| Background:Coronary heart disease(CHD)is the most common and fatal chronic disease in the world.The Atrial Fibrillation(AF)is not only a high incidence rate disease,but also an important factor of increasing mortality of cardiovascular and cerebrovascular diseases.According to epidemiological statistics the proportion of CHD and AF coinfected people is increasing.The disability and lethality of the coexisting diseases are more serious.As aging society and unhealthy lifestyles are coming,the incidence of cognitive impairment has also risen significantly.Cognitive impairment includes memory disorders,aphasia,agnosia,emotional and behavioral disorders,such as anxiety,depression,and impulse,which not only affect health of patients and quality of life severely,but also increase the burden on the families of patients.The number of patients with CHD and AF is large,the prognosis is poor and the mortality is high.The degree of cognitive impairment may be more serious than CHD and AF patients.There have been no reports on the influencing factors of cognitive impairment in the patients with CHD and AF.This experiment will study the influencing factors of cognitive impairment in the patients with CHD and AF,which is of great significance for improving the clinical intervention of the patients with CHD and AF,enhancing their quality of life,and relieving the pressure of their family as well as the whole society.Objective:To identify the influencing factors of cognitive impairment in the patients with CHD and AF,and find interventional treatment factors and provide feasible and effective ways to prevent and treat cognitive impairment.Methods:A total of 101 patients admitted to the Hospital of Jilin University from December 2018 to December 2019 were chosen as the research subject,among which are 78 CHD patients combined with AF,and 23 patients didn’t have CHD or AF(control group).The general clinical features,biochemical indicators,and auxiliary examination data of the selected patients were collected,and the cognitive functions of patients were evaluated with the mini-mental state examination(MMSE).The incidence of cognitive impairment and the MMSE scores of the patients with CHD and AF were compared with the control group.According to MMSE scores,the patients with CHD and AF were divided into normal cognitive functions group and CI group.From age,education level,triglyceride(TG),serum creatinine(SCR),uric acid(UA),total cholesterol(TC),left ventricular ejection fraction(LVEF),low density Lipoprotein,(LDL),homocysteine(Hcy),body mass index(BMI),total bilirubin(TB),left atrial diameter,gender,smoking history,history of hypertension,duration of AF and history of diabetes were analyzed.After that,the indexes were analyzed by oridinal logistic regression.Then,the indexes with significant difference in oridinal logistic regression analysis were analyzed by multivariate analysis.Finally,the influencing factors of CI in the patients with CHD and AF were determined.SPSS 25.0 was used for the statistical analysis of the experimental data.The mean standard deviation(X ±S)is used to represent the counting data.If the normal distribution is satisfied,t-test is used to compare the differences between groups;if the normal distribution is not satisfied,Wilcoxon rank sum test is used to compare the differences between groups.If the test conditions are not satisfied with2ctest,fisher exact probability method is used to compare the differences between groups.The correlation between the two variables was analyzed by the spearman correlation.Oridinal logistic regression was used to do multivariate analysis on the factors with significant differences in the univariate analysis.P < 0.05 for the difference was considered statistically significant.Results:1.The measurement results of cognitive functions with the selected patients A total of 101 patients were selected as the research subject,among which are 78 CHD patients with AF,23 patients didn’t have CHD or AF(control group).In the patients with CHD and AF,31 patients had normal cognitive function and 47 ones had cognitive impairment.In the control group 19 patients had normal cognitive function and 4 ones had cognitive impairment.2.The incidence rate of the patients with CHD and AF and MMSE scores The incidence rate of cognitive impairment in the CHD with AF group (60.26%)was higher compared with the control group(17.39%),and the difference was statistically significant(P<0.05).The measurement scores of cognitive function in CHD with AF group(22.22±3.83)were lower compared with the control group(25.43 ± 2.31),and the difference was statistically significant(P<0.05).3.The comparison of general indicators and auxiliary examination of normal cognitive function group and cognitive impairment group in the patients with CHD and AF The differences were not statistically significant(P>0.05)between normal cognitive function group and cognitive impairment group in the patients with CHD and AF in