Tai[16]2022队列研究英国64.9±3.0203 083ICD9、ICD10代码9、10、12、149
Khondoker[17]2022队列研究英国58.0（50.0，63.0）447 888ICD9、ICD10代码6、7、15、168
Xing[18]2024队列研究中国79.1±9.586 116MMSE量表1、4、59
Xiong[19]2023队列研究英国64.1±2.8171 538ICD9、ICD10代码4、5、9、11、12、139
Dove[20]2023队列研究瑞典70.1±7.517 913ICD代码9、10、12、149
Vassilaki[21]2015队列研究美国（Minnesota）78.5±5.22 176CDR量表3、9、138
), ArticleFig(id=1241070740510929771, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730059519087260, language=CN, label=表1, caption=

纳入研究的基本特征

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作者发表年份（年）研究类型研究地区年龄总样本量评估工具危险因素质量评分
Koyanagi[10]2018横断面研究中国、加纳、印度、墨西哥、俄罗斯、南非62.1±15.632 715WAIS量表1、2、3、158
Grande[11]2020队列研究瑞典75±10.42 478MMSE量表6、7、88
Hu[12]2022队列研究英国62.32±4.08245 483ICD9、ICD10代码1、2、39
Wang[13]2019队列研究瑞典73.6±10.52 648MMSE量表4、5、9、10、12、14、168
Valletta[14]2023队列研究瑞典73.6±10.73 122认知功能亚领域测试（执行功能、情景记忆、知觉速度、语言、视觉空间能力）6、7、89
Dove[15]2023队列研究瑞典72.4±10.02 577认知功能亚领域测试（情景记忆、知觉速度、语言流畅性等）4、9、10、12、149
Tai[16]2022队列研究英国64.9±3.0203 083ICD9、ICD10代码9、10、12、149
Khondoker[17]2022队列研究英国58.0（50.0，63.0）447 888ICD9、ICD10代码6、7、15、168
Xing[18]2024队列研究中国79.1±9.586 116MMSE量表1、4、59
Xiong[19]2023队列研究英国64.1±2.8171 538ICD9、ICD10代码4、5、9、11、12、139
Dove[20]2023队列研究瑞典70.1±7.517 913ICD代码9、10、12、149
Vassilaki[21]2015队列研究美国（Minnesota）78.5±5.22 176CDR量表3、9、138
), ArticleFig(id=1241070740653536113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730059519087260, language=EN, label=Table 2, caption=

Results of Meta-analysis and Sensitivity Analysis of risk factors for cognitive impairment in patients with chronic comorbidities

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危险因素研究篇数异质性检验模型Meta分析结果敏感性分析OR（95% CI）
I2（%）P值OR（95% CI）Z值（P值）
慢性病数量
2种[10,12,18]300.73固定1.15（1.05~1.26）3.05（0.002）1.15（1.05~1.26）
3种[10,18]2680.08随机1.37（0.96~1.94）2.86（0.004）1.32（1.09~1.61）
≥4种[10,12,21]300.77固定1.67（1.49~1.87）8.80（<0.001）1.61（1.49~1.87）
其他共病模式
神经精神类疾病[11,14,17]3200.29固定2.05（1.83~2.29）12.51（<0.001）1.97（1.66~2.35）
癌症/感觉障碍[11,14,17]300.48固定1.32（1.18~1.47）4.85（0.001）1.32（1.18~1.47）
呼吸/MSK/代谢[11,14]200.76固定0.94（0.75~1.19）0.48（0.63）0.94（0.75~1.19）
心血管代谢性疾病数量
2种[13,15,18-19]4700.02随机1.72（1.42~2.07）5.61（<0.001）1.69（1.56~1.82）
≥3种[13,18-19]395<0.01随机2.53（1.41~4.54）3.12（0.002）2.23（2.01~2.27）
心血管代谢性共病模式
糖尿病/心脏病[13,15,18-21]676<0.01随机2.17（1.68~2.80）5.95（<0.001）2.20（1.98~2.44）
糖尿病/中风[13,16,20]3660.05随机2.92（1.49~5.71）3.12（0.002）3.74（2.91~4.81）
糖尿病/高血压[15,19]200.71固定1.93（1.72~2.17）10.94（<0.001）1.93（1.72~2.17）
心脏病/高血压[19,21]200.82固定1.56（1.40~1.74）8.14（<0.001）1.56（1.40~1.74）
中风/心脏病[13,15-16,19-20]5590.05随机2.65（1.89~3.71）10.05（<0.001）2.73（2.24~3.31）
糖尿病/中风/心脏病[13,15-16,20]4460.13固定3.95（2.81~5.56）7.78（<0.001）4.61（3.20~6.63）
生活方式因素
吸烟[10,17]200.49固定1.11（1.05~1.18）3.86（<0.001）1.11（1.05~1.18）
社交活动（低）[13,17]2670.08随机1.52（1.06~2.17）2.30（0.02）1.35（1.42~1.49）
), ArticleFig(id=1241070740804531063, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730059519087260, language=CN, label=表2, caption=

