2026 年第 1 期 第 21 卷

不同年龄冠心病患者认知障碍的临床特征与风险因素研究

Clinical characteristics and risk factors of cognitive impairment in coronary atherosclerotic heart disease patients of different ages

作者：营晓郑文崔永慧阚雅雯李晶刘瑀曾勇

英文作者：Ying Xiao Zheng Wen Cui Yonghui Kan Yawen Li Jing Liu Yu Zeng Yong

单位：首都医科大学附属北京安贞医院冠心病中心，北京100029

英文单位：Coronary Heart Disease Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；认知障碍；临床特征；风险因素

英文关键词：Coronaryatheroscleroticheartdisease;Cognitiveimpairment;Clinicalcharacteristics;Riskfactors

• 摘要：

• 目的 探讨不同年龄段冠心病(冠状动脉粥样硬化性心脏病)患者认知障碍的临床特征与风险因素。方法采用前瞻性队列研究设计，共纳入2021年12月至2023年4月就诊于首都医科大学附属北京安贞医院的9 893例冠心病患者。根据年龄将患者分为中年组（45～59岁，4 121例）和老年组（≥60岁，5 772例）。通过简易精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估患者认知功能；采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量，通过焦虑自评量表（SAS）和抑郁自评量表（SDS）评估焦虑、抑郁状态。采用多因素Logistic回归方法分析探究冠心病患者认知功能障碍的危险因素。结果 中年组认知障碍患病率低于老年组［33.9%（1 396/4 121）比55.6%（3 210/5 772）］（P<0.001）。中年组睡眠质量不佳比例低于老年组（P<0.001）。中年组和老年组SAS和SDS评分差异均无统计学意义（均P>0.05）。多因素Logistic回归分析结果显示，高龄、女性、脑梗死、心肌梗死、睡眠质量不佳、焦虑和抑郁与认知障碍风险增加显著相关（均P<0.05）。不同年龄组分析显示，中年组女性、糖尿病、脑梗死、心肌梗死、睡眠质量不佳和抑郁是认知障碍的独立危险因素；老年组女性、脑梗死、心肌梗死、睡眠质量不佳、焦虑和抑郁是认知障碍的独立危险因素（均P<0.05）。结论 冠心病患者的认知障碍水平较高，高龄、脑梗死、心肌梗死、失眠、焦虑、抑郁会加重冠心病患者的认知障碍。中年冠心病患者约有1/3存在认知障碍，且其危险因素与老年患者存在差异，糖尿病可增加中年患者的认知障碍程度，但对老年患者无显著影响；焦虑不是中年患者认知障碍的风险因素，但可显著增加老年患者认知障碍风险。

• Objective To explore the clinical characteristics and risk factors of cognitive impairment in coronary atherosclerotic heart disease (CHD) patients of different age groups. Methods A prospective cohort study was conducted, enrolling a total of 9 893 CHD patients who visited Beijing Anzhen Hospital, Capital Medical University from December 2021 to April 2023. The patients were divided into middleaged group (4559 years old, 4 121 cases) and elderly group (≥60 years old, 5 772 cases) according to age. Cognitive function was assessed using the minimental state examination (MMSE) and Montreal cognitive assessment (MoCA). Sleep quality was evaluated by the pittsburgh sleep quality index (PSQI), and anxiety and depression status were assessed with the selfrating anxiety scale (SAS) and selfrating depression scale (SDS), respectively. Multivariate Logistic regression analysis was used to identify the risk factors for cognitive impairment in CHD patients. Results The prevalence of cognitive impairment in the middleaged group was lower than that in the elderly group ［33.9%(1 396/4 121) vs 55.6%(3 210/5 772)］(P<0.001). The proportion of poor sleep quality in the middleaged group was lower than that in the elderly group (P<0.001). There were no statistically significant differences in SAS and SDS scores between the middleaged and elderly groups (both P>0.05).The results of multivariate Logistic regression analysis showed that advanced age, female gender, cerebral infarction, myocardial infarction, poor sleep quality, anxiety, and depression were significantly associated with an increased risk of cognitive impairment (all P<0.05). Subgroup analysis by age revealed that in the middleaged group, female gender, diabetes mellitus, cerebral infarction, myocardial infarction, poor sleep quality, and depression were independent risk factors for cognitive impairment; in the elderly group, female gender, cerebral infarction, myocardial infarction, poor sleep quality, anxiety, and depression were independent risk factors for cognitive impairment (all P<0.05). Conclusion  The prevalence of cognitive impairment is relatively high in patients with CHD. Advanced age, cerebral infarction, myocardial infarction, insomnia, anxiety, and depression can exacerbate cognitive impairment in CHD patients. Approximately onethird of middleaged CHD patients have cognitive impairment, and their risk factors differ from those of elderly patients. Diabetes mellitus can increase the severity of cognitive impairment in middleaged patients but has no significant effect on elderly patients; anxiety is not a risk factor for cognitive impairment in middleaged patients but can significantly increase the risk in elderly patients.