维持性血液透析患者认知功能障碍及相关危险因素分析

Analysis of cognitive impairment and related risk factors in maintenance hemodialysis patients with end stage renal disease

目的:探讨维持性血液透析(maintenance hemodialysis,MHD)患者认知功能改变情况及相关危险因素。方法:回顾性分析2016年1月至2017年12月在南京市浦口医院内科接受MHD治疗的85例患者的临床资料,采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)对患者的认知功能进行评价,同时收集患者的相关基线资料,包括年龄、透析龄、受教育年限、体质量指数、合并高血压病、合并糖尿病、血红蛋白水平、白蛋白水平、血尿素氮水平、血肌酐水平,分析影响MHD患者认知功能的危险因素。结果:85例行MHD治疗的患者中,存在认知功能障碍的有59例(69.41%),其视空间与执行、定向力、延迟回忆水平,命名、注意、计算、语言、抽象能力,以及MoCA量表总分均较认知功能正常组的患者明显降低(P<0.05)。单因素分析显示年龄、透析龄、受教育年限及合并糖尿病是发生认知功能障碍的危险因素(P<0.05)。多因素分析提示年龄及透析龄是主要影响MHD治疗患者发生认知功能障碍的独立危险因素(P<0.05)。结论:MHD中有较高比例的患者存在认知功能障碍,年龄及透析龄与患者的认知功能障碍密切相关。

Objective:To investigate the cognitive impairment and the related risk factors in maintenance hemodialysis(MHD)patients who had end stage renal disease(ESRD).Methods:85 patients with ESRD who underwent MHD between January 2016 and December 2017 were recruited in our dialysis center.The cognitive impairment was evaluated by the Montreal cognitive assessment(MoCA)and the clinical data of every patient including age,dialysis age,years of education,body mass index(BMI),hypertension,diabetes,Hb,Alb,BUN and Scr were collected.Cognitive impairment and the related risk factors were analyzed.Results:Among 85 MHD patients,the number of patients with cognitive impairment was 59(69.41%).The score in visual space and executive function,naming,attention and calculation,language,abstract ability,delay recall,orientation and the total MoCA score in the cognitive impairment group were significantly lower than those of the normal cognitive function group(P<0.05).Univariate analysis showed that age,dialysis age,years of education and diabetes were the risk factors for cognitive impairment(P<0.05).Multivariate analysis showed that age and dialysis age were the independent risk factors(P<0.05).Conclusion:The incidence of cognitive impairment in MHD patients with end stage renal disease is relatively high.Age and dialysis age are independent risk factors for cognitive impairment.