华法林和利伐沙班对老年非瓣膜性心房颤动患者认知功能的影响

Effects of warfarin and rivaroxaban on cognitive function in elderly patients with nonvalvular atrial fibrillation

目的探究华法林、利伐沙班对老年非瓣膜性心房颤动(NVAF)患者认知功能的影响。方法采用前瞻性研究方法,收集2021年12月1日至2022年4月30日127例就诊于扬州大学附属医院的NVAF患者。分为对照组(既未服用抗凝药,也未服用抗板药,n=52)、华法林组(n=36)、利伐沙班组(n=39)。收集入组患者年龄、性别、BMI、受教育程度等临床资料,认知功能通过灵敏性更高的蒙特利尔认知评价(MoCA)量表来进行评估,分析认知功能障碍的影响因素,比较三组患者MoCA量表各子项评分及维生素K水平。结果与对照组相比,华法林组、利伐沙班组MoCA评分显著增加(P<0.05);与华法林组相比,利伐沙班组的MoCA评分显著增加(P<0.05)。受教育程度和服用药物情况是认知功能障碍的危险因素(P<0.05)。与对照组和利伐沙班组相比,华法林组的视空间技能与执行能力分数和延迟回忆分数显著减少(P<0.05)。与对照组和利伐沙班组[0.380(0.355,0.398)、0.410(0.385,0.440)]相比,华法林组维生素K水平[0.338(0.325,0.345)]显著减少(P<0.05)。结论NVAF可通过采用抗凝治疗有效预防认知功能障碍,而在抗凝药物的选择上,利伐沙班因其不影响维生素K的代谢较华法林具有更好的优势。

Objective To explore the effects of warfarin and rivaroxaban on cognitive function in elderly patients with non-valvular atrial fibrillation(NVAF).Methods A prospective study was conducted to collect 127 patients with NVAF who were admitted to the Affiliated Hospital of Yangzhou University from December 1,2021 to April 30,2022.They were divided into control group(n=52),warfarin group(n=36)and rivaroxaban group(n=39).It was collected clinical data such as age,gender,BMI and education level of enrolled patients,analyzed cognitive function was assessed by the Montreal Cognitive Assessment(MoCA)scale with higher sensitivity,and the influencing factors of cognitive dysfunction,and compared the scores of subitems of MoCA scale and vitamin K levels of patients in the three groups.Results Compared with control group,MoCA score in warfarin group and rivaroxaban group was significantly increased(P<0.05);Compared with warfarin group,MoCA score in rivaroxaban group was significantly increased(P<0.05).Education level and drug use were risk factors for cognitive dysfunction(P<0.05).Compared with the control group and the rivaroxaban group,the visuospatial skills and executive ability scores and delayed recall scores in the warfarin group were significantly reduced(P<0.05).Compared with control group and rivaroxaban group[0.380(0.355,0.398),0.410(0.385,0.440)],vitamin K level in warfarin group[0.338(0.325,0.345)]was significantly decreased(P<0.05).Conclusion NVAF can effectively prevent cognitive dysfunction by using anticoagulant therapy,and rivaroxaban has a better advantage than warfarin in the choice of anticoagulant drugs because it does not affect vitamin K metabolism.