Analysis of influencing factors of mild cognitive impairment in middle-aged and elderly patients with chronic atrial fibrillation
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摘要:
目的 探讨中老年慢性心房颤动(以下简称慢性房颤)患者轻度认知功能障碍的影响因素，以改善慢性房颤患者的认知功能。 方法 纳入2023年2月—2024年2月在河南省人民医院全科医学科就诊的102例慢性房颤患者为房颤组，纳入同期就诊的年龄与性别匹配的102例窦性心律患者为窦律组。采用蒙特利尔认知评估量表(MoCA)评估患者的认知功能，根据MoCA评分将慢性房颤患者分为认知障碍组(53例)与非认知障碍组(49例)，行单因素及多因素分析。 结果 房颤组的MoCA评分为(23.94±3.28)分，窦律组为(27.17±2.51)分，2组认知功能比较差异有统计学意义(P＜0.05)。房颤组心房颤动卒中风险评估和指导抗凝治疗的评分系统(CHA2DS2-VASc)评分及匹兹堡睡眠指数量表(PSQI)评分均较窦律组高；房颤组合并心力衰竭的比例、抗凝药物及β受体阻滞剂使用的比例均高于窦律组，差异均有统计学意义(P＜0.05)。单因素及多因素logistic回归分析发现，年龄及CHA2DS2-VASc评分均为慢性房颤患者轻度认知功能障碍的影响因素(P＜0.05)。 结论 中老年慢性房颤患者的认知功能较窦律组患者下降，其中视空间及执行功能、记忆及延迟回忆、注意力与计算力、语言、定向力下降更为显著。年龄及CHA2DS2-VASc评分均为慢性房颤患者轻度认知功能障碍的影响因素。 Abstract:Objective To investigate the influencing factors of mild cognitive function impairment in middle-aged and elderly patients with chronic atrial fibrillation (AF), as to improve the cognitive function of chronic AF patients. Methods A total of 102 patients with chronic atrial fibrillation (AF group) and 102 patients with sinus rhythm (SR group) who visited the Department of General Medicine at the First Affiliated Hospital of Zhengzhou University from February 2023 to February 2024 were included. The Montreal cognitive assessment scale (MoCA) was used to assess the patients ' cognitive function. According to the MoCA score, the patients with chronic AF were divided into a cognitive impairment group (n=53) and a non-cognitive impairment group (n=49) for univariate and multivariate analyses. Results The MoCA scores of the chronic AF group and the SR group were (23.94±3.28) points and (27.17±2.51) points, respectively, and the difference was statistically significant (P < 0.05). Compared with SR group, CHA2DS2-VASc score and Pittsburgh sleep quality index (PSQI) score were higher in AF group, the proportion of AF combined with heart and the proportion of using anticoagulant and beta blockers were higher than those of SR group, and the differences were statistically significant (P < 0.05). Univariate and multivariate logistic regression analysis revealed that age and CHA2DS2-VASc score were the influencing factors of mild cognitive impairment in patients with chronic AF (P < 0.05). Conclusion The cognitive function of patients with chronic AF is significantly lower than that of SR group, and the most significant decrease is in visuospatial and executive function, memory and delayed recall, attention and calculation, language, and orientation. The age and CHA2DS2-VASc score are the influencing of mild cognitive impairment in chronic AF patients. -
Key words:
- Atrial fibrillation /
- Mild cognitive impairment /
- Influencing factors
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表 1 房颤组与窦律组中老年患者一般资料比较
