血管性痴呆危险因素研究进展

血管性痴呆（Vascular dementia，VD）是指各种脑血管疾病引起的脑功能障碍而产生的获得性智能损伤综合征的总称。而VD是老年性痴呆第二常见原因，研究表明AD也与血管性因素有关。近年来。随着人口老龄化，VD发病有上升趋势。它不仅严重影响患者的生存质量。也给家庭、社会和国家增加了沉重负担。国外资料报道VD是迄今为止唯一可以防治的痴呆，早期治疗具有可逆性。因此探索VD发病的相关因素、发病机制、早期诊断方法及其防治措施，巳成为医学基础研究和临床研究的主要课题。     

利伐沙班和华法林在非瓣膜性心房颤动患者中的效果研究

目的 比较华法林和利伐沙班在非瓣膜性心房颤动(房颤)患者中的效果.方法 100例非瓣膜性房颤患者,随机分为观察组和对照组,各50例.两组患者均在治疗基础疾病的基础上进行抗凝治疗,观察组给予利伐沙班治疗,对照组给予华法林钠片治疗.比较两组患者栓塞事件发生情况、出血事件发生情况、治疗后凝血指标[凝血酶时间(TT)、纤维蛋白...     

非痴呆型血管性认知功能障碍患者危险因素的初步研究

目的：研究非痴呆型血管性认知功能障碍（ VCIND）发生的主要危险因素。方法选取92例有脑血管病危险因素或脑血管病患者为研究对象,用MMSE、MoCA量表对其进行认知功能评估,并分为2组：观察组为47例VCIND患者,对照组为45例非认知功能障碍患者,收集所有患者的血压、血糖、血脂、同型半胱氨酸（ Hcy ）等生化指标,分析各种危险因素与VCIND的关系。结果与对照组相比较,VCIND组血糖、血脂、Hcy水平明显升高,差异有统计学意义（ P ＜0'．05）。结论血糖、血脂及Hcy水平与VCIND有关,可能是引起VCIND发生、发展的重要危险因素。     

非瓣膜性心房颤动住院患者使用利伐沙班合理性评价

目的分析非瓣膜性心房颤动住院患者使用利伐沙班的合理性及安全性。方法采用回顾性调查方法,参照药品说明书等标准评价使用利伐沙班的非瓣膜性心房颤动住院患者的用药指征、用法用量、药物相互作用及安全性,并考察相关因素对服用利伐沙班后出血的影响。结果共纳入122例患者,利伐沙班用药指征符合率为100%,但利伐沙班日剂量与指南推荐相符率仅为9.8%。服用利伐沙班后出血发生率为9.8%,年龄(≥75岁)及联合使用非甾体抗炎药的患者更易发生出血(OR分别为0.162和0.175)。结论本院非瓣膜性心房颤动住院患者的利伐沙班使用尚合理,但量效关系尚需进一步临床验证。     

脑梗死后血管性痴呆发病危险因素研究

摘要 目的：探讨脑梗死后血管性痴呆（VD）的发病危险因素。方法：随机选择392例急性脑梗死患者,收集临床及实验室资料,采用多因素Logistic回归分析,分析脑梗死后VD发病危险因素。结果：84名患者诊断为VD（21.4%）。单因素分析中,VD与病灶的数目、部位,脑萎缩及WMLs相关,多因素分析中发现左侧或双侧大脑半球病变、病灶的数目和脑萎缩为VD发病的独立危险因素,OR值分别为8.958、1.375和2.297。2组间一般情况,血脂水平无差异（P ﹥0.05）。结论 脑梗死后VD很常见,小血管病变是VD的主要类型,应早期进行针对性的预防和治疗,以减少和延缓VD的发生。     

血管性痴呆相关危险因素临床分析

目的探讨血管性痴呆的相关危险因素。方法选择本院2010年2月至2013年2月血管性痴呆患者共100例,作为观察组,同时选择同期到本院体检的非痴呆患者共100例,对两组对象进行体检,观察并记录两组高血压、糖尿病、冠心病、心肌梗死、心律失常、短暂性脑缺血发作、高脂血症、贫血史情况。分析两组在上述危险因素方面的异同。结果两组高血压、糖尿病、冠心病、短暂性脑缺血发作、高脂血症、贫血所占比例与对照组比较,差异有统计学意义（P〈0.05）。观察组心肌梗死、心律失常所占比例与对照组相比,差异无统计学意义（P〉0.05）。结论血管性痴呆与高血压、冠心病、糖尿病、贫血、短暂性脑缺血发作、高脂血症等因素有关。     

