主动脉瘤的外科修复与痴呆发病率降低。
Surgical repair of aortic aneurysms and reduced incidence of dementia.
机构信息
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.
出版信息
Int J Cardiol. 2019 Mar 1;278:46-50. doi: 10.1016/j.ijcard.2018.11.137. Epub 2018 Dec 7.
BACKGROUND
Dementia and aortic aneurysms share clinical risk factors and molecular signaling pathways. However, the association between dementia and aortic aneurysms has not been examined. The potential effects of open surgical repair (OSR) of aortic aneurysms on future dementia events are unknown.
METHODS
We conducted this nationwide population-based, retrospective cohort study using the Taiwanese National Health Insurance Research Database (NHIRD). The cumulative incidence of dementia over a 13-yearfollow-up period was compared among 1)aortic aneurysms and non-aortic aneurysm patients and 2)aortic aneurysm patients who underwent OSR, endovascular aneurysm repair (EVAR) or nonsurgical treatment (NST).
RESULTS
This study enrolled 19,921 aortic aneurysms patients and 19,921 matched controls. The aortic aneurysm cohort exhibited a significantly increased incidence of dementia compared with the controls (adjusted hazard ratio (HR)=3.559, p<0.001). Furthermore, 5409 aortic aneurysm patients were treated with surgical intervention, whereas 5409 matched aortic aneurysm patients were not. Aortic aneurysm patients who underwent OSR had a significantly lower incidence of dementia than those who underwent NST (adjusted HR=0.638, 95% confidence interval (CI)=0.411-0.764, p<0.001). Patients who underwent EVAR did not have a lower incidence of dementia than those who underwent NST.
CONCLUSION
OSR was associated with a reduced incidence of dementia in patients with aortic aneurysms compared to NST.
背景
痴呆症和主动脉瘤具有共同的临床危险因素和分子信号通路。然而，痴呆症与主动脉瘤之间的关联尚未被研究。开放手术修复（OSR）对未来痴呆事件的潜在影响尚不清楚。
方法
我们使用台湾全民健康保险研究数据库（NHIRD）进行了这项全国性的基于人群的回顾性队列研究。在 13 年的随访期间，比较了 1）主动脉瘤和非主动脉瘤患者，2）接受 OSR、血管内动脉瘤修复（EVAR）或非手术治疗（NST）的主动脉瘤患者的痴呆累积发生率。
结果
这项研究纳入了 19921 名主动脉瘤患者和 19921 名匹配对照。与对照组相比，主动脉瘤组痴呆的发生率明显增加（调整后的风险比（HR）=3.559，p<0.001）。此外，5409 名主动脉瘤患者接受了手术干预，而 5409 名匹配的主动脉瘤患者未接受手术干预。与 NST 相比，接受 OSR 的主动脉瘤患者痴呆的发生率显著降低（调整后的 HR=0.638，95%置信区间（CI）=0.411-0.764，p<0.001）。接受 EVAR 的患者与接受 NST 的患者相比，痴呆的发生率没有降低。
结论
与 NST 相比，OSR 可降低主动脉瘤患者痴呆的发生率。
Zotero 插件