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中华脑血管病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 234 -243. doi: 10.3877/cma.j.issn.1673-9248.2025.03.010

循证医学

心房颤动治疗对认知功能影响的系统评价再评价
肖瑶1, 白玉瀛1, 陶文丹2,†(), 吴波2   
  1. 1　610000　成都，四川大学华西临床医学院
    2　610000　成都，四川大学华西医院神经内科
  • 收稿日期:2025-03-31 出版日期:2025-06-01
  • 通信作者: 陶文丹
  • 基金资助:
    新一代人工智能国家科技重大专项(2022ZD0118005)

Impact of atrial fibrillation treatment on cognitive function: an umbrella review of systematic reviews

Yao Xiao1, Yuying Bai1, Wendan Tao†,2(), Bo Wu2   

  1. 1 West China School of Clinical Medicine, Sichuan University, Chengdu 610000, China
    2 Department of Neurology, West China Hospital, Sichuan University, Chengdu 610000, China
  • Received:2025-03-31 Published:2025-06-01
  • Corresponding author: Wendan Tao
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引用本文：

肖瑶, 白玉瀛, 陶文丹, 吴波. 心房颤动治疗对认知功能影响的系统评价再评价[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(03): 234-243.

Yao Xiao, Yuying Bai, Wendan Tao, Bo Wu. Impact of atrial fibrillation treatment on cognitive function: an umbrella review of systematic reviews[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(03): 234-243.

目的

对心房颤动（AF）治疗策略影响患者认知功能的系统评价/Meta分析进行再评价，为临床实践提供循证证据。

方法

系统检索PubMed、Web of Science、Ovid、SinoMed、中国知网、万方数据库和维普数据库（检索时限为建库至2025年3月22日），纳入评估AF治疗策略对认知功能影响的系统评价/Meta分析。由2名研究者独立筛选文献、提取数据，并采用AMSTAR 2、ROBIS、PRISMA和GRADE工具评价纳入文献的方法学质量、偏倚风险、报告规范及证据质量。

结果

共纳入24篇文献：方法学质量高7篇（29.17%）、中等6篇（25.00%）、低7篇（29.17%）、极低4篇（16.67%）；偏倚风险低4篇（16.67%）、高20篇（83.33%）；报告质量高4篇（16.67%）、中等18篇（75.00%）、低2篇（8.33%）；证据质量中等11项（21.15%）、低23项（44.23%），极低18项（34.62%）。结果显示，抗凝治疗（尤其是直接口服抗凝药）与导管消融术可降低AF患者认知功能障碍风险，但针对痴呆亚型（如阿尔茨海默病、血管性痴呆）的结论尚不一致。

结论

AF治疗可能延缓认知功能衰退，但现有系统评价整体质量有限，亟需高质量研究进一步验证疗效并探索机制。

关键词: 心房颤动, 抗凝治疗, 导管消融, 认知功能障碍, 系统评价再评价
Objective

To conduct an umbrella review of systematic reviews/Meta-analyses evaluating the impact of atrial fibrillation (AF) treatment strategies on cognitive function in AF patients, thereby providing evidence-based insights for clinical practice. 

Methods

PubMed, Web of Science, Ovid, SinoMed, CNKI, Wanfang, and VIP databases (from inception to March 22, 2025) were systematically searched to identify systematic reviews/Meta-analyses assessing the effects of AF treatment strategies on cognitive function. Two researchers independently screened studies, extracted data, and evaluated methodological quality, risk of bias, reporting compliance, and evidence certainty using AMSTAR 2, ROBIS, PRISMA, and GRADE tools.

Results

A total of 24 studies were included. Methodological quality was rated as high in 7 studies (29.17%), moderate in 6 (25.00%), low in 7 (29.17%), and critically low in 4 (16.67%). Risk of bias was low in 4 studies (16.67%) and high in 20 (83.33%). Reporting quality was high in 4 studies (16.67%), moderate in 18 (75.00%), and low in 2 (8.33%). Evidence certainty was moderate for 11 outcomes (21.15%), low for 23 (44.23%), and very low for 18 (34.62%). Results indicated that anticoagulation therapy (particularly direct oral anticoagulants) and catheter ablation might reduce the risk of cognitive impairment in AF patients, but conclusions on dementia subtypes (e.g., Alzheimer's disease, vascular dementia) remained inconsistent. 

Conclusion

AF treatment may delay cognitive decline; however, the overall quality of existing systematic reviews is limited. High-quality studies are urgently needed to validate therapeutic efficacy and explore underlying mechanisms.

Key words: Atrial fibrillation, Anticoagulation therapy, Catheter ablation, Cognitive dysfunction, Umbrella review
图1 文献筛选流程
图2 纳入研究的基本特征。其中，①为痴呆/认知障碍发生率；②为新发全因痴呆的发生率；③为新发阿尔茨海默病的发生率；④为新发血管性痴呆的发生率；⑤为新发认知障碍发生率；⑥为MMSE；⑦为MoCA；⑧为TICSm；⑨为POCD；⑩为认知功能评分改变 注：RCT为随机对照试验；OAC为口服抗凝药；NOAC/DOAC为直接口服抗凝药；VKA为维生素K拮抗药；CA为导管消融术；MMSE为简易精神状态检查；MoCA为蒙特利尔认知评估；TICSm为电话认知状态评估改良版；POCD为术后神经认知功能障碍
图3 AMSTAR 2方法学评价结果。其中，Q1：研究问题和纳入标准是否包括了PICO部分?Q2：是否声明在系统评价实施前确定了系统评价的研究方法?对于与研究方案不一致处是否进行说明?Q3：系统评价作者在纳入文献时是否说明纳入研究的类型?Q4：系统评价作者是否采用了全面的检索策略?Q5：是否采用双人重复式文献选择?Q6：是否采用双人重复式数据提取?Q7：系统评价作者是否提供了排除文献清单并说明其原因?Q8：系统评价作者是否详细地描述了纳入的研究?Q9：系统评价作者是否采用合适工具评估每个纳入研究的偏倚风险?Q10：系统评价作者是否报告纳入各个研究的资助来源?Q11：做Meta分析时，系统评价作者是否采用了合适的统计方法合并研究结果?Q12：做Meta分析时，系统评价作者是否评估了每个纳入研究的偏倚风险对Meta分析结果或其他证据综合结果潜在的影响?Q13：系统评价作者解释或讨论每个研究结果时是否考虑纳入研究的偏倚风险?Q14：系统评价作者是否对研究结果的任何异质性进行合理的解释和讨论?Q15：如果系统评价作者进行定量合并，是否对发表偏倚（小样本研究偏倚）进行充分的调查，并讨论其对结果可能的影响?Q16：系统评价作者是否报告了所有潜在利益冲突的来源，包括所接受的任何用于制作系统评价的资助?
图4 ROBIS偏倚风险评价结果。其中，阶段一：评估相关性。阶段二：确定系统评价制作过程中偏倚风险的程度，其中，领域1：研究的纳入和排除标准；领域2：研究的检索和筛选；领域3：数据提取和质量评价；领域4：数据合成和结果呈现。阶段三：系统评价的偏倚风险
图5 PRISMA报告质量评价结果
图6 GRADE证据质量评价结果 注：MMSE为简易精神状态检查；MoCA为蒙特利尔认知评估；TICSm为电话认知状态评估改良版；POCD为术后神经认知功能障碍
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