【作者】 张晶；

【导师】 张正义；

【作者基本信息】 兰州大学 ， 临床医学·全科医学（专业学位）， 2022， 硕士

【摘要】 第一章心力衰竭合并认知功能障碍住院患者的临床特点目的分析心力衰竭(HF)合并认知功能障碍住院患者的临床特点。方法采用横断面研究方法,以兰州大学第二医院心内科2020年10月至2021年6月期间确诊为HF的88例住院患者为研究对象,收集患者姓名、性别、年龄、病程、合并症、实验室指标、心脏彩超等临床资料。使用蒙特利尔认知评估量表(MoCA)进行认知功能评估。数据进行统计学分析,P<0.05为差异有统计学意义。结果88例HF住院患者平均年龄61.50±8.28岁,MoCA评分为22.59±4.18分。其中认知功能障碍在HF住院患者的患病率为69.32%,各维度异常率由高及低分别为延迟回忆82例(93.18%)、视空间与执行功能73例(82.95%)、注意力71例(80.68%)、抽象64例(72.73%)、语言55例(62.50%)、命名25例(28.41%)、定向力2例(2.27%)。MoCA评分≥26分为认知功能正常组(n=27),MoCA评分<26分为认知功能障碍组(n=61)。认知功能正常组和认知功能障碍组在左室射血分数(LVEF)[(46.56±5.02)%VS(37.49±8.04)%],N-末端脑钠肽前体(NT-pro BNP)[(2343.11±1293.86)pg/ml VS(3089.82±3004.52)pg/ml],同型半胱氨酸(HCY)[(18.68±8.00)ummol/L VS(24.14±15.17)ummol/L],教育年限<12年(40.7%VS 67.2%),合并房颤病史(22.2%VS 50.8%),NYHA心功能分级≥3级(40.7%VS 90.2%)方面差异有统计学意义(均P<0.05)。Pearson相关分析示,MoCA评分与HCY负相关(r=-0.312,P<0.05)、与NT-pro BNP负相关(r=-0.840,P<0.01)、与LVEF正相关(r=0.896,P<0.01)。Logistic回归分析显示,低LVEF(OR=0.801,95%CI:0.672-0.954,P<0.05),NYHA心功能分级≥3级(OR=8.282,95%CI:1.271-53.957,P<0.05)是HF合并认知障碍的独立危险因素。结论1、HF合并认知功能障碍患者主要临床特点为NYHA分级差、低LV EF、教育年限短、HCY升高、NT-pro BNP偏高、合并房颤病史。2、HCY、NTpro BNP越高,认知功能越差;LVEF越高,认知功能越好。3、低LVEF、NYH A心功能分级≥3级是HF合并认知功能障碍的独立危险因素。第二章沙库巴曲/缬沙坦对HFr EF患者认知功能影响的评估目的探讨沙库巴曲/缬沙坦对HFr EF患者认知功能的影响。方法回顾性研究以分析沙库巴曲/缬沙坦对HFr EF患者认知功能的影响,选取2021年6月至2021年12月期间就诊于兰州大学第二医院心内科的HFr EF患者为研究对象。根据治疗方案不同,分为已连续接受沙库巴曲/缬沙坦治疗3个月组和常规接受心力衰竭治疗但未使用沙库巴曲/缬沙坦组,收集患者姓名、性别、年龄、病程、NYHA分级、LVEF、合并症、实验室指标等临床资料。比较两组患者治疗后MoCA评分情况。数据进行统计学分析,P<0.05为差异有统计学意义。结果未使用沙库巴曲/缬沙坦组和使用沙库巴曲/缬沙坦组在LVEF[(36.35±2.68)%VS(38.10±2.73)%]方面差异有统计学意义(P<0.05)。使用沙库巴曲/缬沙坦组MoCA评分为22.85±2.54分,未使用沙库巴曲/缬沙坦组MoCA评分为21.70±3.64分,差异无统计学意义(P>0.05)。结论使用沙库巴曲/缬沙坦治疗的HFr EF患者LVEF明显改善;沙库巴曲/缬沙坦治疗对认知功能无不良影响。更多还原