terms of TB、TG、Scr、TC、LVEF、LDL、UA、left atrial diameter,gender,smoking history,history of hypertension,duration of atrial fibrillation,and history of diabetes.Compared with the normal cognitive functions group,the cognitive impairment group were older,less educated level,higher Hcy,lower BMI value,and the differences were statistically significant(P <0.05).4.The impact of age,education,Hcy and BMI on cognitive impairment in patients the with CHD and AF4.1 The impact of age on cognitive impairment in the patients with CHD and AF(1)The correlation between age and scores of MMSE: taking age as the independent variable and MMSE scores as the dependent variable,there was a negative correlation trend between age and MMSE scores.A linear correlation analysis was performed between age and MMSE scores.The results showed that age was negatively correlated with MMSE scores.The Spearman correlation coefficient was-0.755,P = 0.000 <0.05.The result was statistically significant(P <0.05).(2)The patients with CHD and AF were divided into groups based on age: ≥60 years old and<60 years old(independent variables),the independent variables and cognitive functions of patients(dependent variable)were included in the binary logistic regression model.The result showed that the risk of cognitive impairment in the patients with CHD and AF above 60 years old was 10 times compared with the ones under60 years old(OR=10.0781,95%CI:3.1383-39.6645,P=0.0007<0.05).The result was statistically significant.4.2.The relationship between Hcy and MMSE scores in the patients with CHD and AF A scatter plot was drawn with Hcy as the independent variable and MMSE scores as the dependent variable,showing a negative correlation trend between Hcy and MMSE scores.A linear correlation analysis was performed between the MMSE scores and Hcy.The results showed that Hcy was negatively correlated with the MMSE scores,and the spearman correlation coefficient was-0.582,which was statistically significant(P=0.000 <0.05).4.3 The effect of BMI on cognitive impairment in the patients with CHD and AF(1)The patients were divided into four groups based on BMI:underweight group,normal weight group,overweight group and obesity group.There was no statistical difference in MMSE scores among the four groups(P>0.05/6),but with the increase of BMI,the MMSE score showed an upward trend.The pairwise comparison of the incidence of cognitive impairment among the four groups showed that the incidence of cognitive impairment of normal weight group was higher compared with overweight group(P<0.05/6),There was no statistical significance in the other groups(P>0.05/6).(2)A scatter plot was drawn with BMI as the independent variable and MMSE scores as the dependent variable score.The results showed a positive correlation between BMI and MMSE scores.A linear correlation analysis was performed between the MMSE scores and the BMI,and the results showed that the two variables were positively correlated,with a spearman correlation coefficient of 0.341,and the difference was statistically significant(P = 0.002<0.05).4.4 The univariate logistic analysis of cognitive impairment in the patients with CHD and AF TG,Scr,TB、UA,TC,LVEF,LDL,BMI,Hcy,AF duration,left atrial diameter,gender,smoking history,age,education,history of hypertension,and history of diabetes were used as independent variables,and Whether or not cognitive impairment occurs in patients with CHD and AF(No = 0,yes = 1)was used as dependent variable.Put them into the univariate logistic regression model,and the results showed that education level was a protective factor for cognitive impairment;AF duration was a risk factor for cognitive impairment in the patients with CHD and AF;Hcy is a risk factor for cognitive impairment in the patients with CHD and AF;BMI is a protective factor for cognitive impairment in the patients with CHD and AF.Other variables did not show any correlation with cognitive impairment.4.5 The multivariate logistic analysis of cognitive impairment in the patients with CHD and AF Age,education level,BMI,Hcy,and AF duration were used as independent variables,and Whether or not cognitive impairment occurs in patients with CHD and AF(No = 0,yes = 1)were used as dependent variable.Put them in a multivariate logistic regression model.The results showed that age and Hcy were independent risk factors for cognitive impairment in the patients with CHD and AF group,while education level and BMI were protective factors.Conclusion:1.Cognitive impairment may occur in patients with CHD complicated with AF.2.The cognitive functions of the patients with CHD and AF are related to age,education level,Hcy,BMI,and duration of atrial fibrillation.Among them,age and Hcy are independent risk factors for the patients with CHD and AF,while BMI and education level are protective factors.3.The incidence of CI in the overweight patients with CHD and AF is lower than in normal weight. |
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