不同肾功能损伤患者认知功能差异分析

Difference of cognitive function in patients with different degree of renal dysfunction

目的探讨不同肾功能损伤患者认知功能差异,为其临床研究提供可参考依据。方法共纳入100例该院诊断为尿毒症的患者慢性肾脏病5期组（CKD5）及100例存在肾功能不全但未达到尿毒症的患者（CKD1-4期组）作为病例组,同时随机抽取100例健康人群作为对照组,所有受试者采用简易精神状态量表（MMSE）进行认知功能评价。结果 CKD5期组即刻记忆、注意力及计算力、延迟记忆、MMSE总得分均低于CKD1-4期组与对照组,差异有统计学意义（P〈0.05）;CKD1-4期组注意力及计算力得分低于对照组,差异有统计学意义（P〈0.05）。肾小球滤过率与认知功能呈正相关,随肾小球滤过率的降低,即刻记忆得分、注意力及计算力得分、延迟记忆得分及MMSE总分逐渐降低（P〈0.05）。年龄≥70岁、女性、受教育年限≤5年、合并高血压、肾小球滤过率≤30 ml/min是影响尿毒症患者认知功能的独立危险因素（P〈0.05）。结论尿毒症患者易出现认知功能障碍,其严重程度与肾小球滤过率呈正相关,其中高龄、女性、受教育年限不足、合并高血压、肾小球滤过率低是导致尿毒症患者认知功能障碍的独立危险因素,临床上应对高危患者给予密切关注。

Objective To explore the difference of cognitive impairment in patients with different degree of renal dysfunction so as to provide reference for its clinical research. Methods A total of 100 cases in our hospital diagnosed as uremia in chronic kidney disease stage 5（uremia group） and 100 patients with renal insufficiency but not uremia（renal insufficiency group） were selected into case groups, and 100 randomly selected healthy people into control group. Cognitive function was evaluated in all the subjects using the Mini-mental State Examination（MMSE）. Results The immediate memory, attention and calculating force,delayed memory, and total MMSE scores in the uremia group were significantly lower than those in the renal insufficiency group and the control group, the differences were statistically significant（P〈0.05）. The attention and calculating force scores in the renal insufficiency group were significantly lower than those in the control group（P〈0.05）. Glomerular filtration rate was positively correlated with cognitive function. Immediate memory score, attention and calculation scores, total scores of MMSE and delayed memory gradually reduced with the decrease of glomerular filtration rate（P〈0.05）. Age ≥70 years, female, education ≤5 years, hypertension,glomerular filtration rate≤30 ml/min are the independent risk factors of cognitive impairment in patients with uremia（P〈0.05）. Conclusions Uremic patients are prone to cognitive dysfunction, its severity is positively correlated glomerular filtration rate. The elderly, female, lack of education, hypertension, and low glomerular filtration rate are independent risk factors for cognitive impairment in patients with uremia. Close attention should be paid to high-risk patients in clinic.