老年期痴呆危险因素的病例对照研究

目的 探讨老年期痴呆病人的危险因素.方法 采用病例一对照研究,选择佛山市南海区和顺镇确诊的67例痴呆病人为病例组,选取病人亲属和邻居人群为对照组.问卷调查.结果 有统计学差异的因素有抑郁性格(OR=18.8)、低文化(OR=3.60)、中风史(OR=4.33)、吸烟(OR=1.64),性别(OR=1.52).而糖尿病(OR=0.85)、高血压(OR=0.88)因素无统计学意义.结论 本研究结果表明:性格抑郁、文化低、中风史,吸烟、女性为老年期痴呆的危险因素.     

血管性痴呆精神行为学症状的危险因素探讨

目的研究血管性痴呆（VD）精神行为学症状的危险因素。方法选择本院2011年6月～2012年6月收治的118例血管性痴呆患者作为观察对象（观察组）,选择同期收治的316例非痴呆患者为对照组,采用Logistic回归分析法对VD的相关临床因素进行调查分析。结果观察组中,文化程度、长期饮酒以及存在脑卒中等疾病病史的比例明显高于对照组。Logistic回归分析表明年龄、教育文化程度、既往脑卒中病史以及长期饮酒与VD密切相关,属于临床造成VD后行为异常的重要危险因素。结论年龄、文化程度、既往脑卒中病史是成VD的主要影响因素,脑卒中引发的精神行为学的异常是血管与脑卒中相互作用的结果。     

非瓣膜性房颤患者应用利伐沙班出血危险因素分析

摘要：目的:分析非瓣膜性房颤患者服用利伐沙班发生出血的危险因素。方法:收集2017年3～6月201例使用利伐沙班抗凝治疗的拟行射频消融术的非瓣膜性住院患者资料,记录患者年龄、性别、既往史,以及C反应蛋白、血糖、肝肾功能、心功能指标、合并疾病及联合用药等信息。采用单因素方差分析和多因素回归分析方法评估相关出血危险因素。结果:在所有纳入研究的患者中住院期间共有23例(11.4%)发生了出血,178例(88.6%)未发生出血,利伐沙班引起的出血发生率为11.4%(23/201)。研究发现合并冠心病与利伐沙班引起的出血事件有显著的相关性[P=0.001,OR=4.013,95%CI(1.634,9.859)],此外,联合应用阿司匹林[P=0.001,OR=5.111, 95%CI(1.961,13.319)]或氯吡格雷[P=0.001,OR=5.490,95%CI(2.150,14.017)],其出血风险会显著增加。合用氯吡格雷[P=0.029,OR=3.281, 95%CI(1.129,9.531)]和凝血酶原时间(PT)>13.0 s[P=0.034,OR=2.914,95%CI(1.082,7.851)]可显著增加利伐沙班相关的出血风险。结论:合并冠心病和联用抗血小板药物(阿司匹林、氯吡格雷)与利伐沙班引起的出血事件有显著的相关性。多因素回归分析发现,联用氯吡格雷和PT>13.0 s是非瓣膜性房颤患者应用利伐沙班发生出血的独立危险因素。     

非瓣膜性心房颤动患者应用利伐沙班与达比加群酯长期抗凝治疗的有效性及安全性评价

目的 比较长期应用利伐沙班与达比加群酯在非瓣膜性心房颤动(NVAF)患者抗凝治疗中的有效性及安全性。方法 入选2019年1月至2020年12月于新疆维吾尔自治区人民医院心房颤动中心就诊,服用利伐沙班或达比加群酯抗凝治疗的NVAF患者258例,根据口服不同抗凝药物分为利伐沙班组(92例)与达比加群酯组(166例)。随访12个月,比较2组患者栓塞事件与出血事件[血尿、黑便、其他部位出血(皮下出血、牙龈出血和鼻出血)]的发生率。结果 利伐沙班组出现脑梗死与心肌梗死各2例,栓塞事件发生率为4.3%(4/92);达比加群酯组出现脑梗死2例、心肌梗死4例,栓塞事件发生率为3.6%(6/166)。2组栓塞事件发生率比较,差异无统计学意义(P=0.748)。利伐沙班组共发生出血事件14例(15.2%),均为其他部位出血;达比加群酯组共发生出血事件18例(10.8%),其中血尿4例(2.4%)、黑便2例(1.2%)、其他部位出血12例(7.2%)。2组患者总出血事件发生率比较,差异无统计学意义(P=0.307)。利伐沙班组其他部位出血发生率高于达比加群酯组,差异有统计学意义(P=0.041)。结论 利伐...     

