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Article(id=1241035544352846510, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408138, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723305600000, receivedDateStr=2024-08-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815531098, onlineDateStr=2026-03-18, pubDate=1735056000000, pubDateStr=2024-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815531098, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815531098, creator=13701087609, updateTime=1773815531098, updator=13701087609, issue=Issue{id=1241035543589483182, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815530917, creator=13701087609, updateTime=1773815686426, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036195896029478, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036195896029479, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4548, endPage=4554, ext={EN=ArticleExt(id=1241035544587727535, articleId=1241035544352846510, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effects of tooth loss and denture use on cognitive impairment in the elderly, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the effects of tooth loss and denture use on cognitive impairment in the elderly.

Methods

Based on the data of China Health and Retirement Longitudinal Study (CHARLS), over 60-year-old elderlies were selected as the research subjects.Logistic regression was conducted to explore the effects of tooth loss, denture use on cognitive impairment in elderly and subgroup analysis, and interaction analysis were performed for gender and social participation.

Results

A total of 4 372 elderly people were enrolled, and the rate of cognitive impairment was 16.20% (709/4 372). Older age, female, rural living, lower education, no spouse, with depressive symptoms, and without social-participation are risk factors for cognitive impairment. Group of non-total tooth loss without dentures (OR=1.382; 95% CI: 1.145-1.669) and group of total tooth loss without dentures (OR=2.074; 95% CI: 1.186-3.627) were associated with an increased risk of cognitive impairment. The results of subgroup analysis showed that the male population with non-total tooth loss and no dentures (OR=1.413; 95% CI: 1.077-1.853), with total tooth loss and no dentures (OR=2.600; 95% CI: 1.263-5.352) was still associated with an increased risk of cognitive impairment, while the female with non-total tooth loss and no dentures (OR=1.363; 95% CI: 1.046-1.776) was significantly associated with an increased risk of cognitive impairment.The non-social-participation-group with non-total tooth loss and no dentures (OR=1.475; 95% CI: 1.123-1.937), with total tooth loss and no dentures (OR=2.720; 95% CI: 1.294-5.715) were associated with an increased risk of cognitive impairment.There was no interaction between tooth loss, denture use, genderand social participation in the incidence of cognitive impairment(P>0.05).

Conclusion

The combination of tooth loss and denture use is an independent influence factor for cognitive impairment. The use of dentures can reduce the adverse effects of tooth loss on cognitive dysfunction, especially for those with partial tooth loss. The elderly should be encouraged to retain natural teeth, restore missing teeth in time. Although there is no interaction between tooth loss, denture use and social participation, older adults are suggested to take part in social activities.

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目的

探讨老年人牙齿缺失、义齿使用对认知功能障碍的影响，为有效预防认知功能减退提供思路。

方法

使用中国健康与养老追踪调查（CHARLS）2018年全国调查数据，选取≥60岁的老年人为研究对象，使用logistic回归探讨牙齿缺失、义齿使用对老年人认知功能障碍的影响，并对性别、社会参与进行亚组和交互作用分析。

结果

共纳入≥60岁老年人4 372名，认知功能障碍检出率为16.22%（709/4 372），年龄大、女性、居住在农村、受教育程度低、无配偶、有抑郁症状、无社会参与是认知功能障碍的风险因素。调整混杂因素后，非全牙缺失且无义齿（OR=1.382；95% CI：1.145～1.669），全牙缺失且无义齿（OR=2.074；95% CI：1.186～3.627）均会增加认知功能障碍的风险。亚组分析结果显示，男性人群中非全牙缺失且无义齿（OR=1.413；95% CI：1.077～1.853）、全牙缺失且无义齿（OR=2.600；95% CI：1.263～5.352）仍与认知功能障碍风险增加有关，而女性人群中仅有非全牙缺失且无义齿（OR=1.363；95% CI：1.046～1.776）与认知功能障碍的风险增加相关；无社会参与组中非全牙缺失且无义齿（OR=1.475；95% CI：1.123～1.937）、全牙缺失且无义齿（OR=2.720；95% CI：1.294～5.715）与认知功能障碍风险增加有关，而有社会参与组该变化无统计学意义。牙齿缺失、义齿使用与性别、社会参与各亚组间在认知功能障碍患病方面均无交互作用（P>0.05）。

