老年高血压合并心房颤动患者认知功能障碍危险因素研究

发布时间：2018-03-12 18:10

本文选题：高血压　切入点：心房颤动　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:结合年龄、性别、受教育程度、血生化指标等认知功能障碍和痴呆的相关危险因素,综合探讨老年高血压合并心房颤动(房颤)患者心室率的快慢、血压控制水平、颈动脉内膜中层厚度、及左房与左室大小、射血分数等与认知功能损害的关系。方法:依据纳入排除标准,入选老年高血压合并房颤患者112例,老年高血压患者79例和老年无高血压无房颤患者72例。收集所有入选患者一般临床特征、生化指标及辅助检查资料,并采用简易精神状态检查量表(mini-mental state examination,MMSE)评估患者认知功能。比较老年高血压合并房颤患者、高血压患者及无高血压无房颤患者MMSE等分情况。并依据MMSE得分结果,将老年高血压合并房颤组患者分为认知正常亚组和认知障碍亚组,分析老年高血压合并房颤患者认知功能障碍的危险因素。结果:老年高血压合并房颤患者、老年高血压患者和老年无高血压无房颤患者三组基线资料均衡,三组MMSE总得分差异有统计学意义(22.09±5.18 vs.23.96±3.68 vs.24.94±4.11,P0.01)。两组间比较显示,高血压合并房颤组MMSE得分显著低于高血压组(P0.01)和无高血压无房颤组(P0.01);高血压组MMSE得分低于无高血压无房颤组,但两组差异无统计学意义(P0.05)。比较不同认知域显示,三组定向力(7.79±2.05 vs.8.03±1.44 vs.8.72±1.58,P0.01)、注意力(3.09±1.66 vs.3.94±0.97 vs.3.96±1.34,P0.01)、回忆力(2.19±0.96 vs.2.43±0.69 vs.2.57±0.69,P0.01)得分差异显著,而记忆力(2.83±0.52 vs.2.91±0.29 vs.2.92±0.33,P0.05)、语言能力(6.23±1.80 vs.6.67±1.96 vs.6.72±1.99,P0.05)得分差异均无统计学意义。两组间比较显示,高血压合并房颤组注意力、回忆力得分均显著低于高血压组(P0.05),而两组定向力得分无显著差异(P0.05);高血压合并房颤组较无高血压无房颤组的定向力、注意力、回忆力分均显著降低(P0.01);高血压组与无高血压无房颤组比较,两组间定向力得分差异有统计学意义(P0.05),两组注意力、回忆力得分差异无统计学意义(P0.05)。亚组分析显示,高龄、总胆红素及射血分数对老年高血压合并房颤患者认知功能影响更加显著,高龄是老年高血压合并房颤患者认知功能障碍的危险因素,OR值为2.564,95%的置信区间为(1.361~4.830);总胆红素、射血分数OR值分别为0.948、0.963,95%的置信区间分别为(0.904~0.993)、(0.927~0.999),可看作是老年高血压合并房颤患者认知功能的保护因素。而平均心室率、收缩压、舒张压、脉压、颈动脉内膜中层厚度、左房内径、左室收缩末期内径、左室舒张末期内径等均对老年高血压合并房颤患者认知功能障碍无显著影响。结论:老年高血压合并房颤时认知功能减退,且以定向力、注意力和回忆力减退最为显著。高龄是老年高血压合并房颤患者认知功能障碍的危险因素;射血分数是保护因素;血总胆红素适度升高可能对认知功能有保护作用,其机制可能与氧化应激有关,其与认知功能的关系有待于进一步研究。
[Abstract]:Objective: according to the age, gender, education level, blood biochemical index and related risk factors of cognitive impairment and dementia, comprehensive study of elderly hypertensive patients with atrial fibrillation (AF) in patients with ventricular rate of speed, level of blood pressure control, carotid intima-media thickness and left atrial size and left ventricular ejection fraction, relationship etc. with cognitive impairment. Methods: according to inclusion and exclusion criteria, 112 patients with hypertension in elderly patients with atrial fibrillation, 79 cases of elderly and elderly hypertensive patients without hypertension patients without atrial fibrillation. 72 cases were collected. The clinical characteristics, biochemical indexes and laboratory data, and mini mental state examination (Mini-Mental State examination, MMSE) to assess the cognitive function. Comparing patients with senile hypertension complicated with atrial fibrillation in patients with hypertension and non hypertension patients without atrial fibrillation MMSE. And on the basis of equal MMSE The results will be divided, elderly hypertensive patients with atrial fibrillation were divided into cognitive normal subgroup and cognitive impairment groups, analysis of risk factors of hypertension in elderly patients with atrial fibrillation. Results: cognitive dysfunction in elderly hypertensive patients with atrial fibrillation patients, patients and the elderly hypertension without high blood pressure without atrial fibrillation patients with baseline data of the three groups have balanced. The three groups were of statistical significance MMSE total score difference (22.09 + 5.18 vs.23.96 + 3.68 vs.24.94 + 4.11, P0.01). The comparison between the two groups, hypertension and atrial fibrillation group MMSE score were significantly lower in hypertension group (P0.01) and no hypertension without atrial fibrillation group (P0.01); hypertension group MMSE scores were lower than those without hypertension without atrial fibrillation, but there was no significant difference between the two groups (P0.05). To compare the different cognitive domains, three group orientation (7.79 + 2.05 vs.8.03 + 1.44 vs.8.72 + 1.58, P0.01), attention (3.09 + 1.66 vs.3.94 + 0.97 vs.3.96 + 1.34, P0.01), back The memory (2.19 + 0.96 vs.2.43 + 0.69 vs.2.57 + 0.69, P0.01) scores significantly, and memory (2.83 + 0.52 vs.2.91 + 0.29 vs.2.92 + 0.33, P0.05), language (6.23 + 1.80 vs.6.67 + 1.96 vs.6.72 + 1.99, P0.05) scores were not statistically significant. Compared between the two groups, hypertension atrial fibrillation group attention, memory scores were significantly lower than those in hypertension group (P0.05), but no significant difference between the two groups (P0.05); orientation scores of orientation, AF in patients with hypertension group than in non AF group attention, memory scores were significantly decreased (P0.01); hypertension group and non hypertension there is no AF group, there were statistically significant differences in orientation scores between the two groups (P0.05), two groups of attention, no statistically significant differences in memory score (P0.05). Subgroup analysis showed that the age, total bilirubin and ejection fraction of elderly patients with hypertension complicated with atrial fibrillation cognitive function Can more significant influence, age is a risk factor for hypertension in the elderly patients with atrial fibrillation cognitive dysfunction, OR = 2.564,95% CI (1.361~4.830); total bilirubin, ejection fraction OR = 0.948,0.963,95% confidence interval respectively (0.904~0.993), (0.927~0.999), can be regarded as protective factors for cognitive fibrillation patients the real function of hypertension in the elderly. But the average heart rate, systolic blood pressure, diastolic blood pressure, pulse pressure, carotid intima-media thickness, left atrial diameter, left ventricular end systolic diameter, left ventricular end diastolic diameter had no significant effect on cognitive dysfunction in elderly patients with hypertension complicated with atrial fibrillation. Conclusion: cognitive decline in elderly hypertensive patients with atrial fibrillation, and orientation, attention and memory loss. The most significant age is a risk factor for hypertension in the elderly patients with atrial fibrillation cognitive dysfunction; ejection fraction is protected Factors, and the increase of total bilirubin may have protective effects on cognitive function. The mechanism may be related to oxidative stress, and its relationship with cognitive function needs further study.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R541.75

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