白蛋白校正阴离子间隙与老年认知

doi:10.3969/j.issn.1004-583X.2026.10.005

摘要/Abstract

摘要：

目的探讨白蛋白校正阴离子间隙(albumin-corrected anion gap,corrected AG)与美国老年人认知表现的关系。方法纳入美国国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES)2011-2014年≥60岁人群,采用复杂抽样加权回归、四分位及限制性立方样条分析corrected AG与整体及不同认知域表现的关系。结果共纳入2 530人。corrected AG每升高1个标准差,整体认知Z评分降低0.055(95%CI:-0.083~-0.028,P<0.001);4项次要认知结局经假发现率校正后仍显著,未见非线性。结论较高corrected AG与较差整体认知相关,需纵向研究验证。

关键词: 认知, 白蛋白校正阴离子间隙, 老年人, NHANES, 肾功能

Abstract:

Objective To investigate the association between albumin-corrected anion gap (corrected AG) and cognitive performance among older adults in the United States. Methods Adults aged ≥60 years from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were included. Complex survey-weighted regression, quartile analyses, and restricted cubic spline analyses were performed to evaluate the associations of corrected AG with overall cognitive performance and performance across different cognitive domains. Results A total of 2, 530 participants were included. For each 1-standard-deviation increase in corrected AG, the overall cognitive Z score decreased by 0.055 (95%CI, -0.083 to -0.028; P<0.001). Four secondary cognitive outcomes remained statistically significant after false discovery rate correction, with no evidence of nonlinearity. Conclusion Higher corrected AG was associated with poorer overall cognitive performance in older adults. Longitudinal studies are warranted to further validate this association.

Key words: cognition, albumin-corrected anion gap, older adults, NHANES, kidney function

中图分类号:

R338.64

王栋泽, 王筱涵, 王文远, 张少儒, 王彦永. 白蛋白校正阴离子间隙与老年认知[J]. 临床荟萃, 2026, 41(10): 901-909.

Wang Dongze, Wang Xiaohan, Wang Wenyuan, Zhang Shaoru, Wang Yanyong. Albumin-corrected anion gap and cognitive function in older adults[J]. Clinical Focus, 2026, 41(10): 901-909.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.10.005

https://www.lchc.cn/CN/Y2026/V41/I10/901

图/表 8

参考文献 28

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变量	Q1	Q2	Q3	Q4	F值	P值
非加权样本量	669	594	645	622
加权代表人口(百万)	12.99	11.18	12.02	10.69
年龄(岁)	68.23±6.37	68.92±6.65	69.7±6.75	69.95±6.85	6.334	0.002
PIR	3.55±1.56	3.07±1.52	3.01±1.55	2.82±1.59	9.464	<0.01
BMI(kg/m²)	27.79±5.55	28.83±5.71	29.43±6.57	30.5±7.03	6.880	0.001
体力活动(MET-min/周)	1 577.74±2 771.25	1 541.51±3 000.77	1 342.92±2 558.77	1 195.82±2 614.45	1.982	0.139
平均收缩压(mmHg)	130.58±17.8	130.87±18.62	131.52±19.02	133.03±19.54	1.579	0.216
平均舒张压(mmHg)	69.96±12.18	67.67±13.74	68.19±12.44	66.89±14.47	2.592	0.072
eGFR(ml·min^-1·1.73 m^-2)	77.17±15.31	74.45±15.79	72.14±18.68	68.77±20.92	24.341	<0.01
log UACR	2.41±0.88	2.47±1.03	2.58±0.98	2.90±1.30	14.551	<0.01
PHQ-9评分	2.42±3.39	2.47±3.39	3.03±4.16	3.56±4.63	11.570	<0.01
白蛋白校正AG(mmol/L)	7.66±0.80	9.13±0.28	10.22±0.35	12.29±1.28	3631.895	<0.01
整体认知Z评分	0.46±0.76	0.26±0.75	0.26±0.76	0.07±0.78	16.335	<0.01
CERAD即刻回忆Z评分	0.40±0.91	0.22±0.93	0.21±0.95	0.01±0.94	12.444	<0.01
CERAD延迟回忆Z评分	0.30±0.92	0.19±0.99	0.17±0.94	0.03±0.99	7.975	<0.01
动物命名流畅性Z评分	0.57±1.08	0.28±1.0	0.31±0.96	0.10±0.96	8.044	<0.01
DSST Z评分	0.59±0.94	0.39±0.89	0.40±0.94	0.17±0.97	11.553	<0.01
性别(%)—男	50.5	49.2	44.8	39.3	4.332	0.008
性别(%)—女	49.5	50.8	55.2	60.7
种族/族裔(%)—墨西哥裔美国人	2.6	3.2	3.0	4.9	0.659	0.682
种族/族裔(%)—非西班牙裔亚裔	3.1	3.6	3.4	2.8
种族/族裔(%)—非西班牙裔黑人	7.7	7.6	7.9	9.2
种族/族裔(%)—非西班牙裔白人	82.1	79.4	80.4	77.7
种族/族裔(%)—其他西班牙裔	3.4	4.2	3.1	3.6
种族/族裔(%)—其他/多种族	1.1	2.1	2.2	1.9
教育水平(%)—低于高中	12.2	16.6	15.2	21.0	3.370	0.007
教育水平(%)—高中/GED	18.2	20.9	24.7	22.3
教育水平(%)—大学及以上	69.6	62.5	60.1	56.7
婚姻状况(%)—已婚/同居	70.0	65.4	63.4	58.2	2.836	0.020
婚姻状况(%)—既往婚姻	25.5	28.7	33.2	37.9
婚姻状况(%)—从未结婚	4.5	5.9	3.4	3.9
吸烟状态(%)—从不	49.0	50.2	49.5	49.4	0.958	0.438
吸烟状态(%)—既往	42.6	38.1	38.0	37.5
吸烟状态(%)—当前	8.3	11.8	12.5	13.1
任一年度饮酒≥12杯史(%)—否	22.4	27.9	28.0	32.9	3.007	0.039
任一年度饮酒≥12杯史(%)—是	77.6	72.1	72.0	67.1
达到体力活动指南(%)—否	49.7	54.8	56.5	64.5	4.885	0.005
达到体力活动指南(%)—是	50.3	45.2	43.5	35.5
高血压(%)—否	42.6	37.1	26.2	23.4	12.083	<0.01
高血压(%)—是	57.4	62.9	73.8	76.6
糖尿病(%)—否	88.1	85.5	79.3	70.4	16.497	<0.01
糖尿病(%)—是	11.9	14.5	20.7	29.6
卒中史(%)—否	96.8	93.0	92.7	92.1	2.900	0.051
卒中史(%)—是	3.2	7.0	7.3	7.9
心血管疾病(%)—否	85.5	84.0	79.7	79.3	2.127	0.131
心血管疾病(%)—是	14.5	16.0	20.3	20.7