慢性病共病患者认知障碍危险因素的Meta分析及敏感性分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素研究篇数异质性检验模型Meta分析结果敏感性分析OR（95% CI）
I2（%）P值OR（95% CI）Z值（P值）
慢性病数量
2种[10,12,18]300.73固定1.15（1.05~1.26）3.05（0.002）1.15（1.05~1.26）
3种[10,18]2680.08随机1.37（0.96~1.94）2.86（0.004）1.32（1.09~1.61）
≥4种[10,12,21]300.77固定1.67（1.49~1.87）8.80（<0.001）1.61（1.49~1.87）
其他共病模式
神经精神类疾病[11,14,17]3200.29固定2.05（1.83~2.29）12.51（<0.001）1.97（1.66~2.35）
癌症/感觉障碍[11,14,17]300.48固定1.32（1.18~1.47）4.85（0.001）1.32（1.18~1.47）
呼吸/MSK/代谢[11,14]200.76固定0.94（0.75~1.19）0.48（0.63）0.94（0.75~1.19）
心血管代谢性疾病数量
2种[13,15,18-19]4700.02随机1.72（1.42~2.07）5.61（<0.001）1.69（1.56~1.82）
≥3种[13,18-19]395<0.01随机2.53（1.41~4.54）3.12（0.002）2.23（2.01~2.27）
心血管代谢性共病模式
糖尿病/心脏病[13,15,18-21]676<0.01随机2.17（1.68~2.80）5.95（<0.001）2.20（1.98~2.44）
糖尿病/中风[13,16,20]3660.05随机2.92（1.49~5.71）3.12（0.002）3.74（2.91~4.81）
糖尿病/高血压[15,19]200.71固定1.93（1.72~2.17）10.94（<0.001）1.93（1.72~2.17）
心脏病/高血压[19,21]200.82固定1.56（1.40~1.74）8.14（<0.001）1.56（1.40~1.74）
中风/心脏病[13,15-16,19-20]5590.05随机2.65（1.89~3.71）10.05（<0.001）2.73（2.24~3.31）
糖尿病/中风/心脏病[13,15-16,20]4460.13固定3.95（2.81~5.56）7.78（<0.001）4.61（3.20~6.63）
生活方式因素
吸烟[10,17]200.49固定1.11（1.05~1.18）3.86（<0.001）1.11（1.05~1.18）
社交活动（低）[13,17]2670.08随机1.52（1.06~2.17）2.30（0.02）1.35（1.42~1.49）
), ArticleFig(id=1241070740917777277, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730059519087260, language=EN, label=Table 3, caption=

Exclusion analysis of risk factors of cognitive impairment

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素排除文献排除前排除后
模型OR (95% CI)模型OR (95% CI)
慢性病数量
2种XiaolongXing 2024随机1.15（1.05~1.26）固定1.17（1.03~1.32）
≥4种Heying Hu 2022固定1.67（1.49~1.87）固定1.72（1.39~2.12）
心血管代谢性疾病数量
≥3种XiaolongXing 2024随机2.53（1.41~4.54）固定3.01（2.62~3.46）
2种XiaolongXing 2024随机1.72（1.42~2.07）固定1.81（1.65~1.98）
心血管代谢性共病模式
糖尿病/心脏病XinyouTai 2022随机2.17（1.68~2.80）固定1.95（1.58~2.41）
糖尿病/中风XinyouTai 2022随机2.92（1.49~5.71）固定4.25（3.22~5.59）
糖尿病/中风/心脏病XinyouTai 2022固定4.61（3.20~6.63）固定3.81（2.21~6.55）
), ArticleFig(id=1241070741031023490, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730059519087260, language=CN, label=表3, caption=

