糖尿病维持性血液透析患者认知功能状况及其影响因素

Cognitive Function Stat us and Influencing Factors among Maintenance Hemodialysis Patients with Diabetes

目的调查糖尿病维持性血液透析(diabetes-maintenance hemodialysis,D-MHD)患者认知功能状况及其影响因素。方法便利抽样法选取江苏省2所二级医院血液净化中心行血液透析治疗的患者为研究对象,采用倾向性评分匹配法调整混杂因素,将D-MHD患者设为观察组,非D-MHD患者设为对照组。采用蒙特利尔认知评估量表评估两组患者的认知功能。结果观察组命名、语言维度及整体发生认知障碍比例较对照组高,观察组患者的整体认知和视空间/执行功能、命名、语言维度的评分均较对照组低,差异均有统计学意义(均P<0.05)。不同年龄、性别、文化程度、糖尿病病程、糖化白蛋白和透析前血糖水平的D-MHD患者认知功能总分及某些维度认知评分比较,差异均有统计学意义(均P<0.05)。相关分析显示,认知功能总分或各维度认知水平与年龄、糖尿病病程、糖化白蛋白水平、透析前血糖水平呈负相关,与文化程度呈正相关。结论 D-MHD患者认知水平整体偏低,影响因素较多。应将D-MHD患者血糖水平控制在正常范围内,重视低龄、糖尿病初期、女性患者,并基于文化程度的不同开展个性化健康教育。

Objective To investigate the cognitive function and influencing factors among diabetes-maintenance hemodialysis(D-MHD) patients.Methods The maintenance hemodialysis(MHD) patients with diabetes were set as the observation group and the MHD patients without diabetes were included in the control group.The propensity score-matched method was applied to adjust confounders,the Montreal Cognitive Assessment was used to access cognitive function.Results The proportion of naming, language dimension and cognitive impairment in the observation group was higher than those in the control group, and the differences were statistically significant,the scores of cognition, visual space/executive function, naming and language in the observation group were lower than those in the control group(all P<0.05).There were statistically significant differences in the total score of cognitive function and the cognitive score of some dimensions among patients with D-MHD of different age, gender, education level, diabetes duration, glycosylated albumin and blood glucose level before dialysis(all P<0.05).Correlation analysis showed that the total score of cognitive function or the cognitive level of each dimension was negatively correlated with age, the history of diabetes, the level of glycosylated albumin, the level of blood glucose before dialysis, and positively correlated with education level.Conclusions The cognitive level of D-MHD patients is generally at a low level and its influencing factors are not single.Medical staff should control the blood glucose level within a normal range,focus on the cognitive decline of younger age,early stage of diabetes,and female patients,and carry out individualized health education based on the degree of education.