永久性心房颤动并发慢性心力衰竭患者发生认知障碍的影响因素  

Influencing Factors of Cognitive Impairment in Patients with Permanent Atrial Fibrillation Combined with Chronic Heart Failure

作　　者：许海侠[1] 祁彬[2] XU Haixia;QI Bin(Department of Cardiovascular Medicine,Bozhou People's Hospital,Bozhou,Anhui 236800,China;Intensive Care Unite,Bozhou People's Hospital,Bozhou,Anhui 236800,China)

机构地区：[1]安徽省亳州市人民医院心血管内科,安徽亳州236800 [2]安徽省亳州市人民医院重症监护病房,安徽亳州236800

出　　处：《岭南心血管病杂志》2024年第3期304-310,共7页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨永久性心房颤动(permanent atrial fibrillation,PAF)并发慢性心力衰竭(chronic heart failure,CHF)患者认知功能障碍(cognitive impairment,CI)的影响因素。方法回顾性分析2019年6月至2023年5月因心慌气短、胸闷胸痛、心搏紊乱等症状在安徽省亳州市人民医院心血管内科就诊的患者资料,筛选与本次研究要求相符的患者共523例。将患者按照疾病不同分为PAF组、CHF组、PAF并发CHF组,统计学分析各组疾病导致CI发生的风险系数。再将PAF并发CHF组患者根据是否发生CI分为两个亚组,比较两亚组患者的临床诊查资料,并采用Logistic多因素回归法统计患者发生CI的相关影响因素。结果PAF组、CHF组、PAF并发CHF组患者年龄、简易精神状态量表(mini-mental state examination,MMSE)评分、CI发生率比较,差异均有统计学意义(P<0.05)。单因素分析显示,3组的疾病均会增加CI的发生风险,尤其是PAF并发CHF患者CI发生风险系数最高(OR=2.454,P<0.001)。在PAF并发CHF患者中,发生CI组患者的年龄、左心室射血分数、心房颤动持续时间、MMSE评分、受教育程度、糖尿病发生率、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、纽约心脏协会(New York Heart Association,NYHA)心功能分级与无CI组患者比较,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、MMSE评分、左心室射血分数、NT-proBNP、受教育程度、糖尿病、NYHA心功能分级等指标与PAF并发CHF患者发生CI呈显著相关性(P<0.05)。结论PAF并发CHF会增加CI的发生风险,其他如年龄、MMSE评分、患者受教育程度等也是影响CI发生的相关因素,临床上应注意对CI高风险患者的早期筛查和针对性的防治,以提高PAF并发CHF患者的治疗效果,改善生活质量。Objectives To analyze the influencing factors of cognitive impairment(CI)in patients with permanent atrial fibrillation(PAF)combined with chronic heart failure(CHF).Methods Retrospectively analyzed the data of patients from June 2019 to May 2023 who were treated in Bozhou People's Hospital due to symptoms such as palpitations,shortness of breath,chest tightness,chest pain,and heart rate disorders.A total of 523 patients who meet the requirements of this study were screened.The patients were divided into three groups based on different diseases:PAF group,CHF group,and PAF combined with CHF group.The risk factors for CI in each group were statistically analyzed.Furthermore,the patients in PAF combined with CHF group were divided into two subgroups based on whether CI occurred,and the clinical diagnostic data of the two subgroups were compared.Multiple-factor Logistic regression analysis was used to identify the relevant risk factors for CI occurrence in these patients.Results There were statistically significant differences(P<0.05)in age,mini-mental state examination(MMSE)score,and CI incidence among PAF group,CHF group,and PAF combined with CHF group.Univariate analysis showed that all three groups had an increased risk of CI occurrence,especially in patients with PAF combined with CHF,who had the highest risk coefficient for CI occurrence(OR=2.454,P<0.001).Among the patients with PAF combined with CHF,there were statistically significant differences(P<0.05)in age,left ventricular ejection fraction,duration of atrial fibrillation,MMSE score,education level,diabetes incidence,N-terminal pro-brain natriuretic peptide(NT-proBNP),and New York Heart Association(NYHA)functional class between CI subgroup and non-CI subgroup.Multiple-factor Logistic regression analysis revealed that age,MMSE score,left ventricular ejection fraction,NT-proBNP,education level,diabetes and NYHA classification were all asso⁃ciated with the occurrence of CI in patients with PAF combined with CHF(P<0.05).Conclusions PAF combined with CHF incr

关 键 词：心房颤动 心力衰竭 认知障碍 影响因素 

分 类 号：R541.7[医药卫生—心血管疾病] R541.6[医药卫生—内科学]