老年射血分数降低心力衰竭合并贫血患者的短期认知功能障碍发生风险分析  

Short-term risk of cognitive dysfunction in patients with chronic heart failure and anemia

作　　者：王新强[1] 马继光 李斌[1] 陈静[1] 王亚冰 Wang Xinqiang;Ma Jiguang;Li Bin;Chen Jing;Wang Yabing(Department of Neurology,The Second People’s Hospital of Liaocheng,Liaocheng Second Hospital Affiliated to Shandong First Medical University,Liaocheng 252600,China)

机构地区：[1]聊城市第二人民医院神经内科山东第一医科大学附属聊城二院,252600

出　　处：《中国心血管杂志》2021年第4期333-336,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的评估合并贫血的老年射血分数降低心力衰竭(HFrEF)患者随访短期发生认知功能障碍的风险,并分析其相关危险因素。方法回顾性病例对照研究。选取2016年1月至2018年12月在我院诊治的442例HFrEF老年患者。根据是否合并贫血分为贫血组(94例)和对照组(348例),随访1年比较两组患者认知障碍发生风险,并行多因素logistic回归分析评估认知障碍的危险因素。结果442例HFrEF老年患者中,男性218例,平均年龄(77.7±10.2)岁。94例贫血患者中,轻度、中度和重度贫血分别有37例、31例和26例。两组患者的年龄、合并房颤、合并睡眠呼吸暂停、肾损伤、左室射血分数和血脂水平等均有显著性差异(均为P<0.05)。平均随访(10.3±2.3)个月,失访37例(8.4%),共有55例认知障碍患者。贫血组的认知障碍发生率显著高于对照组(χ_(2)=5.976,P=0.014),且随着贫血程度加重,认知障碍发生率逐渐升高(χ_(2)=8.740,P=0.013)。多因素logistic回归分析显示:高龄(OR=1.791,95%CI:1.230~2.608)、吸烟(OR=2.207,95%CI:1.339~3.638)、心房颤动(OR=3.115,95%CI:1.114~8.710)、左室射血分数(OR=1.937,95%CI:1.332~2.817)、睡眠呼吸暂停(OR=2.135,95%CI:1.462~3.118)和中重度贫血(OR=2.769,95%CI:1.108~6.921)是认知功能障碍的独立危险因素(均为P<0.05)。结论合并贫血的HFrEF老年患者发生认知障碍的风险高,且随着贫血程度加重,认知障碍发生率逐渐升高。Objective To evaluate the risk of cognitive dysfunction in the elderly with heart failure with reduced ejection fraction(HFrEF)complicated with anemia,and to analyze the related risk factors.Methods This was a retrospective case-control study.We selected 442 elderly HFrEF patients who were diagnosed and treated in our hospital from January 2016 to December 2018.All were divided into anemia group(94 cases)and control group(348 cases)according to whether they were combined with anemia,and were followed up for 1 year to compare the risk of cognitive impairment.Multivariate logistic regression analysis was used to evaluate the related risk factors.Results Among the 442 elderly HFrEF patients,218 were male,with an average age of(77.7±10.2)years.Among 94 anemia patients,there were 37 cases,31 cases and 26 cases of mild,moderate and severe anemia,respectively.There were significant differences in age,rates of atrial fibrillation,sleep apnea,renal injury,left ventricular ejection fraction(LVEF),and lipid level between the two groups(all P<0.05).The average follow-up was(10.3±2.3)months,and 37 cases(8.4%)were lost to follow-up.A total of 55 patients had cognitive impairment,which was significantly higher in the anemia group than that in the control group(χ_(2)=5.976,P=0.014).As the degree of anemia increased,the incidence of cognitive impairment gradually increased(χ_(2)=8.740,P=0.013).Multivariate logistic regression analysis showed that advanced age(OR=1.791,95%CI:1.230-2.608),smoking(OR=2.207,95%CI:1.339-3.368),atrial fibrillation(OR=3.115,95%CI:1.114-8.710),LVEF(OR=1.407,95%CI:1.332-2.817),sleep apnea(OR=2.135,95%CI:1.462-3.118)and moderate-to-severe anemia(OR=2.769,95%CI:1.108-6.921)were independent risk factors for cognitive dysfunction(all P<0.05).Conclusions Elderly HFrEF patients with anemia are at high risk of cognitive impairment,which gradually increases as the degree of anemia increases.

关 键 词：心力衰竭 射血分数降低 贫血 认知功能障碍 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病] R556[医药卫生—内科学]