结论

使用义齿可以减轻牙齿缺失对认知功能障碍的影响，尤其是部分牙齿缺失者。应鼓励老年人尽可能保留自然牙，及时修复缺失牙，减少认知功能减退的发生。尽管本研究并未发现牙齿缺失、义齿使用与社会参与的交互作用，但仍建议老年人积极参与社交活动。

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钱英，E-mail:
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张宇蝶（1999—），女，硕士，研究方向：老年护理

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Nature Aging, 2023, 3(5): 532-545., articleTitle=Social participation and risk of developing dementia, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241069991362097839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, xref=null, ext=[AuthorCompanyExt(id=1241069991366292144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, companyId=1241069991362097839, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China), AuthorCompanyExt(id=1241069991383069361, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, companyId=1241069991362097839, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=杭州师范大学护理学院，浙江 杭州 311121)])], figs=[ArticleFig(id=1241069995841614692, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=EN, label=Fig.1, caption=Forest diagram of the effects of tooth loss and denture use on cognitive impairment, figureFileSmall=O4T/Tpy4bTv6EItWEEdl5w==, figureFileBig=WpjZchNaRKkS2oHOiHGXNg==, tableContent=null), ArticleFig(id=1241069995954860908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=CN, label=图1, caption=牙齿缺失、义齿使用对认知功能障碍影响的森林图, figureFileSmall=O4T/Tpy4bTv6EItWEEdl5w==, figureFileBig=WpjZchNaRKkS2oHOiHGXNg==, tableContent=null), ArticleFig(id=1241069996114244463, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=EN, label=Fig.2, caption=Forest diagram of analysis of the effects of tooth loss and denture use on cognitive impairment, figureFileSmall=HwKts2zNQipKN7+UuqH0Fw==, figureFileBig=1JJqYjv6gqKVLdnaIly8/A==, tableContent=null), ArticleFig(id=1241069996193936243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=CN, label=图2, caption=牙齿缺失、义齿使用对认知功能障碍影响的亚组分析森林图, figureFileSmall=HwKts2zNQipKN7+UuqH0Fw==, figureFileBig=1JJqYjv6gqKVLdnaIly8/A==, tableContent=null), ArticleFig(id=1241069996294599544, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=EN, label=Table 1, caption=

Description of cognitive impairment in the elderly with different characteristics

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类别总体（n=4 372）认知功能障碍（n=709）x2P值
年龄（岁）35.403<0.001
60～693 087（70.61）448（14.51）
70～791 146（26.21）218（19.02）
≥80139（3.18）43（30.94）
性别32.462<0.001
男2 621（59.95）357（13.60）
女1 751（40.05）352（20.10）
居住地123.175<0.001
城镇1 585（36.25）127（8.01）
农村2 787（63.75）582（20.88）
教育253.802<0.001
小学及以下2 577（58.94）606（23.52）
初中1 067（24.41）82（7.69）
高中/中专620（14.18）20（3.23）
大专及以上108（2.47）1（0.93）
婚姻25.104<0.001
有配偶3 758（85.96）567（15.09）
无配偶614（14.04）142（23.13）
民族0.1890.664
汉族4 104（93.87）663（16.15）
少数民族268（6.13）46（17.16）
抑郁症状56.206<0.001
是1 404（32.11）396（28.21）
否2 968（67.89）313（10.55）
社会参与33.455<0.001
有2 502（57.23）336（13.43）
无1 870（42.77）373（19.95）
), ArticleFig(id=1241069996412040060, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=CN, label=表1, caption=

