非瓣膜性心房颤动患者血管性痴呆危险因素的病例对照研究

Risk factors for vascular dementia in patients with nonvalvular atrial fibrillation:a case-control study

目的探讨非瓣膜性心房颤动(房颤)患者血管性痴呆的危险因素,评估不同抗凝药物与心房颤动患者发生血管性痴呆的关系。方法采用病例对照研究,选取血管性痴呆的非瓣膜性房颤患者66例(病例组)。对照组为未患血管性痴呆的非瓣膜性房颤患者132例。比较2组患者年龄、性别、体质量指数(BMI)、教育水平、吸烟等一般情况以及糖尿病、高血压、心绞痛、慢性阻塞性肺疾病(COPD)、甲状腺功能亢进、甲状腺功能减退、心肌梗死、血脂异常等疾病史和抗凝药物使用情况。结果2组患者年龄、性别、肥胖发生率及教育年限比较差异无统计学意义(P>0.05),病例组患者吸烟和华法林使用比例,高血压、糖尿病、心绞痛、血脂异常发生率明显高于对照组患者。Logistic回归分析显示,服用利伐沙班进行抗凝治疗的患者血管性痴呆发生风险较使用华法林者下降(OR=0.480,95%CI:0.244~0.944)。糖尿病(OR=2.117,95%CI:1.080~4.149)、高血压(OR=2.224,95%CI:1.109~4.461)、吸烟(OR=2.269,95%CI:1.148~4.488)、血脂异常(OR=2.045,95%CI:1.037~4.032)、有心绞痛病史(OR=2.336,95%CI:1.165~4.682)是非瓣膜性心房颤动患者出现血管性痴呆的危险因素(均P<0.05)。结论与华法林相比,使用利伐沙班进行抗凝治疗是非瓣膜性房颤患者血管性痴呆的保护因素,糖尿病、高血压、吸烟、血脂异常、心绞痛病史则是非瓣膜性房颤患者血管性痴呆发生的危险因素。

Objective To investigate the risk factors of vascular dementia in patients with nonvalvular atrial fibrillation,and to evaluate the relationship between different anticoagulants and vascular dementia in patients with atrial fibrillation.Methods A case-control study was conducted in 66 patients with nonvalvular atrial fibrillation and vascular dementia(the case group).The control group included 132 patients with nonvalvular atrial fibrillation and without vascular dementia.Data of age,sex,body mass index(BMI),education level,smoking and other general conditions including disease history of diabetes,hypertension,angina pectoris,chronic obstructive pulmonary disease(COPD),hyperthyroidism,hypothyroidism,myocardial infarction,dyslipidemia and anticoagulant drug use were compared between the two groups.Results There were no significant differences in age,gender,incidence of obesity and average education years between the two groups(P>0.05).The proportion of smoking and utilization rate of warfarin was significantly higher in the case group than that in the control group(P<0.05).The incidence of hypertension,diabetes,angina pectoris and dyslipidemia were significantly higher in the case group than those in the control group(P<0.05).Logistic regression analysis showed that the risk of vascular dementia was lower in patients taking rivaroxaban anticoagulant therapy than that in patients taking warfarin(OR=0.480,95%CI:0.244-0.944).Diabetes mellitus(OR=2.117,95%CI:1.080-4.149),hypertension(OR=2.224,95%CI:1.109-4.461),smoking(OR=2.269,95%CI:1.148-4.488),dyslipidemia(OR=2.045,95%CI:1.037-4.032)and history of angina pectoris(OR=2.336,95%CI:1.165-4.682)were risk factors for vascular dementia in patients with nonvalvular atrial fibrillation(P<0.05).Conclusion Compared with warfarin,rivaroxaban anticoagulant therapy is a protective factor for vascular dementia in patients with nonvalvular atrial fibrillation,while diabetes,hypertension,smoking,dyslipidemia and history of angina are risk factors for vascular dementia in patients with nonvalvular atrial fibrillation.