认知障碍危险因素的排除分析

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素排除文献排除前排除后
模型OR (95% CI)模型OR (95% CI)
慢性病数量
2种XiaolongXing 2024随机1.15（1.05~1.26）固定1.17（1.03~1.32）
≥4种Heying Hu 2022固定1.67（1.49~1.87）固定1.72（1.39~2.12）
心血管代谢性疾病数量
≥3种XiaolongXing 2024随机2.53（1.41~4.54）固定3.01（2.62~3.46）
2种XiaolongXing 2024随机1.72（1.42~2.07）固定1.81（1.65~1.98）
心血管代谢性共病模式
糖尿病/心脏病XinyouTai 2022随机2.17（1.68~2.80）固定1.95（1.58~2.41）
糖尿病/中风XinyouTai 2022随机2.92（1.49~5.71）固定4.25（3.22~5.59）
糖尿病/中风/心脏病XinyouTai 2022固定4.61（3.20~6.63）固定3.81（2.21~6.55）
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慢性病共病患者认知障碍危险因素的Meta分析
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杨丽 1, 3 , 李琦 1, 3 , 陈星星 4 , 吕宗泽 1, 3 , 谷云青 2, 3 , 苏利梅 2, 3 , 王慧 2, 3, *
现代预防医学 | 临床与预防 2025,52(8): 1509-1516
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现代预防医学 | 临床与预防 2025, 52(8): 1509-1516
慢性病共病患者认知障碍危险因素的Meta分析
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杨丽1, 3, 李琦1, 3, 陈星星4, 吕宗泽1, 3, 谷云青2, 3, 苏利梅2, 3, 王慧2, 3, *
作者信息
  • 1.广州中医药大学第五临床医学院，广东　广州　510405
  • 2.广东省第二中医院
  • 3.广东省中医药研究开发重点实验室
  • 4.南京六合中等专业学校

    • 杨丽 (2000— )，女，硕士在读，研究方向：老年护理

通讯作者:

王慧，E-mail:
Meta-analysis of risk factors for cognitive impairment in patients with multimorbidity
Li YANG1, 3, Qi LI1, 3, Xing-xing CHEN4, Zong-ze LYU1, 3, Yun-qing GU2, 3, Li-mei SU2, 3, Hui WANG2, 3, *
Affiliations
  • The Fifth Clinical College of Guangzhou University of Chinese Medicine， Guangdong, Guangzhou 510405， China
出版时间: 2025-04-25 doi: 10.20043/j.cnki.MPM.202410224
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摘要
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目的

分析慢性病共病患者发生认知障碍的危险因素。

方法

通过检索中、外数据库：PubMed、Web of Science、Embase、Cochrane library、CNKI、Wan Fang Data、VIP、SinoMed。检索慢性病共病患者发生认知障碍的研究。检索建库至2024年7月1日，使用RevMan 5.4和Stata 18.0软件进行Meta分析。

结果

共纳入12篇文献，共1 137 737例患者。结果显示吸烟（OR=1.11，95% CI=1.05~1.18）、低社交活动(OR=1.52，95% CI=1.06~2.17）、患2种慢性病（OR=1.15，95% CI=1.05~1.26）、患3种慢性病（OR=1.37，95% CI=0.96~1.94）、患4种及以上慢性病（OR=1.67，95% CI=1.49~1.87）、患2种心血管代谢性疾病（OR=1.72，95% CI=1.42~2.07）、患3种及以上心血管代谢性疾病（OR=2.53，95% CI=1.41~4.54）及8种共病模式分别为神经精神类（OR=2.05，95% CI=1.83~2.29）、癌症/感觉障碍（OR=1.32，95% CI=1.18~1.47）、糖尿病/心脏病（OR=2.17，95% CI=1.68~2.08）、糖尿病/中风（OR=2.92，95% CI=1.49~5.71）、糖尿病/高血压（OR=1.93，95% CI=1.72~2.17）、高血压/心脏病（OR=1.56，95% CI=1.40~1.74）、中风/心脏病（OR=2.65，95% CI=1.89~3.71）、中风/糖尿病/心脏病（OR=3.95，95% CI=2.81~5.56）差异均有统计学意义(均P<0. 05)。

结论

当前证据显示吸烟、低社交活动、慢病数量、不同共病模式均是慢性病共病患者发生认知障碍的危险因素，临床应早期筛查并干预，降低慢性病共病患者认知障碍的进展。

认知障碍  /  慢性病共病  /  危险因素  /  Meta分析
Objective

To analyze the risk factors for cognitive impairment in patients with multimorbidity.