不同特征老年人的认知功能障碍检出情况［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
类别总体（n=4 372）认知功能障碍（n=709）x2P值
年龄（岁）35.403<0.001
60～693 087（70.61）448（14.51）
70～791 146（26.21）218（19.02）
≥80139（3.18）43（30.94）
性别32.462<0.001
男2 621（59.95）357（13.60）
女1 751（40.05）352（20.10）
居住地123.175<0.001
城镇1 585（36.25）127（8.01）
农村2 787（63.75）582（20.88）
教育253.802<0.001
小学及以下2 577（58.94）606（23.52）
初中1 067（24.41）82（7.69）
高中/中专620（14.18）20（3.23）
大专及以上108（2.47）1（0.93）
婚姻25.104<0.001
有配偶3 758（85.96）567（15.09）
无配偶614（14.04）142（23.13）
民族0.1890.664
汉族4 104（93.87）663（16.15）
少数民族268（6.13）46（17.16）
抑郁症状56.206<0.001
是1 404（32.11）396（28.21）
否2 968（67.89）313（10.55）
社会参与33.455<0.001
有2 502（57.23）336（13.43）
无1 870（42.77）373（19.95）
), ArticleFig(id=1241069996542063494, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=EN, label=Table 2, caption=

Logistic regression analysis of the effects of tooth loss and denture use on cognitive impairment

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数模型1模型2模型3
OR（95% CI）P值OR（95% CI）P值OR（95% CI）P值
牙齿缺失、义齿使用情况
非全牙缺失+有义齿1 5811-1-1-
非全牙缺失+无义齿2 5241.413（1.182～1.688）<0.0011.425（1.182～1.719）<0.0011.382（1.145～1.669）0.001
全牙缺失+有义齿1901.491（1.004～2.212）0.0471.170（0.775～1.767）0.4541.130（0.747～1.709）0.562
全牙缺失+无义齿772.475（1.468～4.173）0.0012.263（1.297～3.951）0.0042.074（1.186～3.627）0.011
年龄（岁）
60～693 087--1-1-
70～791 146--1.297（1.073～1.567）0.0071.290（1.067～1.560）0.008
≥80139--2.949（1.945～4.471）<0.0013.012（1.985～4.571）<0.001
性别
男2 621--1-1-
女1 751--1.515（1.271～1.806）<0.0011.472（1.232～1.758）<0.001
居住地
城镇1 585--1-1-
农村2 787--2.357（1.896～2.930）<0.0012.205（1.770～2.747）<0.001
教育
小学及以下2 577--1-1-
初中1 067--0.349（0.272～0.448）<0.0010.356（0.277～0.457）<0.001
高中/中专620--0.159（0.100～0.253）<0.0010.168（0.106～0.267）<0.001
大专及以上108--0.047（0.006～0.342）0.0030.049（0.007～0.358）0.003
婚姻
有配偶3 758--1-1-
无配偶614--1.404（1.117～1.763）0.0041.363（1.084～1.714）0.008
抑郁症状
无2 968----1-
有1 404----1.391（1.168～1.657）<0.001
社会参与
无1 870----1-
有2 502----0.770（0.649～0.914）0.003
), ArticleFig(id=1241069998056207241, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=CN, label=表2, caption=

牙齿缺失、义齿使用对认知功能障碍影响的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数模型1模型2模型3
OR（95% CI）P值OR（95% CI）P值OR（95% CI）P值
牙齿缺失、义齿使用情况
非全牙缺失+有义齿1 5811-1-1-
非全牙缺失+无义齿2 5241.413（1.182～1.688）<0.0011.425（1.182～1.719）<0.0011.382（1.145～1.669）0.001
全牙缺失+有义齿1901.491（1.004～2.212）0.0471.170（0.775～1.767）0.4541.130（0.747～1.709）0.562
全牙缺失+无义齿772.475（1.468～4.173）0.0012.263（1.297～3.951）0.0042.074（1.186～3.627）0.011
年龄（岁）
60～693 087--1-1-
70～791 146--1.297（1.073～1.567）0.0071.290（1.067～1.560）0.008
≥80139--2.949（1.945～4.471）<0.0013.012（1.985～4.571）<0.001
性别
男2 621--1-1-
女1 751--1.515（1.271～1.806）<0.0011.472（1.232～1.758）<0.001
居住地
城镇1 585--1-1-
农村2 787--2.357（1.896～2.930）<0.0012.205（1.770～2.747）<0.001
教育
小学及以下2 577--1-1-
初中1 067--0.349（0.272～0.448）<0.0010.356（0.277～0.457）<0.001
高中/中专620--0.159（0.100～0.253）<0.0010.168（0.106～0.267）<0.001
大专及以上108--0.047（0.006～0.342）0.0030.049（0.007～0.358）0.003
婚姻
有配偶3 758--1-1-
无配偶614--1.404（1.117～1.763）0.0041.363（1.084～1.714）0.008
抑郁症状
无2 968----1-
有1 404----1.391（1.168～1.657）<0.001
社会参与
无1 870----1-
有2 502----0.770（0.649～0.914）0.003
), ArticleFig(id=1241069998161064846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=EN, label=Table 3, caption=

