Knopman D S, Petersen R C, Cha R H, Edland S D, Rocca W A
The Mayo Alzheimer Disease Research Center, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Neurology. 2005 Oct 11;65(7):986-90. doi: 10.1212/01.wnl.0000171954.92119.c7. Epub 2005 Sep 14.
To study coronary artery bypass grafting (CABG) as a risk factor for dementia and Alzheimer disease (AD) using a case-control design.
The authors used the records-linkage system of the Rochester Epidemiology Project to ascertain incident cases of dementia in Rochester, MN, for the 5-year period 1990 to 1994. The authors defined dementia and AD using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Each case was individually matched by age (+/-1 year) and sex to a person drawn randomly from the same population, and free of dementia in the index year (year of onset of dementia in the matched case).
Among 557 dementia cases, 24 (4.3%) had undergone a CABG prior to the onset of dementia with a median lag time of 5.5 years (range = 0.1 to 15.9). Among 557 controls, 28 subjects (5.0%) had undergone a CABG prior to the index year with a median lag time 3.9 years (range = 0.1 to 12.3); OR = 0.85 (95% CI = 0.49 to 1.49; p = 0.57) for dementia and OR = 0.78 (95% CI = 0.39 to 1.56; p = 0.48) for AD. The findings did not change after adjustment for education. The perioperative courses of cases and controls were comparable. Analyses including only the 481 cases of dementia with presumed neurodegenerative or cerebrovascular etiology were also negative.
This population-based case-control study suggests that coronary artery bypass grafting is not a major risk factor for dementia overall, or for Alzheimer disease.
采用病例对照设计研究冠状动脉旁路移植术（CABG）作为痴呆和阿尔茨海默病（AD）的危险因素。
作者利用罗切斯特流行病学项目的记录链接系统，确定明尼苏达州罗切斯特市1990年至1994年5年间痴呆的发病病例。作者根据《精神障碍诊断与统计手册》第四版（DSM-IV）的标准定义痴呆和AD。每个病例按年龄（±1岁）和性别与从同一人群中随机抽取的、在索引年（匹配病例中痴呆发病年份）无痴呆的人进行个体匹配。
在557例痴呆病例中，24例（4.3%）在痴呆发病前接受了CABG，中位滞后时间为5.5年（范围=0.1至15.9年）。在557例对照中，28例（5.0%）在索引年之前接受了CABG，中位滞后时间为3.9年（范围=0.1至12.3年）；痴呆的比值比（OR）=0.85（95%可信区间[CI]=0.49至1.49；p=0.57），AD的OR=0.78（95%CI=0.39至1.56；p=0.48）。经教育程度调整后，研究结果未发生变化。病例和对照的围手术期过程具有可比性。仅纳入481例推测为神经退行性或脑血管病因的痴呆病例的分析结果也为阴性。
这项基于人群的病例对照研究表明冠状动脉旁路移植术总体上不是痴呆或阿尔茨海默病的主要危险因素。
