Addenbrooke改良认知评估量表在慢性肾脏病患者认知功能的应用

Multi-center studies on the application of Addenbrooke′s cognitive examination revised scale to evaluate cognitive function in patients with chronic kidney disease

目的:探讨Addenbrooke改良认知评估量表(ACE-R)在慢性肾脏病(CKD)患者认知功能评估中的应用。方法:招募南京地区4家综合医院2014年3-7月肾内科门诊及住院治疗的临床确诊的CKD患者共205例,采用ACE-R评估其认知功能,并对结果进行比较分析。结果:(1)NC-NCDs组(89.18±4.80)、Mild-NCDs(77.28±5.80)组和Major-NCDs组(55.90±10.90)之间ACE-R水平相比差异有统计学意义(F=292.28,P<0.01),组间两两比较差异有统计学意义(均P<0.01);(2)ACE-R(AUC=0.944,P<0.01)对Mild-NCDs患者的识别能力显著优于MMSE(AUC=0.777,P<0.01);(3)ACE-R总分区别NC-NCDs和Mild-NCDs患者最佳截断值为83/84(敏感度88.00%,特异度85.90%,约登指数0.739),区别Mild-NCDs和Major-NCDs患者最佳截断值为71/72(敏感度89.70%,特异度96.10%,约登指数0.858)。结论:ACE-R对CKD患者认知损伤不同严重程度具有较好的区分能力,同时可有效识别早期轻度认知功能损伤,适合临床推广用于CKD患者认知功能的评估与研究。

Objective To evaluate the application of Addenbrooke＇s cognitive examination revised （ACE- R） scale to evaluate cognitive function in patients with chronic kidney disease （CKD）. Methods We used ACE- R scale to evaluate the cognitive function on 205 cases of CKD patients received outpatient and inpatient treatment in renal Department of four hospitals in Nanjing. One- way ANOVA analysis, receiver operating characteristic （ROC） curve and other statistical methods were adopted to compare differences. Results （ 1 ） There is significant difference of ACE-R scale scores among group NC-NCDs （89.18 -＋ 4.80） , group Mild-NCDs （77.28 _＋ 5.80） and group Major-NCDs （55.90 _＋ 10.90） （F = 292.28, P 〈 0.01）. There is significant difference between any two groups （all P 〈 0.01 ）. （2） （ACE-R） scale （AUC = 0.944, P 〈 0.01 ） showed significantly higher sensitivity than mini-mental state examination （MMSE） scale （AUC = 0.777, P 〈 0.01 ） on identifying Mild-NCDs patients with chronic kidney disease （P 〈 0.01 ） ; （3） The optimal cut-off value of total ACE-R score between group NC-NCDs and group Mild-NCDs was 83/84, （sensitivity 88.00%, specificity 85.90%, Youden index 0.739）, the optimal cut- off value between group Mild-NCDs and group Major-NCDs was 83/84 （sensitivity 89.70%, specificity 96.10%, Youden index 0.858）. Conclusion ACE-R possesses a good ability in distinguishing different severity of cognitive impairment in patients with CKD. ACE-R can effectively identify early mild cognitive impairment, which is suitable for clinical application as a tool to evaluating and studying of cognitive function in patients with CKD.