Subgroup analysis of the effects of tooth loss and denture use on cognitive impairment based on model 3

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组非全牙缺失+无义齿全牙缺失+有义齿全牙缺失+无义齿P交互值
例数OR（95% CI）P值例数OR（95% CI）P值例数OR（95% CI）P值
性别
男1 6031.413（1.077～1.853）0.0121031.648（0.929～2.926）0.088482.600（1.263～5.352）0.0090.136
女9211.363（1.046～1.776）0.022870.799（0.439～1.454）0.463291.610（0.664～3.906）0.292
社会参与
有1 3691.290（0.992～1.678）0.0571041.163（0.650～2.083）0.611371.455（0.614～3.446）0.3950.517
无1 1551.475（1.123～1.937）0.005861.079（0.595～1.959）0.802402.720（1.294～5.715）0.008
), ArticleFig(id=1241069998257533841, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035544352846510, language=CN, label=表3, caption=

基于模型3的牙齿缺失、义齿使用对认知功能障碍影响的亚组分析

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组非全牙缺失+无义齿全牙缺失+有义齿全牙缺失+无义齿P交互值
例数OR（95% CI）P值例数OR（95% CI）P值例数OR（95% CI）P值
性别
男1 6031.413（1.077～1.853）0.0121031.648（0.929～2.926）0.088482.600（1.263～5.352）0.0090.136
女9211.363（1.046～1.776）0.022870.799（0.439～1.454）0.463291.610（0.664～3.906）0.292
社会参与
有1 3691.290（0.992～1.678）0.0571041.163（0.650～2.083）0.611371.455（0.614～3.446）0.3950.517
无1 1551.475（1.123～1.937）0.005861.079（0.595～1.959）0.802402.720（1.294～5.715）0.008
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牙齿缺失和义齿使用对老年人认知功能障碍的影响
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张宇蝶 , 钱英 , 虞晓芸 , 陈莹 , 王敏
现代预防医学 | 健康与社会行为 2024,51(24): 4548-4554
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现代预防医学 | 健康与社会行为 2024, 51(24): 4548-4554
牙齿缺失和义齿使用对老年人认知功能障碍的影响
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张宇蝶, 钱英 , 虞晓芸, 陈莹, 王敏
作者信息
  • 杭州师范大学护理学院，浙江 杭州 311121

    • 张宇蝶（1999—），女，硕士，研究方向：老年护理

通讯作者:

钱英，E-mail:
Effects of tooth loss and denture use on cognitive impairment in the elderly
Yu-die ZHANG, Ying QIAN , Xiao-yun YU, Ying CHEN, Min WANG
Affiliations
  • School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
出版时间: 2024-12-25 doi: 10.20043/j.cnki.MPM.202408138
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摘要
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目的

探讨老年人牙齿缺失、义齿使用对认知功能障碍的影响，为有效预防认知功能减退提供思路。

方法

使用中国健康与养老追踪调查（CHARLS）2018年全国调查数据，选取≥60岁的老年人为研究对象，使用logistic回归探讨牙齿缺失、义齿使用对老年人认知功能障碍的影响，并对性别、社会参与进行亚组和交互作用分析。

