肥厚型心肌病患者认知功能障碍的发生及影响因素分析

Occurrence and Influencing Factors Associated with Cognitive Impairment in Patients with Hypertrophic Cardiomyopathy

目的:探讨肥厚型心肌病(HCM)患者认知功能障碍的发生及影响因素。方法:收集2018年4月至2019年7月期间空军军医大学第一附属医院超声医学科HCM患者198例。综合北京版蒙特利尔认知评估(MoCA)量表结果及教育程度,判断患者认知功能:文盲且MoCA得分<14分、1年≤教育年限≤6年且MoCA得分<20分、或教育年限>6年且MoCA得分<25分为认知功能障碍组(n=37),其余为认知功能正常组(n=161)。比较两组患者一般资料、超声心动图检查结果及认知功能评估结果。采用多因素logistic回归分析筛选HCM患者认知功能障碍的可能危险因素。结果:HCM患者认知功能障碍的发生率为18.7%(37/198)。与认知功能正常组相比,认知功能障碍组HCM患者年龄较大(P<0.05),受教育年限较短(P<0.05),心功能分级及左心室舒张功能较差(P<0.05),激发左心室流出道压差较高(P<0.05)。认知功能障碍组HCM患者MoCA得分较低(P<0.05),尤其在视空间与执行功能和延迟回忆(P<0.05)两项上得分较差。多因素logistic回归分析结果表明,调整年龄(OR=14.435, 95%CI:4.476-46.550;P<0.001)和教育年限(OR=5.274, 95%CI:2.024-13.744;P=0.001)后,激发左心室流出道压差(OR=3.844, 95%CI:1.551-9.524;P=0.004)是HCM患者认知功能障碍的独立危险因素。结论:激发左心室流出道压差可以增加HCM患者认知功能障碍的发生风险。

Objective: To describe the occurrence of cognitive impairment in hypertrophic cardiomyopathy(HCM) patients and explore possible influencing factors associated with cognitive impairment. Methods: 198 patients with HCM, who were admitted in the department of ultrasound, Xijing Hospital of Air Force Medical University from April 2018 to July 2019, were collected. Both Montreal Cognitive Assessment(MoCA) test and education years were considered to assess cognitive function of these patients. The cutoff score for cognitive impairment to the present study were 14 for illiterate patients, 19 for patients with 1-6 years of education, and 24 for patients with 7 or more years of education. And according to this criterion, HCM patients were divided into cognitive impairment group(n=37)and normal cognitive function group(n=161). Demographic data and clinical characteristics, life style and history of diseases,echocardiography and cognitive assessment were collected and compared between two groups. Multivariate logistic regression analysis was used to assess the possible risk factors for cognitive impairment in HCM patients. Results: The incidence of cognitive impairment in HCM patients was 18.7 %. Patients in cognitive impairment group were older in age(P<0.05), had shorter years of education(P<0.05),poorer cardiac function and diastolic function in left ventricular(P<0.05) and significantly higher pressure of provoked left ventricular outflow tract pressure gradient(LVOT-PG, P<0.05). Besides, patients in cognitive impairment group had lower MoCA score(P<0.05),especially a poorer performance in visual space and executive function and delayed recall(P<0.05). The results of multivariate logistic regression analysis showed that after adjusting for age(OR=14.435, 95 %OR 4.476-46.550;P<0.001) and years of education(OR=5.274,95 %OR 2.024-13.744;P=0.001), LVOT-PG(OR=3.844, 95 % CI: 1.551-9.524;P=0.004) was an independent risk factor for cognitive impairment in HCM patients. Conclusion: LVOT-PG can increase the risk of cognitive impairment in patients with HCM. In the clinic, it is necessary to pay attention to the change of LVOT-PG in HCM patients for early prevention of the occurrence and progression of cognitive impairment.