【Abstract】 Chapter 1 Clinical characteristics of hospitalized patients with heart failure complicated with cognitive impairmentObjective To analyze the clinical characteristics of hospitalized patients with chronic heart failure(HF)complicated with cognitive impairment.Methods Using a cross-sectional study method,88 inpatients diagnosed with HF from October 2020 to June 2021 in the Department of Cardiology,Second Hospital of Lanzhou University were selected as the research objects.Clinical data such as ventricular index and cardiac color Doppler ultrasound.Cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).Statistical analysis was performed on the data,and P<0.05 was considered statistically significant.Results The average age of the 88 HF inpatients was 61.50±8.28 years,and the MoCA score was 22.59±4.18 points.Among them,the prevalence of cognitive dysfunction in hospitalized patients with HF was 69.32%,and the abnormal rates of each dimension from high to low were delayed recall in 82 cases(93.18%),visuospatial and executive function in 73 cases(82.95%),attention in 71 cases.cases(80.68%),abstraction in 64 cases(72.73%),language in 55 cases(62.50%),naming in25 cases(28.41%),and orientation in 2 cases(2.27%).MoCA score ≥26 was divided into normal cognitive function group(n=27),and MoCA score <26 was divided into cognitive dysfunction group(n=61).The left ventricular ejection fraction(LVEF)[(46.56±5.02)% VS(37.49±8.04)%],N-terminal precursor brain natriuretic peptide(NT-pro BNP)[(2343.11±1293.86)pg/ml VS(3089.82±3004.52)pg/ml],homocysteine(HCY)[(18.68±8.00)ummol/L VS(24.14±15.17)ummol/L],years of education <12years(40.7% VS 67.2%),with a history of atrial fibrillation(22.2% VS 50.8%),and NYHA cardiac function class≥3(40.7% VS 90.2%),the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that MoCA score was negatively correlated with HCY(r=-0.312,P<0.05),negatively correlated with NT-pro BNP(r=-0.840,P<0.01),and positively correlated with LVEF(r=0.896,P<0.01).Logistic regression analysis showed that LVEF(OR=0.801,95%CI:0.672-0.954,P<0.05),NYHA cardiac function class ≥3(OR=8.282,95%CI:1.271-53.957,P<0.05)was HF Independent risk factors for comorbid cognitive impairment.Conclusions 1.The main clinical features of HF patients with cognitive impairment are poor NYHA grade,low LVEF,short years of education,elevated HCY,elevated NT-pro BNP,and a history of atrial fibrillation.2.The higher the HCY and NT-pro BNP,the worse the cognitive function;the higher the LVEF,the better the cognitive function.3.LVEF and NYHA cardiac function class ≥3 were independent risk factors for HF complicated with cognitive impairment.Chapter 2 Evaluation of the effects of sacubitril/valsartan on cognitive function in patients with HFr EFObjective To investigate the effects of sacubitril/valsartan on cognitive function in patients with HFr EF.Methods This retrospective study analyzed the effect of sacubitril/valsartan on cognitive function in patients with HFr EF,and selected patients with HFr EF who were admitted to the Department of Cardiology,Lanzhou University Second Hospital from June 2021 to December 2021 as the research objects.According to different treatment regimens,they were divided into the group who had been continuously receiving sacubitril/valsartan for 3 months and the group who received conventional heart failure treatment but did not use sacubitril/valsartan.The names,gender,age of the patients,course of disease,NYHA classification,LVEF,comorbidities,laboratory indicators and other clinical data were collected.The MoCA scores were compared between the two groups after treatment.Statistical analysis was performed on the data,and P<0.05 was considered statistically significant.Results There was a statistically significant difference in LVEF between the sacubitril/valsartan group and the sacubitril/valsartan group [(36.35±2.68)% VS(38.10±2.73)%](P<0.05).The MoCA score of the sacubitril/valsartan group was 22.85±2.54 points,and the MoCA score of the non-sacubitril/valsartan gro up was 21.70±3.64 points,with no significant difference(P>0.05).Conclusions LVEF was significantly improved in HFrEF patients treated with sacubitril/valsartan and sacubitril/valsartan treatment had no adverse effect on cognitive function.更多还原