持续非卧床腹膜透析患者认知功能障碍及其危险因素分析

Cognitive impairment and its risk factors in patients on continuous ambulatory peritoneal dialysis

目的探讨持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者认知功能障碍(cognition impairment,CI)的发病率及其相关危险因素。方法分析2020年8月1日至2021年7月31日于武汉市第一医院行规律CAPD治疗及检查评估的323例患者的临床资料,应用蒙特利尔评分量表(montreal cognitive assessment,MoCA)对所有患者进行认知功能评估并以MoCA评分<26分定义为CI。采用LASSO回归及多因素Logistic回归筛选影响CAPD患者CI发病的独立危险因素。结果323例CAPD患者中,208例发生CI,CI发病率为64.4%,LASSO及Logistic回归分析结果显示,高龄(OR=1.089,95%CI:1.058~1.211,P<0.001)、糖尿病病史(OR=2.530,95%CI:1.256~5.095,P=0.009)、受教育水平低下、血尿酸(OR=1.005,95%CI:1.002~1.007,P=0.002)和总胆固醇(OR=1.836,95%CI:1.310~2.572,P<0.001)是CAPD患者CI发病的独立危险因素,而低密度脂蛋白(OR=0.973,95%CI:0.948~0.998,P=0.043)和已婚(OR=0.161,95%CI:0.047~0.548,P=0.002)是CAPD患者CI发病的独立保护因素。结论CAPD患者CI发病率较高,高龄、受教育水平低下、糖尿病、血尿酸、总胆固醇是CAPD患者CI发病的独立危险因素,低密度脂蛋白、已婚是CAPD患者CI发病的独立保护因素。

Objective To evaluate the incidence and risk factors of cognitive impairment(CI)in patients on continuous ambulatory peritoneal dialysis(CAPD).Methods From August 1,2020 to July 31,2021,a total of 323 CAPD patients were recruited.Cognitive functions were evaluated by Montreal Cognitive Assessment Scale(MoCA)and CI was defined as MoCA<26 points.The independent risk factors for CI were selected by LASSO and Logistic regressions.Results Among them,208(64.4%)fulfilled the criteria for CI.LASSO and Logistic regressions indicated that age(OR=1.089,95%CI 1.058-1.211,P<0.001),history of diabetes mellitus(OR=2.530,95%CI 1.256-5.095,P=0.009),education level,serum uric acid(OR=1.005,95%CI 1.002-1.007,P=0.002)and total cholesterol(OR=1.836,95%CI 1.310-2.572,P<0.001)were independent risk factors for CI.Low density lipoprotein(OR=0.973,95%CI 0.948-0.998,P=0.043)and marital status(OR=0.161,95%CI 0.047-0.548,P=0.002)were independent protective factors for CI in CAPD patients.Conclusion CAPD patients have a high incidence of CI.Age,history of diabetes mellitus,education level,serum uric acid and total choles⁃terol are independent risk factors for CI.Low density lipoprotein and marital status are independent protective factors for CI in CAPD patients.