终末期肾病患者左心室质量指数增加和认知功能下降的相关性研究

Relationship between increased left ventricular mass index and decreased cognitive function in endstage renal disease patients

目的探讨终末期肾病(end stage renal disease,ESRD)患者左室质量指数(left ventricular mass index,LVMI)增加及其他危险因素与认知功能下降之间的关系。方法收集2016年6月～2017年12月在西安交通大学第一附属医院肾内科住院的慢性肾脏病5期未透析患者39例,采集患者的一般资料,行心脏彩色多普勒超声检查,并应用神经心理学量表,对研究对象的整体认知功能及执行功能分别采用蒙特利尔认知量表(montreal cognitive assessment,MoCA)、连线测试A进行评估。对一般资料、心脏彩色多普勒超声检查结果与认知功能评分进行相关性分析及多因素回归分析。结果 (1)患者一般资料与认知评分相关性分析显示,年龄与连线测试A得分呈正相关(r=0.335;P=0.037),教育程度、血钙与连线测试A得分呈负相关(r值分别为-0.546,-0.358;P值分别为0.001,0.025);教育程度及血钙与MoCA得分呈正相关(r值分别为0.593,0.349;P值分别为0.001,0.030),胱抑素C与MoCA得分呈负相关(r=-0.398;P=0.012);(2)左心内径及功能与认知评分相关性研究发现,LVMI与连线测试A得分呈正相关(r=0.471;P=0.003),与MoCA得分呈负相关(r值为-0.332;P值为0.039);(3)多元逐步回归提示:教育程度、LVMI与ESRD患者执行功能下降密切相关(t值分别为-3.891,3.238;P值分别为0.001,0.003);教育程度、胱抑素C及LVMI与ESRD患者整体认知功能下降密切相关(t值分别为0.516,-1.496,-0.022;P值分别为0.001,0.004,0.021)。结论 ESRD患者认知功能受诸多因素影响,LVMI增加可能与其认知功能下降密切相关。

To investigate the relationship between increased left ventricular mass index （LVMI） and other risk factors and decreased cognitive function in end-stage renal disease （ESRD） patients. Methodology We recruited 39 chronic kidney disease patients at stage 5 without dialysis and hospitalized in the Department of nephrology, the first affiliated Hospital of Xi＇ an Jiaotong University in the period from June 2016 to December 2017. Patient＇s demographic data, color Doppler echocaxdiography findings, neuropsychological scale （the Montreal cognitive scale, MoCA） to evaluate the overall cognition function, and the executive function score （connection test A） were collected. Correlation analysis and multivariate regression were conducted to analyze their demographic data, cardiac color Doppler ultrasound findings and cognitive function scores. Results ① The correlation analysis between demographic data and cognitive score showed that age was positively corre- lated with connection testA score （r=0.335, P=0.037）; education level and serum calcium were negatively cor- related with connection test A score （r=-0.546 and-0.358 respectively, P=0.001 and 0.025 respectively） and were positively correlated with MoCA score （r=0.593 and 0.349 respectively, P=0.001 and 0.030 respectively）; cystatin C was negatively correlated with MoCA score （r=-0.398, P=0.012）. ②The correlation between left ventriculax diameter and function and cognitive score showed that LVMI was positively correlated with connection test A score （r=0.471, P=0.003） and negatively correlated with MoCA score （r=-0.332, P=0.039）.③Multivariate stepwise regression analysis showed that education level and LVMI were closely related to the decrease of executive function in ESRD patients （t=-3.891 and 3.238 respectively, P=0.001 and 0.003 respectively）; education level, cystatin C and LVMI were closely related to the decrease of overall cognitive function in ESRD patients （t=-0.516, -1.496 and -0.022 respectively, P=0.001, 0.004 and 0.021 respectively）. Conclusion Many factors affect the cognitive function, and increased LVMI may closely relate to the decreased cognitive function in ESRD patients.