Direct oral anticoagulants and cardiovascular prevention in patients with nonvalvular atrial fibrillation

Introduction: Patients with atrial fibrillation have an increased risk for stroke, systemic embolism and cardiovascular events, including myocardial infarction and cardiovascular death. However, the majority of studies that have analyzed the efficacy of anticoagulants have been focused only on their effects on the risk of stroke.

Areas covered: The available evidence about the association between atrial fibrillation and cardiovascular disease as well as the effects of oral anticoagulation on cardiovascular death and myocardial infarction, with a particular focus on direct oral anticoagulants, was updated in this review.

Expert opinion: The management of patients with atrial fibrillation should not be limited to the prevention of stroke, but should also include the prevention of cardiovascular events. Despite treatment with vitamin K antagonists, many patients with atrial fibrillation still develop cardiovascular complications, particularly individuals whose anticoagulation is difficult to control. Direct oral anticoagulants overcome the majority of limitations of vitamin K antagonists and compared with warfarin, they lead to a greater reduction in the risk of stroke or systemic embolism, all-cause mortality, and intracranial hemorrhage. Although these drugs can only be compared indirectly, it seems that not all direct oral anticoagulants are equal with regard to the prevention of myocardial infarction.     

Impact of renal function on ischemic stroke and major bleeding rates in nonvalvular atrial fibrillation patients treated with warfarin or rivaroxaban: a retrospective cohort study using real-world evidence

Objectives: Renal dysfunction is associated with increased risk of cardiovascular disease and is an independent predictor of stroke and systemic embolism. Nonvalvular atrial fibrillation (NVAF) patients with renal dysfunction may face a particularly high risk of thromboembolism and bleeding. The current retrospective cohort study was designed to assess the impact of renal function on ischemic stroke and major bleeding rates in NVAF patients in the real-world setting (outside a clinical trial).

Methods: Medical claims and Electronic Health Records were retrieved retrospectively from Optum’s Integrated Claims–Clinical de-identified dataset from May 2011 to August 2014. Patients with NVAF treated with warfarin (2468) or rivaroxaban (1290) were selected. Each treatment cohort was stratified by baseline estimated creatinine clearance (eCrCl) levels. Confounding adjustments were made using inverse probability of treatment weights (IPTWs). Incidence rates and hazard ratios of ischemic stroke and major bleeding events were calculated for both cohorts.

Results: Overall, patients treated with rivaroxaban had an ischemic stroke incidence rate of 1.9 per 100 person-years (PY) while patients treated with warfarin had a rate of 4.2 per 100 PY (HR?=?0.41 [0.21–0.80], p?=?.009). Rivaroxaban patients with an eCrCl below 50?mL/min (N?=?229) had an ischemic stroke rate of 0.8 per 100 PY, while the rate for the warfarin cohort (N?=?647) was 6.0 per 100 PY (HR?=?0.09 [0.01–0.72], p?=?.02). For the other renal function levels (i.e. eCrCl 50–80 and ≥80?mL/min) HRs indicated no statistically significant differences in ischemic stroke risks. Bleeding events did not differ significantly between cohorts stratified by renal function.

Conclusions: Ischemic stroke rates were significantly lower in the overall NVAF population for rivaroxaban vs. warfarin users, including patients with eCrCl below 50?mL/min. For all renal function groups, major bleeding risks were not statistically different between treatment groups.     

