住院心房颤动患者血管性认知障碍及相关危险因素分析

Risk Factor Analysis of Vascular Cognitive Impairment for In-hospital Atrial Fibrillation Patients

目的:探讨住院心房颤动(房颤)患者血管性认知功能障碍(VCI)的发生率及相关危险因素。方法:选择兰州大学第二医院住院的房颤患者303例,根据简易智能状态检查量表(MMSE)评分分为无VCI组216例,VCI组87例。评估住院房颤患者VCI的发生率,并对VCI进行单因素及多因素分析。结果:与无VCI组比较,VCI组年龄较大,CHA2DS2-VASC评分≥2分、持续/永久性房颤、合并糖尿病及心力衰竭的比例、收缩压、平均动脉压、脉压,左心房前后径及血肌酐较高,男性比例及左心室舒张末内径较低,差异具有统计学意义(P<0.05或P<0.001)。住院房颤患者VCI发生率为40.3%,随着年龄的增大、CHA2DS2-VASC评分的增高,VCI发生率增加,女性VCI发生率高于男性,持续及永久性房颤患者VCI发生率高于阵发性房颤患者(P<0.05或P<0.001)。多元线性回归分析显示,年龄(OR=-0.1135,95%CI:-0.1708^-0.0562,P=0.0001)、女性(OR=-1.2528,95%CI:-2.2056^-0.3000,P=0.0105)、文化水平(小学OR=3.2193,95%CI:1.8446~4.5940,P<0.0001;初中及以上OR=5.9104,95%CI:4.6055~7.2154,P<0.0001)、心力衰竭(OR=-1.9357,95%CI:-3.5522^-0.3192,P=0.0196)、脑卒中(OR=-1.6349,95%CI:-2.7517^-0.5181,P=0.0044)及左心房前后径(OR=-0.1252,95%CI:-0.1962^-0.0541,P=0.0006)与住院房颤患者VCI发生相关。结论:住院房颤患者VCI发生率高,高龄、女性、较低文化水平、心力衰竭、脑卒中及左心房前后径扩大是房颤患者发生VCI的相关危险因素。

Objective： To explore the incidence and risk factors of vascular cognitive impairment （VCI） for in-hospital atrial fibrillation （AF） patients. Methods： A total of 303 in-hospital AF patients were studied. Based on MMSE score evaluation, the patients were divided into 2 groups： Non-VCI group, n=216 and VCI group, n=87. The incidence of VCI was assessed and different cognitive functions were studied by uni- and multivariate regression analysis. Results： Compared with Non-VCI group, the patients in VCI group had the elder age, higher proportion of CHA2DS2-VASC score ≥ 2, more with persistent/permanent AF, more combining diabetes and heart failure （HF）, more had increased systolic blood pressure, mean arterial pressure, pulse pressure, left atrial （LA） diameter and serum creatinine; less male and decreased left ventricular end-diastolic diameter, P〈0.05 and P〈0.001. The occurrence rate of VCI for in-hospital patients was 40.3%, with age and CHA2DS2-VASC score increasing, the incidence of VCI was elevating and the occurrence rates in female was higher than male, the patients with persistent/permanent AF was higher than paroxysmal AF, P〈0.05 and P〈0.001. Multiple linear regression analysis showed that age （OR=-0.1135, 95% CI -0.1708 to -0.0562, P=0.0001）, female （OR=-1.2528, 95% CI -2.2056 to -0.3000, P=0.0105）, education [primary school level （OR=3.2193, 95% CI 1.844-4.5940, P〈0.0001）,middle school and above level （OR=5.9104, 95% CI 4.6055-7.2154, P〈0.0001）], HF （OR=-1.9357, 95% CI -3.5522 to-0.3192, P=0.0196）, stroke （OR=-1.6349, 95% CI -2.7517 to -0.5181, P=0.0044） and LA diameter （OR=-0.1252, 95% CI-0.1962 to -0.0541, P=0.0006） were related to VCI occurrence in hospitalized AF patients. Conclusion： The incidence of VCI was high in hospitalized AF patients; elder age, female, lower education, HF, stroke and enlarged LA diameter were the risk factors for VCI occurrence in AF patients.