抗凝治疗对心房颤动患者痴呆风险的网状Meta分析  

Net Meta-analysis of anticoagulation therapy on the risk of dementia in patients with atrial fibrillation

作　　者：邢雨涵 张月[2] 张浩永 许方蕾[2] XING Yuhan;ZHANG Yue;ZHANG Haoyong;XU Fanglei(Medical College,Tongji University,Shanghai 200092,China;Department of Nursing,Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学医学院,上海200092 [2]同济大学附属同济医院护理部,上海200065

出　　处：《现代医学》2024年第6期866-874,共9页Modern Medical Journal

基　　金：上海市卫生健康委员会研究课题(202240365);上海市残疾人联合会康复项政策研究专项(2022ZC1017)。

摘　　要：目的:对比评价新型口服抗凝药物(NOACs)与维生素K抗凝剂(VKA)对心房颤动患者痴呆发生的疗效。方法:计算机检索Web of Science、PubMed、Scopus、Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普中文科技期刊全文数据库,基于PICOS原则纳入口服抗凝药物治疗影响心房颤动患者痴呆的相关文献,检索时间截至2023年9月,使用RevMan 5.4软件和R 4.2.3软件进行Meta分析。结果:最终纳入13篇文献,共2 187 211例心房颤动患者。结果显示,NOACs和VKA造成痴呆风险比较存在差异(HR=0.88,95%CI 0.82~0.95);对血管性痴呆和阿尔茨海默病比较不存在显著差异;新型口服抗凝药物之间不存在显著差异,依度沙班和华法林对比存在显著差异(HR=0.36,95%CI 0.11~0.93)。结论:NOACs在预防心房颤动患者痴呆发生方面优于VKA,未来还需要更多临床试验证实该结论。Objective:Atrial fibrillation(AF)is an independent risk factor for dementia,and anticoagulation therapy has been found to be associated with a reduced risk of dementia in patients with AF,but there is a lack of comparison between the various types of anticoagulants;therefore,this study To compare and evaluate the efficacy of new oral anticoagulants(NOACs)versus vitamin K antagonists(VKA)on the development of dementia in patients with artrial fibrillation(AF).Methods:A computerized search of Web of Science,PubMed,Scopus,Cochrane Library,China Biomedical Medical Literature Database(CBM),China Knowledge Network,WanFang,and VIP databases was performed to include relevant study on oral anticoagulant therapy affecting dementia in patients with atrial fibrillation based on the PICOS principle.The search time was up to September 2023,and Meta-analysis was performed using RevMan 5.4 software and R 4.2.3 software.Results:Thirteen papers with a total of 2187211 patients with AF were finally included.The results showed that there was a difference in the comparison of the risk of dementia caused by NOACs and VKA(HR=0.88,95%CI 0.82-0.95);there was no significant difference when comparing vascular dementia and Alzheimer's disease;there was no significant difference between the NOACs,and there was a significant difference in the comparison of edoxaban and warfarin(HR=0.36,95%CI 0.11-0.93).Conclusion:NOACs is superior to VKA in preventing the development of dementia in patients with AF,and more clinical trials are needed to confirm this conclusion in the future.

关 键 词：心房颤动 痴呆 抗凝 新型口服抗凝药 维生素K抗凝剂 

分 类 号：R473.5[医药卫生—护理学]