维持性血液透析的终末期肾病患者认知障碍及相关因素分析

ANALYSIS OF COGNITIVE IMPAIRMENT AND RELATED FACTORS IN MAINTENANCE HEMODIALYSIS PATIENTS WITH END-STAGE RENAL DISEASE

目的分析维持性血液透析(MHD)的终末期肾病患者认知功能障碍的影响因素。方法选择2017年12月—2020年6月解放军第982医院及解放军总医院京东医疗区进行维持性血液透析的终末期肾病212例患者为研究对象,依据蒙特利尔认知量表(MoCA)评定结果将其分为认知功能障碍组和认知功能正常组。比较二组患者的临床资料、生化指标及神经心理评估结果,Logistic回归分析维持性血液透析的终末期肾病患者认知功能障碍的影响因素。结果 212例患者中认知功能障碍组138例,认知功能正常组74例,认知功能障碍发病率为65.09%;认知功能障碍组年龄、透析龄、甲状旁腺激素、抑郁及焦虑发生率均高于认知功能正常组,而血红蛋白、MoCA各亚项评分则低于认知功能正常组,差异有统计学意义(P<0.05)。结论MHD患者认知功能损伤发生率较高,年龄、透析龄、低血红蛋白及高甲状旁腺激素为终末期肾病患者认知功能障碍的独立危险因素。

Objective To analyze the influencing factors of cognitive dysfunction in maintenance hemodialysis patients(MHD).Methods A total of two hundred and twelve patients who underwent maintenance hemodialysis in the 982 Hospital of PLA and the JingDong Medical District of the PLA General Hospital from December 2017 to June 2020 were selected as the study subjects, and they were divided into cognitive impairment group and cognitive normal group according to the Montreal Cognitive Score(MoCA).The clinical data, biochemical indicators, and neuropsychological evaluation results of the two groups of patients were compared, and Logistic regression was used to analyze the influencing factors of cognitive impairment in maintenance hemodialysis patients.Results Among the 212 patients, there were 138 cases in the cognitive impairment group and 74 cases in the cognitive normal group.The incidence of cognitive impairment was 65.09%.The age, dialysis time, parathyroid hormone, depression and anxiety incidence rate of the cognitive impairment groupwere higher than that of the normal group, while the subitem scores of MoCA were lower than those of the normal group, and the difference was statistically significant(P<0.05).Conclusion The incidence of cognitive impairment in MHD patients is higher.Age, dialysis time, low hemoglobin and high PTH are independent risk factors for cognitive dysfunction in end stage renal disease patients.