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

doi:10.11958/20212846

天津医药 ›› 2022, Vol. 50 ›› Issue (8): 840-843.doi: 10.11958/20212846

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

贺宏梅(), 孙健, 王欢欢, 马书静, 张海燕, 邹玉安, 薛茜, 宋爱霞()

河北北方学院附属第一医院神经内科（邮编075000）

收稿日期:2021-12-26 修回日期:2022-04-18 出版日期:2022-08-15 发布日期:2022-08-12
通讯作者: 宋爱霞 E-mail:528121870@qq.com;1979958315@qq.com
作者简介:贺宏梅（1987）,女,主治医师,主要从事脑血管病和神经重症方面研究。E-mail： 528121870@qq.com
基金资助:
2020年度河北省卫健委医学科学研究课题计划(20200550)

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

HE Hongmei(), SUN Jian, WANG Huanhuan, MA Shujing, ZHANG Haiyan, ZOU Yu'an, XUE Qian, SONG Aixia()

Department of Neurology, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China

Received:2021-12-26 Revised:2022-04-18 Published:2022-08-15 Online:2022-08-12
Contact: SONG Aixia E-mail:528121870@qq.com;1979958315@qq.com

贺宏梅, 孙健, 王欢欢, 马书静, 张海燕, 邹玉安, 薛茜, 宋爱霞. 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[J]. 天津医药, 2022, 50(8): 840-843.

HE Hongmei, SUN Jian, WANG Huanhuan, MA Shujing, ZHANG Haiyan, ZOU Yu'an, XUE Qian, SONG Aixia. Risk factors for vascular dementia in patients with nonvalvular atrial fibrillation: a case-control study[J]. Tianjin Medical Journal, 2022, 50(8): 840-843.

摘要/Abstract

摘要：

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。

关键词: 心房颤动, 痴呆,血管性, 利伐沙班, 危险因素

Abstract:

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.

Key words: atrial fibrillation, dementia, vascular, rivaroxaban, risk factors

中图分类号:

R541.7

图/表 2

参考文献 28

[1]	KANG F, MA Y, CAI A, et al. Meta-analysis evaluating the efficacy and safety of low-intensity warfarin for patients >65 years of age with non-valvular atrial fibrillation[J]. Am J Cardiol, 2021, 142:74-82. doi: 10.1016/j.amjcard.2020.12.001.
[2]	FAUCHIER L, PHILIPPART R, CLEMENTY N, et al. How to define valvular atrial fibrillation?[J]. Arch Cardiovasc Dis, 2015, 108(10):530-539. doi: 10.1016/j.acvd.2015.06.002.
[3]	HEALEY J S, AMIT G, FIELD T S. Atrial fibrillation and stroke:how much atrial fibrillation is enough to cause a stroke?[J]. Curr Opin Neurol, 2020, 33(1):17-23. doi: 10.1097/WCO.0000000000000780.
[4]	KIM D, YANG P S, YU H T, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation:data from a population-based cohort[J]. Eur Heart J, 2019, 40(28):2313-2323. doi: 10.1093/eurheartj/ehz386.
[5]	DAGRES N, CHAO T F, FENELON G, et al. European Heart Rhythm Association(EHRA)/Heart Rhythm Society(HRS)/Asia Pacific Heart Rhythm Society(APHRS)/Latin American Heart Rhythm Society(LAHRS)expert consensus on arrhythmias and cognitive function:what is the best practice?[J]. Europace, 2018, 20(9):1399-1421. doi: 10.1093/europace/euy046.
[6]	BUNCH T J. Atrial fibrillation and dementia[J]. Circulation, 2020, 142(7):618-620. doi: 10.1161/CIRCULATIONAHA.120.045866.
[7]	COLLINS P, LEWIN A, VINCZE IRVING N, et al. Atrial fibrillation patients on warfarin and their transition to direct oral anticoagulants[J]. Crit Pathw Cardiol, 2021, 20(2):103-107. doi: 10.1097/HPC.0000000000000251.
[8]	ALBERTS M, CHEN Y W, LIN J H, et al. Risks of stroke and mortality in atrial fibrillation patients treated with rivaroxaban and warfarin[J]. Stroke, 2020, 51(2):549-555. doi: 10.1161/STROKEAHA.119.025554.
[9]	FRIBERG L, ROSENQVIST M. Less dementia with oral anticoagulation in atrial fibrillation[J]. Eur Heart J, 2018, 39(6):453-460. doi: 10.1093/eurheartj/ehx579.
[10]	BRIEN J T, THOMAS A. Vascular dementia[J]. Lancet, 2015, 386(10004):1698-1706. doi: 10.1016/S0140-6736(15)00463-8.
[11]	翁映虹, 黄坚红. 血管性痴呆的定义及诊断进展[J]. 广东医学, 2010, 31(14):1881-1882.
	WEN Y H, HUANG J H. Definition and diagnosis of vascular dementia[J]. Guangdong Med J, 2010, 31(14):1881-1882. doi: 10.3969/j.issn.1001-9448.2010.14.047.
[12]	KALARIA R N. The pathology and pathophysiology of vascular dementia[J]. Neuropharmacology, 2018, 134(Pt B):226-239. doi: 10.1016/j.neuropharm.2017.12.030.
[13]	ALDRUGH S, SARDANA M, HENNINGER N, et al. Atrial fibrillation,cognition and dementia:A review[J]. J Cardiovasc Electrophysiol, 2017, 28(8):958-965. doi: 10.1111/jce.13261.
[14]	CHOPARD R, PIAZZA G, GALE S A, et al. Dementia and atrial fibrillation:pathophysiological mechanisms and therapeutic implications[J]. Am J Med, 2018, 131(12):1408-1417. doi: 10.1016/j.amjmed.2018.06.035.
[15]	李瑞龄, 赵志强. 松弛素在心房颤动中的应用研究进展[J]. 天津医药, 2021, 49(4)441-444.
	LI R L, ZHAO Z Q. Research progress of relaxin in atrial fibrillation[J]. Tianjin Med J, 2021, 49(4):441-444. doi: 10.11958/20201643.
[16]	KVASNICKA T, MALIKOVA I, ZENAHLIKOVA Z, et al. Rivaroxaban-metabolism,pharmacologic properties and drug interactions[J]. Curr Drug Metab, 2017, 18(7):636-642. doi: 10.2174/1389200218666170518165443.
[17]	PETERSON E D, ASHTON V, CHEN Y W, et al. Comparative effectiveness,safety,and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation[J]. Am Heart J, 2019, 212:113-119. doi: 10.1016/j.ahj.2019.02.001.
[18]	KIM D, YANG P S, JANG E, et al. Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation[J]. Europace, 2021, 23(2):184-195. doi: 10.1093/europace/euaa192.
[19]	JACOBS V, MAY H T, BAIR T L, et al. Long-term population-based cerebral ischemic event and cognitive outcomes of direct oral anticoagulants compared with warfarin among long-term anticoagulated patients for atrial fibrillation[J]. Am J Cardiol, 2016, 118(2):210-214. doi: 10.1016/j.amjcard.2016.04.039.
[20]	BAUERSACHS R, ZANNAD F. Rivaroxaban:A new treatment paradigm in the setting of vascular protection?[J]. Thromb Haemost, 2018, 118(S01):S12-S22. doi: 10.1055/s-0038-1636530.
[21]	WALKER K A, POWER M C, GOTTESMAN R F. Defining the relationship between hypertension,cognitive decline,and dementia:A review[J]. Curr Hypertens Rep, 2017, 19(3):24. doi: 10.1007/s11906-017-0724-3.
[22]	BIESSELS G J, DESPA F. Cognitive decline and dementia in diabetes mellitus:mechanisms and clinical implications[J]. Nat Rev Endocrinol, 2018, 14(10):591-604. doi: 10.1038/s41574-018-0048-7.
[23]	黄丽琴. 血管性痴呆和2型糖尿病关系的研究进展[J]. 中风与神经疾病杂志, 2021, 38(6):570-573.
	HUANG L Q. Research progress on the relationship between vascular dementia and type 2 diabetes mellitus[J]. Journal of Apoplexy and Nervous Diseases, 2021, 38(6):570-573. doi: 10.19845/j.cnki.zfysjjbzz.2021.0154.
[24]	HAMED S A. Brain injury with diabetes mellitus:evidence,mechanisms and treatment implications[J]. Expert Rev Clin Pharmacol, 2017, 10(4):409-428. doi: 10.1080/17512433.2017.1293521.
[25]	HELMAN A M, MURPHY M P. Vascular cognitive impairment:Modeling a critical neurologic disease in vitro and in vivo[J]. Biochim Biophys Acta, 2016, 1862(5):975-982. doi: 10.1016/j.bbadis.2015.12.009.
[26]	邓娟, 周华东, 李敬诚, 等. 吸烟与老年性痴呆关系的研究[J]. 重庆医学, 2006, 35(10):921-923.
	DENG J, ZHOU H D, LI J C, et al. Study of cigarette smoking and risk of dementia[J]. Chongqing Medicine, 2006, 35(10):921-923. doi: 10.3969/j.issn.1671-8348.2006.10.028.
[27]	GRAYSON L, THOMAS A J. Smoking,nicotine and dementia[J]. Maturitas, 2012, 72(1):4-5. doi: 10.1016/j.maturitas.2012.01.020.
[28]	APPLETON J P, SCUTT P, SPRIGG N, et al. Hypercholesterolaemia and vascular dementia[J]. Clin Sci(Lond), 2017, 131(14):1561-1578. doi: 10.1042/CS20160382.

