老年非瓣膜性心房颤动患者脑卒中前认知功能的临床特点分析

摘要

Objective To study the clinical features of cognitive impairment before ischemic stroke in elderly non-valvular AF patients and the effect of AF on their cognitive function.Methods Five hundred and forty elderly AIS patients were divided into AF group (n =87) and control group (n=453).Their demographic data were collected.The patients were scored according to the MMSE,NIHSS,and IQCODE on admission and 2 days after admission.Results Of the 540 AIS patients,77 (14.3％) were diagnosed with cognitive impairment and 9 (1.7％) with dementia before ischemic stroke.The age was significantly older,the incidence of DM and vascular disease was significantly higher,the use of anticoagulant drugs was much more,the NIHSS and IQCODE scores were significantly higher,the ratio of IQCODE score≥3.44 and ≥4 was significantly high-er while the use of antiplatelet drugs was much less and the MMSE score was significantly lower in AF group than in control group (P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age,AF and DM were the risk factors for cognitive impairment before ischemic stroke in AF patients (OR=1.144,95 ％CI:1.039-1.259,P=0.006;OR=6.843,95 ％CI:1.936-24.195,P=0.003).Conclusion Cognitive impairment occurred before ischemic stroke in AF patients exacerbates with the increasing age.AF is an independent risk factor for cognitive impairment in elderly AIS patients,importance should thus be attached to its assessment.%目的 探讨合并非瓣膜性心房颤动(房颤)的老年脑卒中患者首发脑卒中前认知功能的临床特点.方法 选取老年急性脑卒中患者540例,伴有非瓣膜性房颤患者87例(房颤组),无房颤患者453例(对照组).收集患者人口学资料,并于入院或就诊后2d内完成神经心理学量表,简易智能状态检查量表(MMSE)、美国国立卫生研究院卒中量表(NIHSS)及简化版老年认知功能减退知情者问卷IQCODE)测评,比较2组资料并做统计学分析.结果 540例老年急性脑卒中患者中,77例(14.3％))脑卒中前有认知功能障碍,9例(1.7％)达到痴呆.房颤组年龄、糖尿病、血管疾病,抗凝药、NIHSS评分、IQCODE评分、IQCODE≥3.44分、IQCODE≥4分比例明显高于对照组,抗血小板药、MMSE评分明显低于对照组,差异有统计学意义(P＜0.05,P＜0.O1).logistic回归分析显示,急性脑卒中患者年龄、房颤和糖尿病为脑卒中前认知功能障碍的危险因素(P＜0.05,P＜0.01),房颤组患者年龄和持续性房颤为脑卒中前认知功能障碍的危险因素(OR=1.144,95％CI:1.039～1.259,P=0.006;OR=6.843,95％CI:1.936～24.195,P=0.003).结论 房颤患者脑卒中前认知功能已有损害,并随着年龄的增大而增加,房颤是老年脑卒中患者认知功能减退的独立危险因素,要重视对房颤患者的认知功能评估.