结果

共纳入≥60岁老年人4 372名，认知功能障碍检出率为16.22%（709/4 372），年龄大、女性、居住在农村、受教育程度低、无配偶、有抑郁症状、无社会参与是认知功能障碍的风险因素。调整混杂因素后，非全牙缺失且无义齿（OR=1.382；95% CI：1.145～1.669），全牙缺失且无义齿（OR=2.074；95% CI：1.186～3.627）均会增加认知功能障碍的风险。亚组分析结果显示，男性人群中非全牙缺失且无义齿（OR=1.413；95% CI：1.077～1.853）、全牙缺失且无义齿（OR=2.600；95% CI：1.263～5.352）仍与认知功能障碍风险增加有关，而女性人群中仅有非全牙缺失且无义齿（OR=1.363；95% CI：1.046～1.776）与认知功能障碍的风险增加相关；无社会参与组中非全牙缺失且无义齿（OR=1.475；95% CI：1.123～1.937）、全牙缺失且无义齿（OR=2.720；95% CI：1.294～5.715）与认知功能障碍风险增加有关，而有社会参与组该变化无统计学意义。牙齿缺失、义齿使用与性别、社会参与各亚组间在认知功能障碍患病方面均无交互作用（P>0.05）。

结论

使用义齿可以减轻牙齿缺失对认知功能障碍的影响，尤其是部分牙齿缺失者。应鼓励老年人尽可能保留自然牙，及时修复缺失牙，减少认知功能减退的发生。尽管本研究并未发现牙齿缺失、义齿使用与社会参与的交互作用，但仍建议老年人积极参与社交活动。

认知功能  /  牙齿缺失  /  义齿  /  老年人
Objective

To explore the effects of tooth loss and denture use on cognitive impairment in the elderly.

Methods

Based on the data of China Health and Retirement Longitudinal Study (CHARLS), over 60-year-old elderlies were selected as the research subjects.Logistic regression was conducted to explore the effects of tooth loss, denture use on cognitive impairment in elderly and subgroup analysis, and interaction analysis were performed for gender and social participation.

Results

A total of 4 372 elderly people were enrolled, and the rate of cognitive impairment was 16.20% (709/4 372). Older age, female, rural living, lower education, no spouse, with depressive symptoms, and without social-participation are risk factors for cognitive impairment. Group of non-total tooth loss without dentures (OR=1.382; 95% CI: 1.145-1.669) and group of total tooth loss without dentures (OR=2.074; 95% CI: 1.186-3.627) were associated with an increased risk of cognitive impairment. The results of subgroup analysis showed that the male population with non-total tooth loss and no dentures (OR=1.413; 95% CI: 1.077-1.853), with total tooth loss and no dentures (OR=2.600; 95% CI: 1.263-5.352) was still associated with an increased risk of cognitive impairment, while the female with non-total tooth loss and no dentures (OR=1.363; 95% CI: 1.046-1.776) was significantly associated with an increased risk of cognitive impairment.The non-social-participation-group with non-total tooth loss and no dentures (OR=1.475; 95% CI: 1.123-1.937), with total tooth loss and no dentures (OR=2.720; 95% CI: 1.294-5.715) were associated with an increased risk of cognitive impairment.There was no interaction between tooth loss, denture use, genderand social participation in the incidence of cognitive impairment(P>0.05).

Conclusion

The combination of tooth loss and denture use is an independent influence factor for cognitive impairment. The use of dentures can reduce the adverse effects of tooth loss on cognitive dysfunction, especially for those with partial tooth loss. The elderly should be encouraged to retain natural teeth, restore missing teeth in time. Although there is no interaction between tooth loss, denture use and social participation, older adults are suggested to take part in social activities.

