认知功能减低与心力衰竭患者预后关系的分析  

Prognostic value of Montreal Cognitive Assessment in heart failure patients

作　　者：吕思奇 谭慧琼[1] 刘少帅[1] 刘小宁[1] 郭潇[1] 高东方 莫然 朱俊[1] 于丽天[1] Lyu Siqi;Tan Huiqiong;Liu Shaoshuai;Liu Xiaoning;Guo Xiao;Gao Dongfang;Mo Ran;Zhu Jun;Yu Litian(Emergency and Critical Care Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院急重症中心,100037

出　　处：《中华心血管病杂志》2020年第2期136-141,共6页Chinese Journal of Cardiology

摘　　要：目的探讨中国心力衰竭(心衰)患者认知功能减低的发病情况及其对预后的影响。方法该研究为前瞻性观察性研究。2012年12月至2014年11月从中国24家医院连续入选心衰患者990例,所有患者均进行蒙特利尔认知评分(MoCA),以评估患者的认知功能,按得分将患者分为MoCA<26分组(存在认知功能减低)和MoCA≥26分组(不存在认知功能减低)。记录入选患者的基线资料,并随访1年。主要终点包括1年全因死亡,次要终点包括1年心血管死亡、主要不良心脑血管事件(MACCE)、因心衰住院。采用单因素和多因素Cox回归分析评估心衰患者1年全因死亡、心血管死亡的危险因素,采用单因素和多因素logistic回归分析评估MACCE、因心衰住院的危险因素。结果990例心衰患者中MoCA评分<26分者628例,占63.4%(MoCA<26分组),MoCA≥26分者362例(MoCA≥26分组)。与MoCA≥26分组比较,MoCA<26分组患者年龄较大(P<0.01),女性、纽约心脏协会(NYHA)心功能Ⅲ~Ⅳ级、慢性阻塞性肺疾病、缺血性心脏病者比例较高(P均<0.05),体重指数(BMI)、教育程度和医疗保险率较低(P均<0.01),行介入治疗、器械置入和心脏外科手术史者比例较低(P均<0.05),β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张Ⅱ素受体阻滞剂(ARB)使用率较低(P均<0.05)。MoCA<26分组患者1年全因死亡、心血管死亡和MACCE发生率均明显高于MoCA≥26分组[分别为10.2%(64/628)比2.2%(8/362)、5.9%(37/628)比0.8%(3/362)和9.6%(60/628)比2.5%(8/362),P均<0.001],因心衰住院率两组间差异无统计学意义[19.7%(124/628)比16.6%(60/362),P=0.217]。单因素Cox回归分析结果显示,MoCA<26分是心衰患者1年全因死亡(HR=4.739,95%CI 2.272~9.885,P<0.01)、心血管死亡(HR=7.258,95%CI 2.237~23.548,P=0.001)的危险因素。单因素logistic回归分析结果显示MoCA<26分是心衰患者1年MACCE发生的危险因素(OR=4.143,95%CI 2.031~8.453,P<0.01)。在校正了其他危险因素Objective To explore the occurrence of cognitive impairment in Chinese heart failure(HF)patients and it's impact on prognosis.Methods In this prospective observational study,a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014.All patients were administrated with the interview-format Montreal Cognitive Assessment(MoCA),according to which they were divided into MoCA<26(with cognitive impairment)group and MoCA≥26(without cognitive impairment)group.Baseline data were collected and a 1-year follow up was carried out.Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes.Results Cognitive impairment was evidenced in 628 patients(63.4%)and they were more likely to be older,female,and with higher proportion of New York Heart Association(NYHA)classⅢ-Ⅳ,chronic obstructive pulmonary disease(COPD),ischemic heart disease,while body mass index(BMI),education level,and medical insurance rate were lower(all P<0.05)as compared to patients in MoCA≥26 group.The rate of percutaneous intervention,device implantation,cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group(all P<0.05).During the 1-year follow up,patients in the MoCA<26 group had higher all-cause mortality(10.2%(64/628)vs.2.2%(8/362),P<0.01),cardiovascular mortality(5.9%(37/628)vs.0.8%(3/362),P<0.01)and major adverse cardiac and cerebrovascular events(MACCE)(9.6%(60/628)vs.2.5%(8/362),P<0.01)than patients in the MoCA≥26 group.In univariate regression,MoCA<26 was associated with increased all-cause mortality(HR(95%CI):4.739(2.272-9.885),P<0.01),cardiovascular mortality(HR(95%CI):7.258(2.237-23.548),P=0.001)and MACCE(OR(95%CI):4.143(2.031-8.453),P<0.01).After adjustment by multivariate regression,MoCA<26 was indicated as an independent risk factor for all-cause mortality(HR(95%CI):6.387(2.533-16.104),P<0.01),cardiovascular mortality(HR(95%CI):10.848(2.586-45.506),P=0.001)and MACCE(OR(95%CI):4.081(1.299-12.816),P=0.016)

关 键 词：心力衰竭 认知障碍 预后 蒙特利尔认知评分 

分 类 号：R541.6[医药卫生—心血管疾病]