维持性血液透析患者认知功能障碍与中医证型特征的相关性

Correlations between cognitive dysfunction and features of syndromes of traditional Chinese medicine in patients with maintenance hemodialysis

目的探讨维持性血液透析(MHD)患者认知功能障碍与中医证型特征的相关性。方法选取2018年1月—2021年1月苏州大学附属无锡第九人民医院血液净化中心MHD患者113例,采用中文版蒙特利尔认知评估量表(MoCA)评估患者认知功能,并分为认知功能正常组(n=53)与认知功能障碍组(n=60)。比较2组患者年龄、性别、透析龄、原发病、透析频率、卒中病史、实验室指标、中医证型分布及评分等差异。结果 2组年龄、卒中史、血清白蛋白(Alb)、营养不良-炎症评分(MIS)比较,差异有统计学意义(P<0.05)。认知功能障碍组瘀血阻络证分布率及评分高于认知功能正常组,差异均有统计学意义(P<0.01)。二元Logistic回归分析结果显示,年龄、卒中史、MIS得分、瘀血阻络证是MHD患者认知功能障碍的独立影响因素(P<0.01)。结论 MHD患者普遍存在认知功能障碍,中医证型以瘀血阻络证、肾精亏虚证、气血亏虚证多见,且与瘀血阻络证存在一定的相关性。

Objective To explore the correlations between cognitive dysfunction and features of syndromes of traditional Chinese medicine in patients with maintenance hemodialysis(MHD). Methods A total of 113 MHD patients in blood purification center of Wuxi Ninth People′s Hospital Affiliated to Soochow University from January 2018 to January 2021 were selected, and they were divided into normal cognitive function group(n=53) and cognitive dysfunction group(n=60) after evaluation of the Chinese version Montreal Cognitive Assessment(MoCA). The differences in age, gender, dialysis age, primary diseases, dialysis frequency, history of stroke, laboratory indexes, distributions and scores of syndromes of traditional Chinese medicine were compared between the two groups. Results There were significant differences in age, history of stroke, serum albumin(Alb) and Malnutrition-inflammation Score(MIS) between the two groups(P<0.05). The distribution rate and score of syndrome of stasis blood obstructing collaterals in the cognitive dysfunction group were significantly higher than those in the normal cognitive function group(P<0.01). Binary Logistic regression analysis showed that age, history of stroke, MIS score and syndrome of stasis blood obstructing collaterals were the independent influencing factors for cognitive dysfunction in MHD patients(P<0.01). Conclusion Cognitive dysfunction is frequently occurred in MHD patients, and the syndromes of stasis blood obstructing collaterals, deficiency of kidney essence and deficiency of Qi and blood are the common types. Cognitive dysfunction is related to syndrome of stasis blood obstructing collaterals.