| Background: Heart failure is a group of clinical syndromes that occur due to various cardiac structures or impaired ventricular filling and / or ejection function.The main clinical manifestations are decreased cardiac output,which cannot meet the metabolic needs of the body's tissues,and consequently,pulmonary circulation congestion with or without systemic circulation congestion,and insufficient tissue and organ perfusion.Heart failure is an end-stage clinical manifestation of many heart diseases,and has epidemiological characteristics such as high morbidity,high readmission rate,and high mortality.Many studies in recent years have found that a significant proportion of patients with chronic heart failure(CHF)are accompanied by cognitive problems.Cognitive impairment(CI)is increasing in CHF patients,and it is closely related to the increase in hospitalization,mortality,and poor clinical prognosis.At present,with the continuous research in the field of heart failure,the study of patients with CHF combined with CI has attracted more and more attention of clinicians.Many studies have found that ejection fraction is closely related to CI.The lower the ejection fraction,the higher the incidence of CI.However,there are few related studies on CI in patients with intermediate or retained heart failure with ejection fraction,especially for CI.Studies on patients with chronic non-heart failure with reduced ejection fraction(non-HFr EF)and cognitive function have not been reported at home and abroad.Therefore,this experiment takes this type of heart failure population as the research object,explores the occurrence of CI and possible risk factors in patients with chronic non-HFr EF,provides scientific basis for clinical intervention,and effectively controls and manages heart failure in coronary heart disease.Improve the prognosis and reduce mortality in patients with heart failure.Objective: This experiment collects relevant clinical data of chronic non-HFr EF patients and conducts statistical analysis to explore the incidence and potential risk factors of CI that affect chronic chronic non-HFr EF patients,in order to find an effective set of chronic chronic non-HFr EF patients.HFr EF patients combine CI treatment and management methods to effectively improve the cognitive function of this type of heart failure group,and provide new treatment ideas and schemes for this type of heart failure group.Methods: A total of 106 patients who were hospitalized in the Cardiovascular Department of the Second Hospital of Jilin University from December 2018 to December 2019 were collected,of which 30 patients with heart failure without heart failure were the control group;left ventricular ejection fraction ?40%,heart Seventy-six CHF patients with functional grade ?-? were the experimental group.The diagnosis of heart failure in the selected patients complies with the "China Heart Failure Diagnosis and Treatment Guide 2018",and the cardiac function classification criteria meet the cardiac function classification of the New York College of Cardiology(NYHA).First collect general clinical data of selected patients,mainly including course,education,age,gender,history of medication,hypertension,atrial fibrillation,history of diabetes;then collect blood glucose,blood lipids,creatinine,urea nitrogen within 24 hours of admission,C-reactive protein,NT-pro BNP and other experimental indicators.Finally,the Mini-Mental State Examination(MMSE)was used to assess the cognitive function of the selected patients.All MMSE scores in this study were performed in a quiet environment.MMSE score ?24 was divided into cognitive function group,MMSE score <24 was divided into cognitive function group.The statistical analysis of the data was performed using the spss25.0 statistical software package.The numerical variables were described using the mean standard deviation((?)ąS).If the normality test was satisfied,the t test was used to analyze the difference between the groups.If the normality test was not used,Wilcoxon Rank sum test.The categorical variable is described by the number of cases n(%),and the analysis is used ?~2 to analyze the differences between the groups.If the ?~2test conditions are not met,the differences between the groups are tested using Fisher's exact probability method.For pairwise comparisons between multiple groups,the bonferroni method is used to control the probability of a class of errors.Univariate logisitic regression analysis was used to explore the influencing factors of cognitive abnormalities.Multivariate logistic regression analysis was performed on the statistically significant indicators of single factor analysis to screen for independent risk factors.The difference was statistically significant with P <0.05.Results: 1.Comparison of clinical data between patients without heart failure and patients with chronic non-HFr EF A total of 106 patients met the selection criteria in this experiment.The control group was 30 patients with heart failure without heart failure,and the experimental group was 76 patients with chronic non-HFr EF.Through statistical analysis,the differences between the experimental group and the control group in terms of NT-pro BNP,EF,cognitive function,cardiac function classification were statistically significant(P <0.05);the experimental group and the control group were in marriage,gender,Course of disease,age,occupation,smoking history,education level,C-reactive protein,triglycerides,total cholesterol,high density lipoprotein,low density lipoprotein,hemoglobin content,creatinine,urea nitrogen,homocysteine,etc.The difference was not statistically significant(P> 0.05).2.Comparison of General Clinical Data between Cognitive normal group and CI Group in patients with Chronic non-HFr EF According to the measurement results of the MMSE Cognitive Evaluation Scale,they were divided into 39 cases with normal cognitive function(?24 points)and 37 cases in CI group(<24 points).There was no statistical difference between the cognitive function group and the CI group in terms of gender,occupation,marriage,education level,course of disease,as well as smoking history,hypertension history,diabetes