维持性血液透析患者认知功能异常发生情况及危险因素分析

Occurrence of cognitive dysfunction in maintenance hemodialysis patients and its risk factors

目的分析维持性血液透析(MHD)患者认知功能异常的发生情况,并探讨MHD患者发生认知功能异常的危险因素。方法选取2018年1月至2018年12月在浙江中医药大学附属第一医院血液净化中心接受MHD治疗且治疗时间≥3个月的18岁以上患者78例,收集患者的一般资料。使用中文版蒙特利尔认知评估(C-MoCA)量表测定MHD患者的认知水平。将患者分为认知功能异常患者(C-MoCA评分<26分)和认知功能正常患者(C-MoCA评分≥26分),比较两者的一般资料、生化指标、营养指标。采用logistic回归分析MHD患者发生认知功能异常的危险因素。结果78例MHD患者中认知功能异常38例(48.7%)。与认知功能正常患者相比,认知功能异常患者透析龄、血清磷和血尿素氮水平均较低,年龄较大(均P<0.05)。在营养指标方面,除BMI外,认知功能异常患者相较认知功能正常患者上臂肌围、握力、前白蛋白、每日蛋白质摄入和每日能量摄入均低(均P<0.05)。多因素logistic回归分析显示,低上臂肌围、低前白蛋白水平和低每日能量摄入是MHD患者发生认知功能异常的独立危险因素(均P<0.05)。结论MHD患者认知功能异常的发生率较高,低上臂肌围、低前白蛋白水平、低每日能量摄入是其发生认知功能异常的独立危险因素。

Objective To analyze the incidence of cognitive dysfunction in maintenance hemodialysis(MHD)patients and its risk factors.Methods Clinical data of 78 patients who received MHD treatment for≥3 months in Blood Purifica-tion Center of the First Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2018 were retrospectively analyzed.The Chinese version of Montreal Cognitive Assessment(C-MoCA)scale was used to mea-sure the cognitive level of MHD patients,there were 38 patients with C-MoCA score<26(48.7%,cognitive dysfunction group)and 40 patients with C-MoCA score≥26(cognitive function normal group).Results Compared with cognitive function normal group,cognitive dysfunction group had older age,lower dialysis age,lower serum phosphorus and blood urea nitrogen levels(all P<0.05).In terms of nutritional indicators,cognitive dysfunction group had lower upper arm mus-cle circumference,grip strength,prealbumin,daily protein intake and daily energy intake than normal cognitive function group(all P<0.05).Multivariate logistic regression analysis showed that low upper arm muscle circumference,low preal-bumin level,and low daily energy intake were independent risk factors for cognitive dysfunction in patients with MHD(all P<0.05).Conclusion The incidence of cognitive dysfunction in MHD patients is high.Low upper arm muscle circumfer-ence,low prealbumin level,and low daily energy intake are independent risk factors for cognitive dysfunction in MHD pa-tients.