Methods

Studies on the occurrence of cognitive impairment in patients with multimorbidity were identified by searching Chinese and foreign databases: PubMed, Web of Science, Embase, Cochrane library, CNKI, Wan Fang Data, VIP, SinoMed. The search period was from database inception to July 1, 2024, meta-analysis was performed using RevMan5.4 and Stata18.0 software.

Results

A total of 12 studies were included, comprising 1 137 737 patients. The meta-analysis indicated that smoking (OR=1.11，95% CI=1.05-1.18), low social activity (OR=1.52，95% CI=1.06-2.17), having two chronic diseases (OR=1.15，95% CI=1.05-1.26), having three chronic diseases (OR=1.37，95% CI=0.96-1.94), having four or more chronic diseases (OR=1.67，95% CI=1.49-1.87), having two cardiovascular metabolic diseases (OR=1.72，95% CI=1.42-2.07), having three or more cardiovascular metabolic diseases (OR=2.53，95% CI=1.41-4.54), and eight multimorbidity models were the neuropsychiatric (OR=2.05，95% CI=1.83-2.29), cancer/sensory impairment (OR=1.32，95% CI=1.18-1.47) diabetes/heart disease (OR=2.17，95% CI=1.68-2.08) diabetes/stroke (OR=2.92，95% CI=1.49-5.71), diabetes/hypertension (OR=1.93，95% CI=1.72-2.17), hypertension/heart disease (OR=1.56，95% CI=1.40-1.74), stroke/heart disease (OR=2.65，95% CI=1.89-3.71), and stroke/diabetes-heart disease (OR=3.95，95% CI=2.81-5.56) showed statistically significant differences (all P<0.05).

Conclusion

Current evidence suggests that smoking, low social activity, number of chronic diseases, and different patterns of multimorbidity are all risk factors for cognitive impairment in patients with multimorbidity, and that early clinical screening and intervention is warranted to reduce the progression of cognitive impairment in patients with multimorbidity.