history,renal insufficiency,ACEI / ARB and statin administration(P> 0.05).3.Comparison of blood biochemical Data between Cognitive normal group and CI Group in patients with Chronic non-HFr EF There were no significant differences in C-reactive protein,triglycerides,total cholesterol,high-density lipoprotein,low-density lipoprotein,hemoglobin content,creatinine,and urea nitrogen between the two groups of patients(P> 0.05).4.Analysis of clinical data of patients with chronic non-HFr EF combined with cognitive impairment Compared with the normal cognitive function group,patients with chronic non-HFr EF combined with CI group had statistically significant differences in age,NT-pro BNP,EF,cardiac function classification,homocysteine,atrial fibrillation,and nosinto P <0.05).5.The effects of NT-pro BNP and urea nitrogen on cognitive function in patients with chronic non-HFr EF 5.1 According to the difference analysis,it was found that there were statistical differences between NT-pro BNP and homocysteine in patients with normal cognitive function and cognitive impairment group(P <0.05);NT-pro BNP and homocysteine were respectively Correlation analysis between acid and MMSE scale scores showed that the cognitive score was negatively correlated with homocysteine(r =-0.405,P <0.01)and negatively correlated with NT-pro BNP(r =-0.350,P <0.01).5.2 Taking the patients with chronic heart failure as a dependent variable and incorporating the above indicators as independent variables into the binary logistic regression analysis model,the results showed that NT-pro BNP(OR=1.2094,95%CI : 1.0425-1.4681,P <0.05),homocysteine content(OR=1.0664,95%CI:1.0188-1.1284,P<0.05)is related to the existence of cognitive impairment.6.The effect of EF on cognitive function in patients with chronic nonHFr EF According to the difference analysis,EF was found to be statistically different between patients with normal cognitive function and CI group(P <0.05).Linear correlation analysis was performed between EF and MMSE scale scores,and the results showed that cognitive function score and EF There was a positive correlation(r = 0.419,P <0.01).Based on whether patients with chronic non-HFr EF combined CI as the dependent variable and EF as the independent variable were included in the binary logistic regression analysis model,the results showed that EF and CI were related(OR = 0.9048,95% CI: 0.8475-0.9579,P <0.05).7.The effect of age on cognitive function in patients with chronic nonHFr EF 7.1 According to the difference analysis,it was concluded that there was a statistical difference in age between patients with normal cognitive function and CI group(P <0.05).A linear correlation analysis was performed between age and MMSE scale scores to show that the cognitive score and the Age(r =-0.440,P <0.01)was negatively correlated.7.2 The age group <55 years,55-75 years,and> 75 years were compared in pairs.The study found that there was no significant difference in the age group <55 years compared with the 55-75 years group and> 75 years group(P> 0.05);but the difference between the 55-75-year-old group and the> 75-year-old group was statistically significant(P <0.05),and the incidence of cognitive impairment was significantly higher in the> 75-year-old group than in the 55-75-year-old group.7.3 Include independent variables(age group)and dependent variables(cognitive score)in a binary logistic regression model.The results showed that the risk of developing CI was 5.4 times that of the 55-75 year-old group,the difference was statistically significant(OR=5.4286,95%CI:1.1221-31.9107,P<0.05).8.The cardiac function classification on cognitive function in patients with chronic non-HFr EF Patients with chronic heart failure were divided into three groups of cardiac function class ?,cardiac function class ?I,and cardiac function class IV according to cardiac function classification.The results showed that there was a statistically significant difference in cardiac function ? and cardiac function ?(P <0.05).Then,the independent variables of cardiac function ?,cardiac function ?,cardiac function ? and dependent variable(cognitive function score)were included in the binary logistic regression model.The results showed that the risk of CI in the heart function group ?I was 5.1 times that of the heart function group ?,and the difference was statistically significant(OR=5.1944,95%CI:1.8166-16.6143,P<0.05).9.The history of atrial fibrillation on cognitive function in patients with chronic non-HFr EF According to the difference analysis,it was concluded that the history of atrial fibrillation had statistical differences in MMSE cognitive function scores(P <0.05).The history of atrial fibrillation(no = 0;yes = 1)were taken as independent variables,and the dependent variable(cognitive function score)was included in the binary logistic regression model.The results showed that the risk of CI in patients with CHF and AF was 4.2 times that of patients without AF,and the difference was statistically significant(OR=4.2533,95%CI:1.6456-11.6581,P<0.05).10.Multivariate regression analysis of patients with chronic nonHFr EF with CI All possible factors affecting the cognitive function of patients with chronic non-HFr EF were included in multi-factor logistic regression analysis.After controlling other confounding factors,the results showed that NT-pro BNP,EF,homocysteine,age,atrial A history of fibrillation is an independent risk factor for CI in patients with chronic non-HFr EF.That is,patients with advanced age,a history of atrial fibrillation combined with hyperhomocysteinemia,and patients with chronic non-HFr EF are more likely to develop CI.Conclusion: 1.Patients with chronic non-HFr EF are more likely to develop CI than patients with heart disease without heart failure.2.EF,homocysteine,age,and history of AF are independent risk factors for CI in patients with chronic non-HFr EF.3.Chronic non-HFr EF patients with high homocysteine,high NTpro BNP,low EF,advanced age,and a history of atrial fibrillation are more likely to develop CI;heart function grade ?I CHF has a greater risk of CI than heart function grade ?. |
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