广西医学

目的探讨中国社区老年人躯体功能轨迹模式及其与轻度认知障碍（MCI）的关系。方法基于中国健康与养老追踪调查（CHARLS）数据，纳入基线期（2011年）调查时年龄≥60岁且2013年、2015年、2020年均完成随访的1 992名社区老年人作为研究对象，收集其基线期调查的相关资料及2020年的认知功能评估结果。采用简易躯体能力测试评估社区老年人躯体功能，并运用基于群组的轨迹模型识别躯体功能轨迹，对比不同轨迹组的基线特征及MCI发生情况。采用Logistic回归分析社区老年人躯体功能轨迹与MCI的关系并进行亚组分析。结果共识别出3类轨迹：低-骤降组（8.3%）、中-渐降组（42.6%）、高-缓降组（49.1%）。不同轨迹组的年龄、收缩压、性别、婚姻状况、高血压占比、心脏病占比、饮酒状况、吸烟状况、流行病学研究中心抑郁量表评分、日常生活活动能力评分、握力、睡眠时长、文化程度、MCI发生率比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，未调整任何协变量的情况下，与高-缓降组相比，低-骤降组和中-渐降组发生MCI的风险升高（P<0.05）；在调整相关协变量后，上述关系仍成立（P<0.05）。在性别、婚姻状况、高血压、糖尿病、心脏病、饮酒及吸烟等亚组中，低-骤降组和中-渐降组轨迹均与MCI发生风险升高相关，且效应方向基本一致，各亚组间差异均无统计学意义（P交互>0.05）。结论中国社区老年人躯体功能存在异质性，较低水平及较快下降的躯体功能轨迹与MCI风险显著相关。

Objective To investigate physical function trajectory mode among the community⁃dwelling elderly in China and its relation with their mild cognitive impairment (MCI). Methods Based on data from the China Health and Retirement Longitudinal Study (CHARLS), a total of 1992 community⁃dwelling elderly people aged ≥60 years at the baseline survey in 2011 and who completed the follow⁃up in 2013, 2015 and 2020 were enrolled as the research subjects, and their relevant information of baseline survey and evaluation results of cognitive function in 2020 were collected. The short physical performance battery was used to assess physical function of the community⁃dwelling elderly, and the group⁃based trajectory model was adopted to identify physical function trajectories. The baseline characteristics‌ of different trajectory groups and MCI occurrence were compared. Logistic regression was employed to analyze the relation between physical function trajectories and MCI in the community⁃dwelling elderly, and the subgroup analysis was performed. Results Three distinct categories of trajectories were identified as follows: low⁃rapid decline (8.3%), moderate⁃gradual decline (42.6%), and high⁃slow decline (49.1%). There were statistically significant differences in age, systolic blood pressure, gender, marital status, hypertension proportion, heart disease proportion, drinking, smoking, Center for Epidemiologic Studies Depression scale⁃10 score, activities of daily living score, grip strength, sleep duration, educational level, and the incidence rate of MCI between different trajectory groups (P<0.05). The results of Logistic regression analysis revealed that without adjusting any covariates, compared with the high⁃slow decline group, the risk of MCI occurrence in the low⁃rapid decline group and the moderate⁃gradual decline group increased (P<0.05). After adjusting for relevant covariates, the aforementioned relation still held (P<0.05). In the subgroups of gender, marital status, hypertension, diabetes mellitus, heart disease, drinking and smoking, the trajectories of the low⁃rapid decline group and the moderate⁃gradual decline group were related to the increased risk of MCI occurrence, and the effect direction was basically the same. There was no statistically significant difference between the subgroups (Pinteraction>0.05). Conclusion Physical function among the community⁃dwelling elderly in China exhibits heterogeneity. Lower level and fast decline trajectories of physical function are significantly related to MCI occurrence risk.

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