目的 研究高龄非瓣膜性房颤合并轻度认知功能障碍(MCI)患者,使用利伐沙班抗凝治疗与认知功能障碍改善的关系.方法 入选陕西省人民医院住院的高龄非瓣膜性房颤合并MCI患者作为研究对象并根据患者服药依从性分为利伐沙班治疗组(10 mg/d,32例)及阿司匹林治疗组(75 mg/d, 20例),均给予控制血压、血糖、血脂等治疗.随访1年,评估两组患者出血及血栓栓塞事件.通过简易精神状态检查表(MMSE)、蒙特利尔认知评估表(MoCA)、日常生活活动能力评分(ADL)分别评估基线、随访6个月及1年后患者认知功能障的状态.结果 随访1年后利伐沙班组2例患者发生出血,无血栓栓塞事件发生;阿司匹林组1例患者发生出血,2例患者发生血栓栓塞,两组出血(P=0.851)及血栓事件(P=0.068)发生风险无明显差异.随访1年后与治疗前比较利伐沙班组患者MMSE、MoCA、ADL评分及阿司匹林组患者MoCA评分均明显升高(P<0.05),1年后与阿司匹林组比较利伐沙班组患者MMSE、MoCA、ADL评分均明显升高(P<0.05).结论 高龄非瓣膜性房颤患者使用利伐沙班抗凝治疗不但可以预防血栓栓塞发生,还可以改善MCI患者的认知功能.
Objective To investigate the effect of livaroxaban anticoagulant therapy in the improvement of mild cognitive impairment (MCI) in elderly patients with non-valvular atrial fibrillation. Methods Patients with non-valvular atrial fibrillation and MCI were enrolled for analysis. All patients were given basic medical treatment to control blood pressure, sugar and lipid, and were divided into livaroxaban group (n=32, 10 mg per day) and aspirin group (n=20, 75 mg per day) according to the selection of anticoagulant agents after consulting with patients. The event of bleeding and thromboembolism were recorded during 1 year follow-up. Mini-mental state examination (MMSE), montreal cognitive assessment (MoCA), and activity of daily living(ADL) scores were evaluated at baseline, 6 months and 1-year follow-up in both groups. Results During 1 year follow-up, there were 2 patients with bleeding and no thromboembolism occurred in livaroxaban group; and 1 patient with bleeding and 2 patients with thromboembolism in aspirin group. The occurrence of bleeding and thromboembolism were not significantly different in both groups. MMSE, MoCA, and ADL scores in livaroxaban group and MoCA score in aspirin group evaluated in 1 year were significantly higher than those at baseline (P<0.05). MMSE, MoCA, and ADL scores in livaroxaban group were significant higher than those in aspirin group after 1 year follow-up. Conclusion Livaroxaban anticoagulant therapy can prevent thromboembolism and improve MCI in elderly patients with non-valvular atrial fibrillation.