非瓣膜性房颤患者应用达比加群相关出血事件的危险因素分析

目的:分析非瓣膜性房颤患者服用达比加群发生出血的危险因素。方法:本研究是一个单中心、回顾性研究,旨在探索达比加群相关出血事件的危险因素。应用某院电子病历管理系统,收集于2014年11月-2016年7月期间517例接受达比加群抗凝治疗的非瓣膜性房颤患者资料,包括患者年龄、性别、体质量、血常规、血脂、血糖、肝肾功能、合并疾病以及治疗药物等。结果:所有纳入研究的患者住院期间共有49例(9.5%)发生了出血,468例(90.5%)未发生出血。2组患者在性别、体质量、用药前红细胞压积、血小板计数、肝功能、血脂、空腹血糖、凝血指标以及合并高血脂症、肝功能不全和心功能不全方面的差异无显著性。然而,出血事件往往倾向发生于老年以及合并高血压和糖尿病的患者。肾功能不全是导致达比加群出血的重要危险因素之一,其中肌酐>115μmol·L^-1、估测肾小球滤过率<60mL/(min·1.73m^2)会显著增加房颤患者服用达比加群发生出血不良反应的风险。此外,联合应用抗血小板药物可增加房颤患者服用达比加群的出血风险,当联合应用双联抗血小板药物时出血风险显著升高(OR=4.16,95%CI 2.07~8.37)。结论:非瓣膜性房颤患者使用达比加群发生出血事件的危险因素有高龄,合并高血压、糖尿病,肌酐>115μmol·L^-1,肾小球滤过率<60mL/(min·1.73m^2)以及联合应用抗血小板药物。     

Effectiveness and safety of rivaroxaban in nonvalvular atrial fibrillation: data from a contemporary Spanish registry

Objective: To ascertain the clinical profile, management and rates of thromboembolic and bleeding complications in a contemporary cohort of patients with nonvalvular atrial fibrillation (NVAF) on rivaroxaban treatment, with a particular focus on some subgroups of patients.

Methods: Retrospective study that included all NVAF patients who started treatment with rivaroxaban for the prevention of stroke or systemic embolism between December 2012 and December 2015. Rates of outcomes (stroke, nonfatal myocardial infarction, major bleeding, intracranial bleeding and death) during follow-up were calculated.

Results: A total of 732 patients (mean age 76.4?±?9.2?years; 54.5% women) were included. Comorbidities were common (hypertension 87.5%; diabetes 26.5%; renal insufficiency 24.6%; prior stroke/transient ischemic attack 16.8%). Mean CHA₂DS₂-VASc was 3.9?±?1.5 and HAS-BLED 2.3?±?0.9; 61.9% of patients were rivaroxaban naïve users. After a mean treatment period of 22.7?±?7.4?months, rates of stroke, nonfatal myocardial infarction, major bleeding, intracranial bleeding and death were 1.8, 1.0, 3.2, 0.4 and 5.5 events per 100 patient-years, respectively. Rates of stroke and death were higher in patients >75?years (vs. ≤75?years) and in patients with prior stroke/transient ischemic attack or renal insufficiency. Rates of major bleeding were higher among patients >75?years and in patients with prior stroke/transient ischemic attack.

Conclusions: In this contemporary Spanish cohort of NVAF patients on rivaroxaban, patients had many comorbidities, a high thromboembolic risk and a moderate bleeding risk. Overall, rates of stroke and bleeding complications were low and similar to other previous studies. These data suggest that rivaroxaban is effective and safe in routine practice.     

The safety and persistence of non-vitamin-K-antagonist oral anticoagulants in atrial fibrillation patients treated in a well structured atrial fibrillation clinic

Aims To examine the long-term persistence and safety of the non-vitamin-K-antagonist oral anticoagulants (NOACs) dabigatran (D), rivaroxaban (R) and apixaban (A) in patients with non-valvular atrial fibrillation (AF) treated in the framework of a well structured, nurse-based AF unit for initiation and follow-up of NOAC.

Methods Retrospective clinical data were collected for 766 consequent patients from a single cardiology outpatient clinic incorporating the AF unit.

Results The follow-up time, median (q1-q3), was 367 days (183–493) for D patients (n?=?233), 432 days (255–546) for R patients (n?=?282) and 348 days (267–419) for A patients (n?=?251). No significant differences were found between the three groups with regard to age, sex, renal function, or CHA₂DS₂-VASc score. For all bleeding events the incidence rates per 100 patient-years of follow-up (95% confidence interval [CI], p-value) were reported more often for treatment with R (17.2, 12.7–22.8) than for D (7.0, 4.0–11.3, p?=?0.001) and A (8.7, 5.2–13.6, p?=?0.013). The differences remained significant after adjustment for clinically relevant variables. Discontinuation rates (n?=?167) were lower for A (11.5, 7.5–16.8) than for D (30, 23.4–37.9, p?<?0.001) and R (23.9, 18.6–30.1, p?=?0.001), and were mainly attributed to drug-specific side effects and bleedings. The majority of discontinued patients (n?=?142, 85%) proceeded with other types of oral anticoagulants.

Limitation The main limitation of the study is the small patient population with a short follow-up time.

