60岁以上非瓣膜性房颤住院患者无症状性脑梗死与轻度认知障碍的临床研究

The clinical study on the relationship between silent cerebral ischemia and cognitive impairment in inpatiens older than sixty with nonvalvula atrial fibrillation

目的探讨60岁以上非瓣膜性房颤(nonvalvula atrial fibrillation,NAF)住院患者无症状性脑梗死(silent cerebral ischemia,SCI)与轻度认知障碍(m Iid cognitive impairment,MCI)的关系。方法 2014年11月至2015年11月惠州市中心人民医院住院的患者,共纳入98例,根据是否有NAF分为NAF组45例,窦性心律(sinus rhythm,SR)组53例。收集所有患者的一般临床资料,于住院1周内采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,Mo CA)和头颅MRI分别进行认知功能评估和SCI检测。结果 NAF组Mo CA总评分低于SR组[16(10,20)vs.20(15,23),P=0.006]。NAF组患者至少出现1个SCI病灶的比例高于SR组(80.0%vs.52.8%,P=0.018)。NAF组比SR组SCI病灶更好发于皮层或皮层下白质(25.2%vs.12.4%,P=0.017)。多因素分析显示,AF患者Mo CA评分与教育程度有关;SR患者则与年龄、教育程度有关。结论 AF是认知功能下降的独立危险因素,同时与SCI发生有关。受教育程度也是影响老年患者认知功能的因素之一。

Objectives The aim of this study was to study the relationship between silent cerebral ischemia （SCI） and mild cognitive impairment （MCI）in inpatients with nonvalvula atrial fibrillation （NAF） and those with sinus rhythm （SR） older than sixty. Methods Ninety-eight inpatients were enrolled from November 2014 to November 2015 in Hui- zhou Municipal Central Hospital： 45 patients with NAF and 53 with SR. All general clinical data was collected. The Montreal Cognitive Assessment （MoCA） and brain MRI were used to assess the cognitive performance of patients within 1 weeks of admission. Results The MoCA scores were lower in patients with NAF than in those with SR[16（I0,20） vs. 20 （15,23）, P=0.006]. At least one foci of SCI was present in patients 80% with NAF and 52.8% with SR （NAF vs. SR, P= 0.018）.The rates of SCIs in the cortex/subcortex were higher in the NAF group than in the SR group （25.2% vs. 12.4%, P= 0.017）. Multivariate analysis showed that MoCA score were related to the degree of education in NAF patients and were related to age and education level in SR patients. Conclusions NAF is an independent risk factor for cognitive impair- ment in NAF patient and associated with the SCI present. Educational level is a factor affecting the cognitive function with elderly patients.