Cognitive function  /  Tooth loss  /  Denture  /  Elderly
张宇蝶, 钱英, 虞晓芸, 陈莹, 王敏. 牙齿缺失和义齿使用对老年人认知功能障碍的影响. 现代预防医学, 2024 , 51 (24) : 4548 -4554 . DOI: 10.20043/j.cnki.MPM.202408138
Yu-die ZHANG, Ying QIAN, Xiao-yun YU, Ying CHEN, Min WANG. Effects of tooth loss and denture use on cognitive impairment in the elderly[J]. Modern Preventive Medicine, 2024 , 51 (24) : 4548 -4554 . DOI: 10.20043/j.cnki.MPM.202408138
正文
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认知功能障碍包括轻度认知功能障碍和痴呆，早期表现为明显的记忆力下降，伴有日常生活与社会活动能力损害，晚期将出现行为障碍和精神症状，甚至完全丧失独立生活的能力[1]。一项全球范围的系统综述显示，认知功能障碍的患病率为5.1%～41.0%，中位数为19.0%[2]。我国老年人轻度认知功能障碍的患病率约为21.5%，且随年龄的增长而显著升高[3]。牙齿缺失是认知功能障碍的潜在危险因素之一[4]。一项长达20年的队列研究发现[5]，重度牙齿缺失率（牙齿缺失数>2颗/年）会使老年人发生轻度认知功能障碍的风险增加28%。有队列研究发现使用义齿是认知功能减退的保护因素[6]，有Meta分析结果表明[7]，及时使用义齿进行修复治疗可降低与牙齿缺失有关的认知功能减退风险，另有队列研究发现使用义齿会导致认知功能的加速减退[8]。因此，牙齿缺失和义齿使用对认知功能的影响仍有待更多的实证研究来证明。本研究探讨牙齿缺失、义齿使用对认知功能障碍的影响，为制定老年人认知功能减退的干预措施提供参考。
1 资料与方法
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1.1 数据来源
本文使用2018年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）的数据，该项调查针对中国45岁及以上的中老年人展开，覆盖150个县级单位、450个村级单位，约1万户家庭中的1.7万人[9]。所有参与者及/或其家属均获得知情同意，研究经北京大学生物医学伦理委员会批准（IRB 00001052-11015）。本研究选取≥60岁的老年人，排除重要字段缺失的数据，最终共纳入研究对象4 372例。
1.2 研究变量
1.2.1 认知功能
本研究结合CHARLS调查问卷相关内容，选择简易精神状态(Mini Mental State Exam, MMSE)量表测量认知功能[10]，包括定向力（5个条目）、数字运算（5个条目）、情景记忆（20个条目）和图形绘制（1个条目）4个维度，共31个条目，回答正确为1分，答错或者不知道为０分。总分范围为0～31分，得分越高表示认知功能越好，<11分定义为认知功能障碍[11]。
1.2.2 牙齿缺失和义齿使用
包括是否全牙缺失（是、否）和是否安装假牙（是、否）两个问题，分为非全牙缺失且有义齿、非全牙缺失且无义齿、全牙缺失且有义齿以及全牙缺失且无义齿共4组。
1.2.3 协变量
人口学变量包括年龄、性别（男性和女性）、婚姻状况（有配偶和无配偶）、居住地（城镇和乡村）、受教育情况（小学及以下、初中、高中/中专、大专及以上）和民族（汉族和少数民族）；社会心理变量主要包括社会参与和抑郁。社会参与通过询问被调查者过去一个月内是否参与了以下11项社交活动衡量，包括跟朋友交往、棋牌活动、帮助他人、跳舞健身等、社团活动、志愿者与慈善活动、无偿照顾病人、继续教育、炒股、上网、其他社会活动，只要参加任意一项社交活动就定义为有社会参与，没有参加社交活动为无社会参与。抑郁采用流调中心抑郁量表（CESD-10）测量，共包括10个条目，采用0～3分Likert4级评分，总分范围为0～30分，得分越高表示抑郁程度越深，得分≥10分定义为有抑郁症状。
1.3 统计方法