Conclusion In a retrospective study at a single AF clinic, NOACs showed significantly different bleeding rates and varied discontinuation rates when compared to each other, related mainly to agent-specific side effects and bleedings. The majority of patients that discontinued proceeded with other types of oral anticoagulant.     

肺叶切除术后房颤发生的影响因素分析

目的 分析肺叶切除术后房颤发生的影响因素。方法 回顾性分析2013年2月—2017年2月在本院328例行肺叶切除术患者的临床资料。根据肺叶切除术后是否发生房颤将患者分为房颤组（132例）和对照组（196例）,对肺叶切除术后房颤发生的影响因素进行分析。结果 单因素分析显示,肺叶切除术后房颤的发生与患者年龄、性别、吸烟史、第一秒用力呼气量/用力肺活量（FEV1%）、术前肺部感染、术后氧分压等均有关（P＜0.05）;多因素Logistic回归分析结果显示,年龄＞65岁、术前FEV1%<70%、术前肺部感染、术后氧分压<100 mmHg是肺叶切除术后发生房颤的危险因素。住院期间房颤组患者短期病死率、住院时间、住院费用均高于对照组,差异有统计学意义（P＜0.05）。结论 肺叶切除术后房颤的危险因素较多,如高龄、术前肺部感染、FEV1%下降、术后氧分压低等,临床上需要加强对这些因素的预防,以降低术后房颤的发生率。     

利伐沙班用于超高龄非瓣膜性房颤患者的安全性评价

目的:观察超高龄非瓣膜性房颤(non-valvular fibrillation,NVAF)患者临床特点和抗凝治疗安全性。方法:回顾性分析武汉市第三医院2020年5月至2021年4月接受利伐沙班抗凝治疗的NVAF患者,根据年龄分为观察组(年龄≥80岁)和对照组(<80岁)。观察2组患者发生缺血性脑卒中、心肌梗死、全身性栓塞、大出血及死亡事件的风险。结果:116人完成随访,观察组59人,对照组57人。所有患者至少合并1种慢性疾病,低体质量和肾功能不全是超高龄NVAF患者的生理特点。93.2%患者服用低于标准剂量的利伐沙班,52.5%患者有高或中等依从性。随访结束,2组患者缺血事件、大出血、临床相关非大出血和死亡事件的发生率相似。结论:对于超高龄NVAF患者应充分评估卒中风险和出血风险,低于标准剂量利伐沙班能否达到预期效果需进一步研究。     

利伐沙班在非瓣膜性房颤患者中的临床应用分析及建议

目的：制定利伐沙班在临床非瓣膜性房颤患者中应用的合理性评价标准和用药建议,为规范其临床合理应用提供依据。方法：汇总国内外利伐沙班相关指南、专家共识和文献,形成利伐沙班在非瓣膜性房颤患者中应用的合理性评价标准,回顾性调查某院2018年下半年非瓣膜性房颤住院患者中使用利伐沙班病例,通过纳入标准,将符合要求的病例按照评价标准进行合理性分析;通过发放调查问卷汇总医生和患者在使用利伐沙班过程中的关注点,针对性制定合理化用药建议。结果：2018年下半年,利伐沙班在非瓣膜性房颤住院患者中使用例数共计217例,实际统计分析病例106例,利伐沙班使用不合理率为19.81%（21/106）,以低剂量人群和特殊病理状态患者给药剂量和围手术期用药时机错误为主要原因,不良反应发生率为6.60%（7/106）,均为出血性不良反应;医生和患者在使用利伐沙班中的关注点多集中在监护指标、出血事件处理和用药注意事项等方面。结论：利伐沙班在临床非瓣膜性房颤患者中应用较广泛,其疗效良好,但仍然存在不合理用药情况,特别是在给药剂量和围手术期用药方面,临床药师应密切关注利伐沙班临床应用指南等的更新,制定合理性评价标准和用药建议,积极与医生和患者沟通,促进利伐沙班合理使用。     

Rates of major bleeding with rivaroxaban in real-world studies of nonvalvular atrial fibrillation patients: a meta-analysis

Numerous real-world studies estimating major bleeding rates in rivaroxaban patients with nonvalvular atrial fibrillation have been published. We performed a meta-analysis to better quantify the rates of different types of major bleeding seen with rivaroxaban in observational studies. The pooled rates of major bleeding with rivaroxaban were generally low and consistent with those reported in its pivotal randomized controlled trial.