Cognitive dysfunction  /  Multimorbidity  /  Risk factors  /  Meta-analysis
杨丽, 李琦, 陈星星, 吕宗泽, 谷云青, 苏利梅, 王慧. 慢性病共病患者认知障碍危险因素的Meta分析. 现代预防医学, 2025 , 52 (8) : 1509 -1516 . DOI: 10.20043/j.cnki.MPM.202410224
Li YANG, Qi LI, Xing-xing CHEN, Zong-ze LYU, Yun-qing GU, Li-mei SU, Hui WANG. Meta-analysis of risk factors for cognitive impairment in patients with multimorbidity[J]. Modern Preventive Medicine, 2025 , 52 (8) : 1509 -1516 . DOI: 10.20043/j.cnki.MPM.202410224
正文
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调查显示，慢性病患病率逐年上升，且多种慢性病往往同时共存[1]。同一个体同时患有两种或两种以上的慢性疾病或病症的现象被称为慢性病共病（Multimorbidity）[2]。截至2021年末，我国慢性病共病患病率为43.65%[3]，且近年来呈增长趋势。已有研究发现慢性病共病会加速认知功能衰退，即慢性病共病累积越多，认知能力下降越显著，认知障碍发生风险也随之增加[4-5]。慢性病共病和认知障碍共同影响会严重导致患者健康预期寿命损失、生活质量下降和医疗成本上升，甚至增加其死亡风险，对个人、家庭及社会造成严重的医疗和经济负担[6]。因此对慢性病共病患者进行认知障碍危险因素的早期筛查与干预，对于预防和延缓认知障碍的进程具有重要意义。目前国内外已有若干研究对慢性病共病患者发生认知障碍的危险因素进行探讨，但其部分研究结果存在不一致之处[4]，且尚未进行系统的荟萃分析。本研究旨在通过对已发表文献中慢性病共病患者发生认知障碍的危险因素进行荟萃分析，为制订有针对性预防和管理策略提供证据支持。
1　资料与方法
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1.1　检索策略
采取主题词与自由词结合的方法在PubMed、Web of Science、Embase、Cochrane library、CNKI、Wan Fang Data、VIP、SinoMed数据库中检索相关文献。检索时间为建库至2024年7月1日。以PubMed数据库为例检索策略见图1。
1.2　文献纳入与排除标准
1.2.1　纳入标准
（1）研究对象为慢性病共病发生认知障碍的患者；（2）结局指标：慢性病共病患者发生认知障碍的危险因素，研究数据可提取HR/OR/RR及95% CI；（3）研究类型为队列研究或横断面研究；（4）研究工具：使用认知障碍相关量表；（5）文献语种：中文或英文文献。
1.2.2　排除标准
（1）综述/会议或个案等文献；（2）文献数据不全、文献发表重复或全文无法获取；（3）文献质量低；（4）文献为动物实验。
1.3　文献数据提取及质量评价
由2名研究人员对检索到的文献进行独立筛选和资料提取，如有争议与第3名研究者协商决定。内容提取如下：第一作者、发表年份、年龄均值、研究地区、研究类型、评估工具、样本总量、危险因素。对纳入文献进行质量评价，横断面研究选择美国卫生保健质量和研究机构（Agency for Healthcare Research and Quality, AHRQ）[7]的评价标准进行评价，共11个条目，其中≥8分为高质量，4~7分为中等质量，0~3分为低质量。队列研究采用纽卡斯尔渥太华量表（Newcastle-Ottawa Scale, NOS）[8] 的标准进行质量评价，该量表满分 9分，≥7分为高质量，4~6分为中等质量，1~3分为低质量。
1.4　统计学分析
使用Revman 5.4和Stata 18.0软件进行数据分析；采用比值比（Odds Ratio，OR）为效应量，并计算合并效应量和95% CI。采用I2进行异质性检验，若I2<50%，P≥0.1，采用固定效应模型，反之则采用随机效应模型[9]。运用Q检验对合并效应量及95% CI进行检验。对于存在明显异质性的危险因素，改变合并效应模型和逐一剔除法进行敏感性分析判断结果稳定性。发表偏倚使用Egger检验，若P>0.05，提示发表偏倚可能性较小。
2　结果
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2.1　文献检索结果
初次检索所获文献共12 563篇，阅读全文后最终纳入符合标准文献共12篇，均为英文文献，见图2。
2.2　文献基本特征及质量评价
本研究共纳入12[10-21]篇文献，其中包括11篇队列研究，质量评价均在7分以上；横断面研究1篇，质量评价为8分。共纳入危险因素16个，共1 137 737例研究对象，见表1。
2.3　Meta分析结果
患2种慢性病、患4种及以上慢性病、神经精神类、癌症/感觉障碍、糖尿病/高血压、心脏病/高血压、糖尿病/中风/心脏病共病模式、吸烟8个危险因素不存在异质性，采用固定效应模型，差异有统计学意义（P<0.05）；患3种慢性病、患2种心脏代谢性疾病、患3种及以上心脏代谢性疾病、糖尿病/心脏病、糖尿病/中风、心脏病/中风共病模式、社交活动（低）7个危险因素存在异质性，采用随机效应模型，差异有统计学意义（P<0.05），见表2。
2.3.1　敏感性分析