本研究使用SPSS 26.0进行数据分析。计数资料使用频数或百分比表示，组间比较采用卡方检验。以非全牙缺失且有义齿组为对照，通过控制潜在混杂因素，使用二分类logistic回归分析计算牙齿缺失、义齿使用与认知功能障碍关系的OR 值。模型1：未调整混杂因素；模型2：在模型1的基础上调整年龄、性别、居住地、受教育程度、婚姻；模型3：在模型2的基础上调整抑郁和社会参与。此外，按照性别、社会参与进行亚组及相乘交互作用分析。使用Graphpad Prism 8.0绘制森林图。检验水准α=0.05。
2 结果
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2.1 不同特征老年人的认知功能障碍检出情况
本研究共纳入老年人4 372名，其中男性2 621名（59.95%），居住在城镇1 585名（36.25%），有配偶3 758名（85.96%）。检出认知功能障碍者709名，检出率为16.22%。年龄越大、女性、居住在农村、受教育程度越低、无配偶、有抑郁症状、无社会参与的老年人认知功能障碍的检出率较高，差异具有统计学意义（P<0.05）。具体见表1。
2.2 牙齿缺失、义齿使用对认知功能障碍的影响
非全牙缺失且有义齿者、非全牙缺失且无义齿者、全牙缺失且有义齿者、全牙缺失且无义齿者四组的认知功能障碍检出率分别为13.16%、17.63%、18.42%、27.27%，差异具有统计学意义（P<0.05）。
以是否发生认知功能障碍为因变量（0=否；1=是），牙齿缺失和义齿使用情况（1=非全牙缺失且有义齿；2=非全牙缺失且无义齿；3=全牙缺失且有义齿；4=全牙缺失且无义齿）为自变量进行logistic回归分析。模型1结果显示，与非全牙缺失且有义齿相比，非全牙缺失且无义齿、全牙缺失且有义齿、全牙缺失且无义齿与认知功能障碍的患病风险显著相关。在模型2中，调整了年龄（1=60～69岁；2=70～79岁；3=≥80岁）、性别（1=男；2=女）、居住地（1=城镇；2=乡村）、受教育程度（1=小学及以下；2=初中；3=高中/中专；4=大专及以上）、婚姻（1=有配偶；2=无配偶）后，与非全牙缺失且有义齿相比，非全牙缺失且无义齿、全牙缺失且无义齿与认知功能障碍的关联仍然显著。在模型3中，进一步调整抑郁（0=无；1=有）和社会参与（0=无；1=有），与非全牙缺失且有义齿相比，非全牙缺失且无义齿，全牙缺失且无义齿与认知功能障碍的风险增加仍然相关。具体见表2和图1。
2.3 基于模型3的牙齿缺失、义齿使用对认知功能障碍影响的亚组分析
基于模型3的性别亚组分析结果显示，男性人群中非全牙缺失且无义齿、全牙缺失且无义齿与认知功能障碍风险增加有关，女性人群中仅非全牙缺失且无义齿与认知功能障碍的风险增加显著相关。
社会参与的亚组分析显示，无社会参与人群中非全牙缺失且无义齿、全牙缺失且无义齿与认知功能障碍风险增加有关，而在有社会参与人群中该变化无统计学意义。具体见表3和图2。
交互作用检验显示，牙齿缺失、义齿使用与性别、社会参与的各亚组对认知功能障碍的影响不存在相乘交互作用（P>0.05）。
3 讨论
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本研究着重探讨老年人牙齿缺失、义齿使用与认知功能障碍之间的关系。研究结果表明，在控制了年龄、性别等因素后，全牙缺失且无义齿的老年人认知功能障碍的患病风险最高，是非全牙缺失且有义齿者的2.074倍。与非全牙缺失且有义齿的老年人相比，非全牙缺失且无义齿组的认知功能障碍患病风险显著增加，而全牙缺失且有义齿组无显著变化，说明使用义齿可以修复因牙齿缺失造成的认知功能损失，与既往研究结果一致[12]。已有多位学者证实义齿对个体的认知功能具有保护作用[13]。Suma等[14]学者对日本养老院的老年人进行调查，发现0～19颗自然牙且有义齿组与≥20颗自然牙组的认知功能障碍患病风险无明显差异，而0～19颗自然牙且无义齿组的患病风险增加了1倍。Yang等[15]学者研究发现，与≥20颗自然牙的老年人相比，10～19颗自然牙的非义齿使用者的认知功能障碍风险增加了19%，0～9颗自然牙的非义齿使用者增加了28%，0颗自然牙的义齿使用者增加了14%。这些研究都表明自然牙齿的保留、缺失牙齿的修复、义齿的使用可以降低认知功能障碍的患病风险。