维持性血液透析对慢性肾衰竭患者认知功能影响的临床研究

Impact of maintenance hemodialysis on cognitive function of patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)治疗对慢性肾衰竭(chronic renal failure,CRF)患者认知功能的影响。方法选择新疆博尔塔拉蒙古自治州人民医院2014年1月至2015年8月期间收治的行MHD治疗的CRF患者65例为研究对象,同时纳入该院同时期排除肾病和脑血管病的健康体检者65例作为健康对照组。采集患者的基本资料,在血液透析前后分别采用蒙特利尔认知量表(Montreal Cognitive Assessment,MoCA)对患者进行认知功能评定。根据MoCA评分将65例患者分为认知水平正常组(normal cognition,简称NC组)和认知功能障碍组(cognitive impairment,简称CI组),进而观察MHD对CRF患者认知功能的影响。结果纳入的65例CRF患者中,MoCA评分的平均值为(21.8±4.4)分,低于对照组平均评分水平(P<0.05)。依据蒙特利尔认知量表认知功能障碍的划分标准,65例患者仅有22例患者(33.8%)属于正常水平,其余43例患者(66.2%)均存在不同程度的认知功能障碍。NC组透析后MoCA评分为(23.2±1.7)分,明显低于透析前(26.5±1.2)分,CI组透析后MoCA评分为(18.7±3.6)分,明显低于透析前(21.3±2.9)分,2组差异均具有统计学意义(P0.05)。多因素分析提示,文化程度低、年龄大、血红蛋白水平低及透析时间长是影响MHD患者认知功能障碍的相关因素,差异均具有统计学意义(P<0.05)。结论 MHD可以影响CRF患者认知功能,同时文化程度、年龄、血红蛋白水平及透析龄可能是影响认知功能的相关危险因素。

Objective To investigate the impact of maintenance hemodialysis （MHD） on cogni- tive function of patients with chronic renal failure （CRF）. Methods Sixty-five cases of CRF undergoing MHD were recruited between January 2014 to August 2015 from Department of Nephrology, the People＇s Hospital of Bo＇ertala Zhou. The effect of MDH on cognitive function in patients with CRF was observed. The cognitive function was assessed by the Montreal Cognitive Scale （MoCA） before and after treatment. Sixty-five patients were divided into normal cognition （NC） group （n = 22）, and cognitive impairment （CI） group （n = 43） according to the MoCA scores. Results The average scores of MoCA in MHD patients were （21.8± 4. 4）, which were significantly lower than those in the control group. After MHD, the MoCA scores in NC group （23. 2 ± 1.7） and CI group （18. 7 ±3. 6） were significantly lower than those before MHD [（26. 5 ± 1.2） and （21.3 ± 2. 9） respectively]. There was significant difference between the two groups （P〈0. 05）. The multivariate analysis revealed that low education level, older age, low hemoglobin levels and a long duration of dialysis were factors influencing cognitive dysfunction of MHD patients with the differences being statistically significant （P〈0. 05）. Conclusions MHD can influence cognitive function in patients with CRF, and education level, age, hemoglobin levels and duration of dialysis may be the risk factors.