血液透析患者透析相关性低血压的发生情况与认知功能的关系

Relationship between Incidence of Intradialytic Hypotension and Cognitive Function in Hemodialysis Patients

【目的】探讨血液透析(HD)患者透析相关性低血压(IDH)的发生率与认知功能的关系。【方法】于本院接受维持性HD(MHD)的终末期肾脏病患者182例,观察其接受MHD3个月内IDH发生率,分析IDH影响因素。分别采用简易智能精神状态量表(MMSE)、健康调查简表(SF-36)评估比较IDH及非IDH患者MHD6个月、12个月的认知功能和生活质量,并比较两组患者生存率。【结果】①182例患者中IDH发生率为33.0%(60/182)。IDH组患者年龄、超滤率高于非IDH组(P<0.05),血浆白蛋白、有残余尿量者低于非IDH组(P<0.05)。Logistic分析发现年龄、超滤率、血浆白蛋白是IDH发生的独立影响因素(P<0.05)。②两组基线认知功能及生活质量评分相比较差异无显著性(P>0.05),治疗6、12个月后IDH组MMSE、SF-36评分均低于非IDH组(P<0.05)。IDH组治疗6、12个月认知功能障碍发生率(13.3%、23.3%)均高于非IDH组(3.3%、8.2%),且差异有显著性(P<0.05)。③Kaplan-Meier法及Log-rank检验分析显示,IDH组生存时间短于非IDH组(P<0.05)。【结论】IDH在MHD患者中发病率高,高龄、低血浆白蛋白水平及高超滤率是其危险因素,IDH的发生与认知障碍和较差预后密切相关。

【Objective】To explore the levels and clinical significance of NAG and beta 2-MG in patients with chronic nephritis.【Methods】The patients with chronic nephritis admitted in our hospital were selected as the observation group»and healthy adults who underwent physical examination were selected as the control group.The differences of urinary NAG,beta 2-MG,blood inflammatory factors(hs-CRP and TNF-a)and renal function indexes(SCr,BUN and ALB)between the two groups were,compared The correlation of urinary NAG and beta 2-MG with blood inflammatory factors and renal function indexes in patients with chronic nephritis was analyzed.【Results】The levels of NAG and beta 2-MG in chronic nephritis group which were higher than those in control group(P<0.01).Meanwhile the levels of hs-CRP,TNF-a,SCr and BUN in chronic nephritis group were higher than those in control group(P<0.01).However,the RBC»HGB and ALB levels in patients with chronic nephritis were lower than those in the control group(P<0.01).Both NAG and(32MG levels in patients with chronic nephritis were positively correlated with levels of hs-CRP,TNF-a»SCr and BUN,while they were negatively correlated with levels of RBC,HGB and ALB.【Conclusion】The levels of NAG and beta 2-MG in patients with chronic nephritis are higher,which are correlated with inflammatory factors and renal function.