Page 110 - 中国全科医学2022-13

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2.Department of Cardiology，Tianjin First Central Hospital，Tianjin 300192，China
3.School of Nursing，Peking University Health Science Center，Beijing 100871，China
4.School of Nursing，Liaoning University of Traditional Chinese Medicine，Liaoning 100847，China
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Corresponding author：YANG Huifeng，Lecturer；E-mail：yanghuifeng08@126.com
【Abstract】 Background Cognitive impairment（CI）is a common complication of chronic heart failure（CHF），which
may significantly increase the risk of poor prognosis，so early identification of associated factors of CI in CHF is of great significance.
Although there have been many relevant studies recently，their conclusions are inconsistent. Objective To perform a systematic
review of the influencing factors of CI in CHF. Methods In August 2021，studies relevant to influencing factors of CI among
patients with CHF were searched in databases including PubMed，Embase，The Cochrane Library，Web of Science，CINAHL，
PsychINFO，CNKI，Wanfang Data，CQVIP，and SinoMed from inception to August 2021. Two researchers independently screened
studies based on the inclusion and exclusion criteria，extracted data，and performed risk of bias assessment using the Newcastle-
Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist，then conducted a descriptive analysis of the
factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis. Results Fourteen studies were included，involving
6 324 cases of CHF，and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF，
and 22 factors increased the risk，but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis
demonstrated that education level〔OR=0.45，95%CI（0.30，0.70）〕，age〔OR=1.17，95%CI（1.10，1.24）〕，diabetes
〔OR=2.17，95%CI（1.17，4.01）〕，anemia〔OR=3.03，95%CI（1.80，5.10）〕and left ventricular ejection fraction〔OR=0.91，
95%CI（0.88，0.94）〕were associated with CI in CHF. Conclusion High education level lowered the risk of CI in CHF，while
older age，diabetes，anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of
included studies，the above-mentioned conclusion still needs to be verified by more high-quality studies.
【Key words】 Chronic heart failure；Cognitive impairment；Influencing factors；Systematic review

慢性心力衰竭（chronic heart failure，CHF）是多种心血 表的研究成果；（4）数据无法完整提取 / 有明显错误的文献；
管疾病的终末阶段。随着心血管疾病发病率和患病率的日益 （5）仅通过单因素分析比较不同特征 CHF 患者 CI 发生情况
升高和人口老龄化步伐的加快，CHF 的发病率和患病率呈不 差异的文献。
断增高趋势，其再住院率、死亡率居高不下 ［1］ 。一项流行病 1.2 文献检索策略 于 2021 年 8 月，计算机检索 PubMed、
学调查研究结果显示，我国≥ 35 岁成年人心力衰竭的患病率 EmBase、The Cochrane Library、Web of Science、CINAHL、
约为 1.3%，其中 CHF 占 80% ［2］ 。CHF 可导致认知功能障碍 PsychINFO、中国知网、万方数据知识服务平台、维普中文
（cognitive impairment，CI），而 CI 又会增加 CHF 患者再住院、 科技期刊全文数据库、中国生物医学文献数据库，获取有
死亡等的风险 ［3-4］ 。CI 已对 CHF 患者的预后构成严重威胁， 关 CHF 患者 CI 发生影响因素的研究，检索时限均为建库至
早期识别影响 CHF 患者发生 CI 的因素有助于及时采取干预 2021 年 8 月。同时辅以手工检索，并追溯纳入文献的参考文
措施来预防或延缓 CI 的发生。目前，有研究者对 CHF 患者 献。检索策略采取主题词与自由词相结合的方式。英文检索
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发生 CI 的影响因素进行了探讨，发现年龄、性别、文化程度、 词包括：heart failure/cardiac failure，cognition disorder /cognitive
左心室射血分数（left ventricular ejection fraction，LVEF）等因 dysfunction/cognitive impairment/cognitive decline/cognitive
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素在 CHF 患者 CI 的发生、发展中起着重要作用。但受研究 disorder /cognitive defect /cognitive deficit /cognitive disabilit ，
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设计方案、调查地域、调查对象群体特征等多种因素的影响， risk factor /influencing factor /influence factor /contributing factor /
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不同研究的结果之间存在较大差异。因此，本研究采用定性 impact factor /relevant factor /correlative factor /relative factor /
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与定量相结合的方法对影响 CHF 患者发生 CI 的因素进行系 associated factor /predictor 。中文检索词包括：心力衰竭 / 心衰
统评价，以期为 CHF 患者 CI 的预防、早期发现与干预提供 / 心功能不全，认知障碍 / 认知功能 / 认知损害 / 认知损伤 / 认
循证依据。 知减退 / 认知减低，危险因素 / 影响因素 / 相关因素 / 预测因素。
1 资料与方法 以 PubMed 为例，具体检索策略：
1.1 文献纳入与排除标准 纳入标准：（1）研究对象，符合 #1 "heart failure"［MeSH Terms］OR "heart failure"［Title/
心力衰竭诊断标准、经主治医生诊断患有 CHF 者，病情严重 Abstract］ OR "cardiac failure"［Title/Abstract］
程度不限，年龄≥ 18 岁；（2）研究类型，观察性研究，包 #2 "cognition disorders"［MeSH Terms］OR "cognitive
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括队列研究、病例对照研究和横断面研究；（3）研究内容， dysfunction"［MeSH Terms］OR "cognition disorder "［Title/
CHF 患者发生 CI 的影响因素或预测因素；（4）结局指标， Abstract］OR "cognitive dysfunction"［Title/Abstract］OR
采用≥ 1 项认知功能评估工具或 CI 诊断标准对 CHF 患者进行 "cognitive impairment"［Title/Abstract］OR "cognitive decline"
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筛查。排除标准：（1）非中、英文文献；（2）重复发表的文献； ［Title/Abstract］OR "cognitive disorder "［Title/Abstract］OR
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（3）综述、系统评价、个案报道、会议论文、以摘要形式发 "cognitive defect "［Title/Abstract］ OR "cognitive deficit "［Title/