Table 1. Comparison of general clinical data between the atrial fibrillation group and the sinus rhythm group
项目 房颤组(n=102) 窦律组(n=102) 统计量 P值 年龄(x±s, 岁) 71.25±9.21 71.12±9.14 < 0.001a 0.999 性别(男/女, 例) 58/44 58/44 < 0.001b 0.999 脑力劳动[例(%)] 50(49.0) 64(62.7) 3.360b 0.067 大学及以上文化[例(%)] 22(21.6) 26(25.5) 0.437b 0.804 城镇居住[例(%)] 71(69.6) 78(76.5) 1.220b 0.269 BMI(x±s) 24.91±5.93 24.29±3.93 0.877a 0.382 CHA2DS2-VASc评分[M(P25, P75), 分] 4.00(2.00, 5.00) 3.00(2.00, 4.00) -3.085c 0.004 高血压[例(%)] 58(56.9) 60(58.8) 0.080b 0.777 冠心病[例(%)] 47(46.1) 40(39.2) 0.982b 0.322 心力衰竭[例(%)] 22(21.6) 1(1.0) 21.610b 0.001 高脂血症[例(%)] 5(5.0) 8(7.8) 0.739b 0.390 糖尿病[例(%)] 34(33.3) 43(42.2) 1.690b 0.194 抗血小板药物[例(%)] 23(22.5) 29(28.4) 0.929b 0.335 抗凝药物[例(%)] 38(37.3) 7(6.9) 27.400b 0.001 β受体阻滞剂[例(%)] 39(38.2) 23(22.5) 5.932b 0.015 他汀类药物[例(%)] 39(38.2) 39(38.2) < 0.001b 0.999 PSQI总分[M(P25, P75), 分] 10.00(6.00, 15.00) 4.00(2.00, 8.00) -8.072c 0.001 注：a为t值，b为χ2值，c为Z值。 
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表 3 房颤组与窦律组中老年患者认知功能比较(x±s, 分)
Table 3. Comparison of cognitive function between middle-aged and elderly patients with atrial fibrillation and those with sinus rhythm(x±s, points)
组别 例数 MoCA总分 视空间及执行功能 命名 记忆及延迟回忆 注意力与计算力 语言 抽象能力 定向力 房颤组 102 23.94±3.28 3.98±0.84 2.93±0.25 3.36±0.88 4.54±0.86 2.69±0.55 1.97±0.17 4.41±1.10 窦律组 102 27.17±2.51 4.42±0.74 2.98±0.14 4.52±0.69 5.07±0.80 2.87±0.33 2.00±0.00 5.29±0.75 t值 6.677 3.976 1.709 10.501 4.544 2.942 1.749 6.677 P值 0.001 0.001 0.089 0.001 0.001 0.004 0.082 0.001
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表 4 慢性房颤患者轻度认知功能障碍的单因素logistic回归分析
Table 4. Univariate logistic regression analysis of mild-cognitive dysfunction in patients with chronic atrial fibrillation
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.206 0.043 23.165 0.001 1.229 1.130~1.336 性别 1.943 0.456 18.176 0.001 6.979 2.857~17.049 文化程度 -1.064 0.511 4.346 0.037 0.345 0.127~0.938 CHA2DS2-VASc评分 0.777 0.174 19.932 0.001 2.174 1.546~3.058 PSQI总分 0.109 0.047 5.449 0.020 1.115 1.018~1.223 注：本表仅列出差异有统计学意义的变量。变量赋值如下，无认知障碍=0，认知障碍=1；年龄≤65岁=0，年龄＞65岁=1；男性=0，女性=1；大学以下文化=0，大学及以上文化=1；CHA2DS2-VASc评分＜4分=0，CHA2DS2-VASc评分≥4分=1；PSQI总分＜10分=0，PSQI总分≥10分=1。
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表 5 慢性房颤患者轻度认知功能障碍的多因素logistic回归分析
Table 5. Multivariate logistic regression analysis of mild cognitive dysfunction in patients with chronic atrial fibrillation
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.230 0.064 12.970 0.001 1.259 1.111~1.427 性别 0.073 0.052 2.011 0.156 1.076 0.972~1.190 文化程度 -0.654 0.567 1.331 0.249 0.520 0.171~1.579 CHA2DS2-VASc评分 0.542 0.175 8.092 0.007 1.254 1.106~1.423 PSQI总分 0.018 0.067 0.074 0.786 1.018 0.894~1.160
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