中青年维持性血液透析患者轻度认知功能损害与透析间低血压相关性研究

Clinical study on the relationship between mild cognitive impairment and intradialytic hypotension in young and middle-aged maintenance hemodialysis patients

目的:分析中青年维持血液透析(MHD)患者轻度认知功能损害(MCI)与透析间低血压(IDH)相关性。方法:选取中青年MHD患者108例,透析期间MHD患者的SBP最低值低于90mmHg,或出现低血压相关症状需回输生理盐水或葡萄糖溶液定义为IDH。采用应用简易智力状态检查量表和蒙特利尔认知评估量表评价患者的认知功能,调查入选患者的临床资料及实验室指标,分析IDH与MCI相关性结果:108例中青年MHD患者中IDH23例,发生率21.3%;MCI50例,患病率46.3%;MCI组与非MCI组相比,男性、透析龄长、合并糖尿病、IDH患者比例高,TG、LDL、UA、CRP水平高,受教育初中以上患者比例低,差异有统计学意义。MoCA积分与透析龄、糖尿病、IDH呈负相关,与受教育程度呈正相关(r值分别为-0.388、-0.226、-0.386、0.469,P<0.05)。Logistic单因素分析显示,透析龄、糖尿病、受教育水平、IDH、UA、CRP均与MCI相关。Logistic多因素分析显示,校正透析龄、糖尿病、受教育水平、UA、CRP后,IDH仍是IDH的独立影响因素。结论:中青年MHD患者MCI发生率较高,IDH为MCI的独立危险因素。

Objective:To analyze the relationship between mild cognitive impairment(MCI)and intradialytic hypotension(IDH)in young and middle-aged maintenance hemodialysis(MHD)patients.Methods:A total of 108 young and middle-aged MHD patients were enrolled.During dialysis,the lowest SBP value in patients with MHD was less than 90 mmHg,or hypotension-related symptoms need to be returned to saline or glucose solution,which was defined as IDH.The cognitive function of the patients was evaluated by the Simple Intelligence State Check Scale and the Montreal Cognitive Assessment Scale.The clinical data and laboratory indicators of the selected patients were investigated,and the correlation between IDH and MCI was analyzed.Results:Among 108 patients,23 cases had IDH,the incidence rate was 21.3%;50 cases had MCI,the prevalence rate was 46.3%.Compared with the non-MCI group,the male,long-dialysis,diabetes and IDH patients had a higher proportion,the levels of LDL,UA,and CRP were higher,and the proportion of patients with junior high school or higher was lower,and the difference was statistically significant.MoCA scores were negatively correlated with dialysis age,diabetes and IDH,and positively correlated with education level(r values were-0.338,-0.226,-0.386,0.469,P<0.05).Logistic single factor analysis showed that dialysis age,diabetes,education level,IDH,UA,and CRP were all associated with MCI.Logistic multivariate analysis showed that IDH was still an independent factor of MCI after adjusting dialysis age,diabetes,education level,UA,and CRP.Conclusion:The incidence of MCI is higher in patients with young and middle-aged MHD.IDH is an independent risk factor of MCI.