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

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 2

参考文献 28

相关文章 15

编辑推荐

Metrics

本文评价

[1]	高攀, 谢冰歆, 周赞东, 刘彤. 慢性肾脏病循环中FGF23对心房纤维化的促进作用[J]. 天津医药, 2024, 52(9): 917-923.
[2]	王远珍, 魏红艳, 常丽仙, 张映媛, 刘春云, 刘立. 原发性肝癌干预前并发肺部感染风险预测模型的建立与验证[J]. 天津医药, 2024, 52(9): 940-945.
[3]	王磊, 孟坤, 王兵. 支气管肺炎患儿反复喘息的影响因素分析及预测模型构建[J]. 天津医药, 2024, 52(8): 850-853.
[4]	薛玉恒, 茆宁, 刘文强, 杨倩倩, 徐艳, 王军. 基于早期血小板相关参数的支气管肺发育不良风险预测模型的构建与验证[J]. 天津医药, 2024, 52(7): 748-754.
[5]	王敏, 王龙胜, 陈磊. 骨质疏松症患者腰椎骨折预测模型的构建[J]. 天津医药, 2024, 52(7): 766-769.
[6]	韩琴, 韩秀丽, 陈伟然. 老年脑卒中患者康复治疗后抑郁障碍的影响因素分析[J]. 天津医药, 2024, 52(6): 639-642.
[7]	郑康鹏, 唐鑫国, 徐琦, 樊钰亭, 梁博, 付晓伟, 方路. 胆囊癌根治手术成功实施列线图预测模型的建立和验证[J]. 天津医药, 2024, 52(5): 536-540.
[8]	徐杨, 袁宇, 高金妹. 超声检查对骨折患者下肢深静脉漂浮血栓脱落的诊断意义[J]. 天津医药, 2024, 52(5): 548-551.
[9]	冯李婷, 李莉, 谢鑫, 王星. 天津地区部分居民慢性阻塞性肺疾病影响因素分析[J]. 天津医药, 2024, 52(4): 427-431.
[10]	纪晓娟, 韩浩, 张丽侠. 急性髓系白血病合并血流感染的病原菌分布与耐药性变迁及患者死亡的危险因素分析[J]. 天津医药, 2024, 52(2): 167-171.
[11]	张明龙, 方媛媛, 隋晓鹏, 陈欣欣, 李留东, 王海涛. Peguero-Lo-Presti指数诊断的左心室肥厚与阵发性心房颤动射频导管消融术后复发的关系[J]. 天津医药, 2024, 52(2): 210-214.
[12]	谷巍, 张惠娜, 侯丽萍, 于敏, 程黎蓉. 脂质相关指数与糖尿病肾病相关性研究[J]. 天津医药, 2024, 52(12): 1308-1312.
[13]	涂静, 夏晨曦, 李婷. 2型糖尿病亚临床周围神经病变与TIR的相关性及危险因素探讨[J]. 天津医药, 2024, 52(11): 1188-1192.
[14]	尼加提·阿力木, 马士凤, 夏木斯娅·阿里木江, 张静, 郑荣秀. 儿童糖尿病合并尿路感染的临床特征及危险因素分析[J]. 天津医药, 2024, 52(10): 1051-1055.
[15]	季莉莉, 许元丰, 史红娟, 陈文亚, 刘良卿. 帕金森病患者冻结步态列线图预测模型的构建[J]. 天津医药, 2023, 51(6): 658-661.