老年无卒中房颤病人的痴呆发病风险及其危险因素分析

Analysis of the risk and influencing factors of dementia in elderly patients with atrial fibrillation without stroke

目的探讨老年无卒中房颤病人的痴呆发病风险及其危险因素。方法纳入2014年7月至2017年2月我院收治的113例无卒中房颤病人,按照随访其是否发生痴呆分为痴呆组和对照组。分析2组病人的临床资料、用药情况,采用多因素Logistic回归分析影响无卒中房颤病人发生痴呆的危险因素。结果113例病人的中位随访时间为41(25~61)个月,6例病人失访,最终107例房颤病人发生痴呆者34例,发生率为31.77%。痴呆组持续/永久性房颤比例、年龄、高血压、心力衰竭比例高于对照组,应用新型口服抗凝药比例低于对照组,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,持续/永久性房颤(OR=33.534)、年龄(OR=1.127)、高血压(OR=10.605)是痴呆发生的独立危险因素(P<0.05),应用新型口服抗凝药(OR=0.265)是痴呆发生的保护性因素(P<0.05)。结论对于无卒中的房颤病人应高度警惕痴呆的发生,特别是持续/永久性房颤病人,而新型的口服抗凝药能够有效降低痴呆发生风险。

Objective To investigate the risk of dementia in the elderly patients with atrial fibrillation without stroke and to analyze the risk factors of dementia.Methods A total of 113 patients with atrial fibrillation without stroke admitted to the hospital from July 2014 to February 2017 were enrolled.The patients were divided into dementia group and control group based on the follow-up result.The clinical data and medication status of the two groups were analyzed,and the risk factors of dementia were analyzed by multivariate Logistic regression analysis.Results The median follow-up time of 113 patients was 41(25-61)months.Six patients were lost to follow-up.Of the 107 patients with atrial fibrillation,34 patients presented with dementia,with an incidence rate of 31.77%.The age,and the proportion of persistent/permanent atrial fibrillation,hypertension and heart failure in the dementia group were significantly higher than those in the control group(all P<0.05),while the administration rate of new oral anticoagulant was significantly lower(P<0.05).Multivariate Logistic regression analysis showed that persistent/permanent atrial fibrillation(OR=33.534),age(OR=1.127),and hypertension(OR=10.605)were independent risk factors for dementia(P<0.05),and new oral anticoagulant(OR=0.265)was a protective factor for dementia(P<0.05).Conclusions The patients with atrial fibrillation without stroke should be highly alert to the occurrence of dementia,especially in the patients with persistent/permanent atrial fibrillation,but the new oral anticoagulant can effectively reduce the risk of dementia.