维持性血液透析患者人体成分与认知功能障碍的关系

Relationship between body composition and cognitive impairment in patients with maintenance hemodialysis

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者人体成分与认知功能障碍(cognitive impairment,CI)的关系。方法选择2020年3月-2020年12月首都医科大学宣武医院及北京市昌平区医院血液透析室MHD 3个月以上、病情稳定的患者作为研究对象。应用简易智力状态检查量表(mini-mental state examination,MMSE)及蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)进行认知评估,应用人体成分检测仪(body composition monitor,BCM)检查获得人体成分分析参数,根据年龄、性别、受教育时间、合并症(高血压、糖尿病)进行1∶1匹配,将MHD患者分为CI组(MoCA<26分)与非CI组(MoCA≥26分)各60例,应用独立样本t检验和秩和检验比较两组间临床资料与人体成分分析参数的差异。采用单因素及多因素Logistic回归分析MHD患者CI的危险因素。结果(1)MHD患者CI患病率为55.83%。(2)认知功能评分与人体成分相关性分析:MoCA评分与瘦体组织质量(lean tissue mass,LTM)呈正相关,与身体总体水(total body water,TBW)及细胞外水分(extracellular water,ECW)呈负相关(P<0.05)。(3)CI组与非CI组一般情况及临床资料的比较:CI组的Charlson合并症指数高于非CI组,CI组的白蛋白低于非CI组(P<0.05)。(4)CI组与非CI组人体成分的比较:CI组LTM低于非CI组,CI组TBW、ECW、细胞内水分(intracellular water,ICW)高于非CI组(P<0.05)。(5)多因素Logistic回归分析结果提示Charlson合并症指数≥5分(OR=12.839,95%CI 2.253~20.801,P=0.001)及LTM<33 kg(OR=5.284,95%CI 1.029~27.150,P=0.046)是MHD患者发生CI的独立危险因素。结论约一半MHD患者存在CI。MHD患者认知功能下降与体内水分增加、LTM降低相关。合并症增加及LTM降低是MHD患者发生CI的危险因素。

Objective To investigate the relationship between body composition and cognitive impairment(CI)in patients with maintenance hemodialysis(MHD).Methods Stable MHD patients undergoing dialysis for>3 months in Xuanwu Hospital and Changping District Hospital from March 2020 to December 2020 were selected as study subjects.Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used for Cognitive Assessment.Body composition monitor(BCM)was used for body composition analysis.According to MoCA score 60 MHD patients with cognitive impairment(MoCA<26,CI group)and 60 age,gender,education level and comorbidity(hypertension,diabetes)-matched MHD patients with normal cognition(MoCA≥26,non-CI group)were enrolled in the study.The clinical data and body composition were compared between in the two groups.The risk factors of CI in MHD patients were analyzed by univariate and multivariate Logistic regression.Results The prevalence of CI in MHD patients was 55.83%.MoCA was positively correlated with lean tissue mass(LTM)and negatively correlated with total body water(TBW)and extracellular water(ECW)(P<0.05).Charlson complication index in CI group was higher than that in non-CI group,and albumin level in CI group was lower than that in non-CI group(P<0.05).LTM of CI group was lower than that of non-CI group.TBW,ECW and intracellular water(ICW)of CI group were higher than those of non-CI group(P<0.05).Multivariate Logistic regression analysis showed that Charlson complication index≥5(OR=12.839,95%CI:2.253-20.801,P=0.001)and LTM<33 kg(OR=5.284,95%CI:1.029-27.150,P=0.046)were independent risk factors for CI in MHD patients.Conclusion Prevalence of CI is high in MHD patients,which may be related to the increase of body water and the decrease of LTM.The increase of complications and the decrease of LTM are the risk factors for CI in MHD patients.