分析牙齿缺失、义齿使用和认知功能之间的关系，根据现有的研究报道最可能的原因是咀嚼功能机制[16]，正常的咀嚼活动可以刺激大脑增加脑血流量，从而促进皮质区的激活、提高血氧水平，有利于脑细胞活动和增强认知功能[17]。动物研究表明咀嚼不足会使基底前脑胆碱能神经元退化和学习能力抑制，最终导致学习和记忆受损[7]。义齿可以替代缺失牙进行咀嚼活动，改善口腔健康状况，从而保护认知功能；但有研究表明[16,18]，义齿使用者的咀嚼效率仍不足以与全口自然牙者相匹配。此外，有研究发现义齿使用者身体意象障碍的程度更高，并且牙齿缺失和义齿使用都会使个体发生心理困扰的风险增加1倍[19]。因此，义齿对自然牙缺失带来的负面影响的补偿作用仍有待从生理、心理等多方面进行深入研究。
亚组及交互效应分析结果显示，牙齿缺失、义齿使用与性别、社会参与对认知功能障碍的患病情况不存在相乘交互作用，表明牙齿缺失、义齿使用与认知功能障碍的关系在不同性别和社会参与情况的人群中差异不显著，牙齿缺失与义齿使用情况是认知功能障碍的独立影响因素，提示各群体的老年人均应树立正确的口腔健康意识，重视牙齿缺失问题，积极进行缺失牙修复与义齿安装。性别亚组分析结果显示，在非全牙缺失的人群中，无义齿的男性和女性认知功能障碍的风险都高于有义齿组，说明使用义齿无论对男性还是女性老年人的认知功能都具有保护作用。在非全牙缺失且无义齿的人群中，男性认知功能障碍的患病风险高于女性，这可能与女性更关注自己的身体健康，更愿意学习健康相关知识有关[20]。此外，本研究发现与非全牙缺失且有义齿组相比，全牙缺失且无义齿与男性认知功能障碍风险增加显著相关，而在女性中无统计学意义，这可能与本研究中女性全牙缺失且无义齿组的样本量较少（仅29例）有关。社会参与的亚组分析结果显示，在无社会参与人群中，非全牙缺失且无义齿、全牙缺失且无义齿老年人的认知功能障碍患病风险仍显著增加，而在有社会参与人群中该变化无统计学意义，表明社会参与可能是认知功能障碍的保护因素。根据“用进废退理论”，参与智力、社交活动等会刺激大脑从而改善认知功能；反之社会参与度的降低会使大脑因刺激减少而易导致认知功能减退[21-22]。
本文存在以下局限性：①由于仅采用CHARLS 2018年的横断面数据，无法验证老年人牙齿缺失、义齿使用和认知功能障碍之间的因果推断；②由于CHARLS数据限制，未对具体自然牙数量与认知功能之间的关系进行剂量-反应分析；③由于牙齿缺失和义齿使用不同组的样本分布不均，未能对性别、社会参与之外的其他变量进行亚组和交互作用分析。后续可进一步扩大样本量，通过纵向研究并纳入更多的控制变量来明确牙齿缺失、义齿使用对老年人认知功能影响的动态变化以及剂量-反应关系，以此针对性地提出有效地预防和延缓老年人认知功能下降的建议。
综上，自然牙缺失和不使用义齿是老年人认知功能障碍的危险因素。未来应积极响应世界卫生组织的“8020”计划，即鼓励80岁及以上的老年人至少保留20颗自然牙，消除“老掉牙”是一种自然规律的刻板印象，鼓励老年人定期进行牙科诊治，及时修复缺失牙。尽管本研究并未发现牙齿缺失、义齿使用与社会参与的交互作用，但仍建议老年人积极参与社交活动，拓宽社交网络。
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2024年第51卷第24期
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doi: 10.20043/j.cnki.MPM.202408138
  • 接收时间：2024-08-11
  • 首发时间：2026-03-18
  • 出版时间：2024-12-25
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  • 收稿日期：2024-08-11
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    杭州师范大学护理学院，浙江 杭州 311121

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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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