老年非瓣膜性心房颤动患者轻度认知功能障碍的罹患情况及影响因素  

Features of mild cognitive impairment in elderly patients with non-valvular atrial fibrillation and its influencing factors

作　　者：杨艺[1] 王芳 张存泰[1] YANG Yi;WANG Fang;ZHANG Cun-Tai(Department of General Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Geriatrics,Second Hospital of Huangshi,Huangshi 435002,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属同济医院综合医疗科,湖北武汉430000 [2]黄石市第二医院老年病科,湖北黄石435002

出　　处：《中华老年多器官疾病杂志》2021年第11期807-811,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：湖北省自然科学基金项目(2020CFB316)。

摘　　要：目的探讨老年非瓣膜性房颤与轻度认知功能障碍(MCI)的关系及相关影响因素。方法回顾性分析2018年10月至2019年9月于华中科技大学同济医学院附属同济医院综合医疗科住院且符合要求的104例老年患者的临床资料,其中房颤组和非房颤组各52例。应用简易精神状态评价量表(MMSE)与蒙特利尔认知评估量表(MoCA)评估2组患者MCI的检出率、临床特点及危险因素。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验进行组间比较。多因素分析采用logistic回归模型。结果房颤组患者的MMSE总分和MoCA总分均低于非房颤组[MMSE:(27.37±1.53)和(28.33±1.01)分;MoCA:(24.71±1.54)和(26.29±1.63)分];MCI检出率明显高于非房颤组(MMSE:38.5%和7.7%;MoCA:61.5%和30.8%),差异均有统计学意义(P<0.05)。利用MoCA量表评估7个分认知域,显示房颤组患者的定向能力、视空间与执行功能、语言能力、抽象概括能力均低于非房颤组,差异有统计学意义(P<0.05)。以MoCA量表阳性定义为MCI患者,选取对MMSE量表和MoCA量表评估MCI均有影响的5个因素作为自变量代入logistic回归分析,结果显示较高的受教育年限是MCI的保护因素,而房颤、高龄、高血压是MCI的独立危险因素,其中房颤是更强的危险因素(OR=3.163,95%CI 1.190~8.406;P<0.05)。结论老年非瓣膜性房颤患者MCI检出率显著增高,其认知功能障碍主要表现在定向能力、视空间与执行功能、语言能力和抽象概括能力等方面。房颤、年龄、高血压对MCI有影响,通过有效管理房颤等危险因素,可以对MCI的防治起到积极作用。Objective To investigate the characteristics of mild cognitive impairment(MCI)in the elderly patients with non-valvular atrial fibrillation and its affecting factors.Methods We retrospectively analyzed the clinical data of 104 elderly inpatients in the Department of General Medicine of Tongji Hospital of Huazhong University of Science and Technology from October 2018 to September 2019,with 52 cases in atrial fibrillation group(AF group)and non-atrial fibrillation group(non-AF group)respectively.Cognitive function was assessed using mini-mental state evaluation(MMSE)and Montreal cognitive assessment(MoCA)for the detection rate,clinical characteristics and risk factors of MCI in both groups.SPSS statistics 26.0 was used for data analysis.According to the data type,t-test,non-parametric rank sum test orχ^(2) test was used for comparison between groups.Logistic regression model was used for multivariate analysis.Results Compared with the non-AF group,the AF group had lower total MMSE[(27.37±1.53)vs(28.33±1.01)]and MoCA[(24.71±1.54)vs(26.29±1.63)];and significantly higher detection rate of MCI(MMSE:38.5%vs 7.7%;MoCA:61.5%vs 30.8%),the difference being statistically significant(P<0.05).Evaluation of 7 sub-cognitive domains using the MoCA showed that the orientation ability,visual space and executive function,language ability,and abstract generalization in the AF group were worse than in the Non-AF group,the difference being statistically significant(P<0.05).MCI patients were defined as MoCA being positive,and five risk factors(atrial fibrillation,hypertension,hyperlipidemia,age,education level)that had an impact on MCI both by the MMSE and MoCA were selected as independent variables for logistic regression analysis.The results showed that longer schooling years were protective factors for MCI,while atrial fibrillation,advanced age and hypertension were independent risk factors for MCI,of which atrial fibrillation was a stronger risk factor(OR=3.163,95%CI 1.190-8.406;P<0.05).Conclusion Detection rate of MCI increas

关 键 词：老年人 非瓣膜性房颤 轻度认知功能障碍 

分 类 号：R541.75[医药卫生—心血管疾病]