变量	Q1	Q2	Q3	Q4	F值	P值
非加权样本量	669	594	645	622
加权代表人口(百万)	12.99	11.18	12.02	10.69
年龄(岁)	68.23±6.37	68.92±6.65	69.7±6.75	69.95±6.85	6.334	0.002
PIR	3.55±1.56	3.07±1.52	3.01±1.55	2.82±1.59	9.464	<0.01
BMI(kg/m²)	27.79±5.55	28.83±5.71	29.43±6.57	30.5±7.03	6.880	0.001
体力活动(MET-min/周)	1 577.74±2 771.25	1 541.51±3 000.77	1 342.92±2 558.77	1 195.82±2 614.45	1.982	0.139
平均收缩压(mmHg)	130.58±17.8	130.87±18.62	131.52±19.02	133.03±19.54	1.579	0.216
平均舒张压(mmHg)	69.96±12.18	67.67±13.74	68.19±12.44	66.89±14.47	2.592	0.072
eGFR(ml·min^-1·1.73 m^-2)	77.17±15.31	74.45±15.79	72.14±18.68	68.77±20.92	24.341	<0.01
log UACR	2.41±0.88	2.47±1.03	2.58±0.98	2.90±1.30	14.551	<0.01
PHQ-9评分	2.42±3.39	2.47±3.39	3.03±4.16	3.56±4.63	11.570	<0.01
白蛋白校正AG(mmol/L)	7.66±0.80	9.13±0.28	10.22±0.35	12.29±1.28	3631.895	<0.01
整体认知Z评分	0.46±0.76	0.26±0.75	0.26±0.76	0.07±0.78	16.335	<0.01
CERAD即刻回忆Z评分	0.40±0.91	0.22±0.93	0.21±0.95	0.01±0.94	12.444	<0.01
CERAD延迟回忆Z评分	0.30±0.92	0.19±0.99	0.17±0.94	0.03±0.99	7.975	<0.01
动物命名流畅性Z评分	0.57±1.08	0.28±1.0	0.31±0.96	0.10±0.96	8.044	<0.01
DSST Z评分	0.59±0.94	0.39±0.89	0.40±0.94	0.17±0.97	11.553	<0.01
性别(%)—男	50.5	49.2	44.8	39.3	4.332	0.008
性别(%)—女	49.5	50.8	55.2	60.7
种族/族裔(%)—墨西哥裔美国人	2.6	3.2	3.0	4.9	0.659	0.682
种族/族裔(%)—非西班牙裔亚裔	3.1	3.6	3.4	2.8
种族/族裔(%)—非西班牙裔黑人	7.7	7.6	7.9	9.2
种族/族裔(%)—非西班牙裔白人	82.1	79.4	80.4	77.7
种族/族裔(%)—其他西班牙裔	3.4	4.2	3.1	3.6
种族/族裔(%)—其他/多种族	1.1	2.1	2.2	1.9
教育水平(%)—低于高中	12.2	16.6	15.2	21.0	3.370	0.007
教育水平(%)—高中/GED	18.2	20.9	24.7	22.3
教育水平(%)—大学及以上	69.6	62.5	60.1	56.7
婚姻状况(%)—已婚/同居	70.0	65.4	63.4	58.2	2.836	0.020
婚姻状况(%)—既往婚姻	25.5	28.7	33.2	37.9
婚姻状况(%)—从未结婚	4.5	5.9	3.4	3.9
吸烟状态(%)—从不	49.0	50.2	49.5	49.4	0.958	0.438
吸烟状态(%)—既往	42.6	38.1	38.0	37.5
吸烟状态(%)—当前	8.3	11.8	12.5	13.1
任一年度饮酒≥12杯史(%)—否	22.4	27.9	28.0	32.9	3.007	0.039
任一年度饮酒≥12杯史(%)—是	77.6	72.1	72.0	67.1
达到体力活动指南(%)—否	49.7	54.8	56.5	64.5	4.885	0.005
达到体力活动指南(%)—是	50.3	45.2	43.5	35.5
高血压(%)—否	42.6	37.1	26.2	23.4	12.083	<0.01
高血压(%)—是	57.4	62.9	73.8	76.6
糖尿病(%)—否	88.1	85.5	79.3	70.4	16.497	<0.01
糖尿病(%)—是	11.9	14.5	20.7	29.6
卒中史(%)—否	96.8	93.0	92.7	92.1	2.900	0.051
卒中史(%)—是	3.2	7.0	7.3	7.9
心血管疾病(%)—否	85.5	84.0	79.7	79.3	2.127	0.131
心血管疾病(%)—是	14.5	16.0	20.3	20.7