（1）改变合并效应模型，观察数据差异大小判断结果是否稳定。除糖尿病/中风共病模式外其他危险因素一致性较好，结果具有稳定性见表2。（2）逐一剔除法，对I2>50%且>2篇的文献采取逐一剔除法进行敏感性分析。除患2种慢性病、患2种、患3种及以上心血管代谢性疾病、糖尿病/中风、糖尿病/心脏病共病模式外，其余meta分析结果与原研究结果一致，见表3；敏感性分析图的结果显示除患3种及以上心血管代谢性疾病外均未发生反转，结果具有稳定性，见图4。
2.3.2　发表偏倚检验
本研究采用漏斗图及Egger检验进行发表偏倚分析，结果显示漏斗图无明显偏倚；Egger检验糖尿病/心脏病共病模式（P=0.439）、中风/心脏病共病模式（P=0.679），均不存在发表偏倚，见图5。
3　讨论
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3.1　生活方式因素
本研究结果显示吸烟、低社交活动等不健康的生活方式会增加慢性病患者发生认知障碍的风险。（1）吸烟：过度吸烟造成血管损伤加速脑神经血管病变，进而增加认知障碍的风险。（2）低社交活动：Stern [22]血管假说与知识储备假说表明，积极社交活动可补偿慢性病共病对认知障碍的影响。相反，低社交活动将进一步推进病情进展。Qiu等[23]研究表明不健康的生活方式因素越多，慢性病共病相关的认知功能下降越快。因此，应重点关注吸烟、低社交活动的慢性病患者，加强认知障碍的风险筛查，并对早期生活方式进行干预。
3.2　慢性病数量因素
本研究结果显示，慢性病共病数量与认知障碍发生风险增加密切相关。认知功能下降会随着慢性病共病数量的增加而呈现剂量依赖性加速，这与Jin等人研究结果一致[24]。研究报告指出[25]，一些不是认知功能障碍既定风险因素的健康问题或疾病，当与风险因素组合会导致高虚弱指数，进而增加认知障碍的发生风险。由此表明，高疾病负担会增加认知障碍的风险，改善患者整体疾病状况、降低共病数量能有效降低这一风险。因此，对老年早期慢性病患者实施针对性干预，预防共病发展很有必要。
3.3　共病模式因素
3.3.1　心血管代谢性共病模式
本研究结果显示心血管代谢性共病模式最为常见，且相比其他共病模式发生认知障碍风险更高，研究表明[26]，心血管代谢性共病模式会产生特定的积累效应。糖尿病特征的慢性高血糖导致氧化应激，引发包括动脉粥样硬化病变在内的系统性动脉粥样硬化是神经退行性病变的基础过程；卒中或心脏病会造成慢性脑灌注不足，导致脑血管病变的发生[27]；高血压损伤血管内皮，引发脑血管损伤[28]，这几种相互叠加的机制导致血管和神经退行性病变，加速认知功能退化。此外，慢性病患者常伴慢性炎症，炎症在心血管代谢性共病的发病机制中存在重要作用，加速认知衰退的进程[28]。本研究表明，两种心血管代谢性共病模式中，糖尿病/中风共病模式与认知障碍的相关性最强，考虑为单一心脏代谢性疾病中中风对认知功能下降的影响最为显著[24]，糖尿病也会通过对髓鞘的毒性作用直接导致神经元死亡[27]；高血压/心脏病共病模式与认知障碍的相关性最低，考虑为高血压与心脏病主要通过血管内皮损伤引发脑血管损伤，这一过程相对渐进；中风/心脏病/糖尿病共病模式的认知障碍发生率约为未患病人群的4倍。其原因考虑为三种慢性病之间相互作用导致的累积效应，从而显著加剧认知障碍[29]。然而，由于本研究仅纳入一个三种慢性病共病模式，导致未能对其他三种共病模式进行分析，未来应纳入更多文献，进行全面评估。综上，不同心血管代谢性共病模式对认知障碍发生的潜在风险不同，因此，积极识别共病模式对于制订精准干预策略、延缓认知障碍发展有重要意义。
3.3.2　其他共病模式
（1）神经精神类共病模式: 本研究结果表明神经精神类共病是认知障碍发生的危险因素。研究表明[30]认知障碍与神经精神类疾病有相通的病理基础，神经系统疾病会增加认知功能退化的风险，行为症状也可反映认知障碍的前驱表现。（2）癌症/感觉障碍共病模式：本研究结果显示癌症/感觉障碍共病模式与认知障碍发生相关。研究表明[31] 这可能与癌症治疗常导致慢性疼痛和神经损伤从而引发感觉障碍有关。（3）呼吸/MSK/代谢共病模式：本研究显示呼吸/MSK/代谢共病模式对认知障碍发生无影响。然而，Shang[4]表明严重的呼吸疾病可能导致认知障碍发生率增高，与本研究结果相悖。考虑到本研究纳入研究较少，可能是结果出现较大偏差的原因之一。
3.4　本研究的局限性
（1）本研究纳入研究多为队列研究，仅1篇横断面研究，结果可能存在偏倚；（2）本研究中认知障碍评估工具不统一，可能造成测量偏倚；（3）本研究部分危险因素纳入研究较少，无法进行异质性分析。
基金
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  • 广东省中医药局科研项目(20221031)
文献
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2025年第52卷第8期
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文章信息
doi: 10.20043/j.cnki.MPM.202410224
  • 接收时间：2024-10-16
  • 首发时间：2026-03-17
  • 出版时间：2025-04-25
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  • 收稿日期：2024-10-16
基金
广东省中医药局科研项目(20221031)
作者信息
    1.广州中医药大学第五临床医学院，广东　广州　510405
    2.广东省第二中医院
    3.广东省中医药研究开发重点实验室
    4.南京六合中等专业学校

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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