结局	例数	模型1			模型2			模型3			BH- FDR q
结局	例数	β	95%CI	P	β	95%CI	P	β	95%CI	P	BH- FDR q
整体认知Z评分	2 530	-0.108	-0.137, -0.080	<0.01	-0.078	-0.108, -0.048	<0.01	-0.055	-0.083, -0.028	<0.01
CERAD即刻回忆Z评分	2 533	-0.107	-0.150, -0.065	<0.01	-0.083	-0.130, -0.036	0.01	-0.068	-0.114, -0.021	0.006	0.023
CERAD延迟回忆Z评分	2 530	-0.073	-0.116,-0.030	0.002	-0.055	-0.099, -0.011	0.016	-0.043	-0.083, -0.004	0.032	0.032
动物命名流畅性Z评分	2 520	-0.126	-0.184, -0.067	<0.01	-0.092	-0.143, -0.040	0.001	-0.064	-0.114, -0.013	0.015	0.023
DSST Z评分	2 463	-0.126	-0.165, -0.087	<0.01	-0.081	-0.120, -0.042	<0.01	-0.045	-0.081, -0.008	0.017	0.023

结局	例数	模型1			模型2			模型3			BH- FDR q
结局	例数	β	95%CI	P	β	95%CI	P	β	95%CI	P	BH- FDR q
整体认知Z评分	2 530	-0.108	-0.137, -0.080	<0.01	-0.078	-0.108, -0.048	<0.01	-0.055	-0.083, -0.028	<0.01
CERAD即刻回忆Z评分	2 533	-0.107	-0.150, -0.065	<0.01	-0.083	-0.130, -0.036	0.01	-0.068	-0.114, -0.021	0.006	0.023
CERAD延迟回忆Z评分	2 530	-0.073	-0.116,-0.030	0.002	-0.055	-0.099, -0.011	0.016	-0.043	-0.083, -0.004	0.032	0.032
动物命名流畅性Z评分	2 520	-0.126	-0.184, -0.067	<0.01	-0.092	-0.143, -0.040	0.001	-0.064	-0.114, -0.013	0.015	0.023
DSST Z评分	2 463	-0.126	-0.165, -0.087	<0.01	-0.081	-0.120, -0.042	<0.01	-0.045	-0.081, -0.008	0.017	0.023

结局	例数		趋势P	Q2 vs Q1			Q3 vs Q1			Q4 vs Q1
结局	例数		趋势P	β	95%CI	P	β	95%CI	P	β	95%CI	P
整体认知Z评分	2 530	<0.01		-0.090	-0.206, 0.025	0.121	-0.041	-0.127, 0.045	0.337	-0.169	-0.253, -0.084	<0.01
CERAD即刻回忆Z评分	2 533	0.002		-0.095	-0.239, 0.049	0.187	-0.069	-0.188, 0.049	0.243	-0.227	-0.351, -0.103	<0.01
CERAD延迟回忆Z评分	2 530	0.025		-0.048	-0.217, 0.122	0.569	-0.026	-0.157, 0.104	0.683	-0.134	-0.251, -0.016	0.027
动物命名流畅性Z评分	2 520	0.034		-0.169	-0.320, -0.019	0.029	-0.081	-0.224, 0.061	0.253	-0.202	-0.357, -0.047	0.012
DSST Z评分	2 463	0.152		-0.062	-0.185, 0.061	0.312	0.014	-0.080, 0.109	0.761	-0.104	-0.210, 0.002	0.053