维持性血液透析患者认知功能与血清炎症指标及脂联素水平的关系研究

Association of cognitive function with serum inflammatory indicators and adiponectin levels in patients with maintenance hemodialysis

目的 探讨维持性血液透析(MHD)患者认知功能与血清炎症指标(包括CRP、TNF-α、IL-6)及脂联素(ADPN)水平的关系。方法 选取2018年1至12月在浙江中医药大学附属第一医院血液净化中心行MHD的患者78例。采用中文版蒙特利尔认知评估量表评估患者认知功能,评分<26分为认知功能异常组(38例),≥26分者为认知功能正常组(40例)。比较两组患者基线资料;比较两组患者血清炎症指标和ADPN水平;分析MHD患者ADPN水平与血清炎症指标的相关性;分析MHD患者认知功能的影响因素。结果 认知功能异常组患者年龄大于认知功能正常组(P<0.05),透析龄小于认知功能正常组(P<0.05),血清磷和尿素氮水平均低于认知功能正常组(均P<0.05)。认知功能异常组患者血清TNF-α、IL-6水平均高于认知功能正常组(均P<0.05),ADPN水平低于认知功能正常组(P<0.05)。两组患者血清CRP水平比较差异无统计学意义(P>0.05)。相关性分析显示,MHD患者血清ADPN水平与血清IL-6水平呈负相关(rs=-0.347,P<0.05),与血清TNF-α、CRP水平均无相关性(均P>0.05)。多因素logistic回归分析显示,高血清TNF-α水平是MHD患者发生认知功能异常的独立危险因素(OR=1.062,95%CI:1.008~1.119,P<0.05),而高血清磷水平(OR=0.197,95%CI:0.054~0.715)、高ADPN水平(OR=0.867,95%CI:0.766~0.982)均是MHD患者认知功能的保护因素(均P<0.05)。结论 MHD患者中认知功能异常者血清炎症指标TNF-α、IL-6水平较高,ADPN水平较低。高血清TNF-α水平是MHD患者发生认知功能异常的独立危险因素,高血清ADPN水平是独立保护因素。

Objective To explore the relationship of cognitive function with serum inflammatory indicators and adiponectin(ADPN)levels in patients with maintenance hemodialysis(MHD).Methods A total of 78 patients who underwent MHD in the Blood Purification Center of the First Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2018 were enrolled.According to Montreal cognitive assessment scale(MoCA),patients were classified as cognitive dysfunction group(MoCA score<26,n=38)and normal cognitive group(MoCA≥26,n=40).The general data,biochemical indexes,inflammatory indexes and serum adiponectin levels of the two groups were compared.The factors related to cognitive function in MHD patients were analyzed.Results The age of cognitive dysfunction group was older,and the age of dialysis was younger than those of the normal cognitive group(P<0.05);the levels of serum phosphorus and urea nitrogen in cognitive dysfunction group were lower than those of the normal cognitive function group(both P<0.05).The levels of serum TNF-αand IL-6 in the cognitive dysfunction group were higher than those in the cognitive normal group(both P<0.05),and the ADPN level was lower than that in the cognitive normal group(P<0.05).There was no significant difference in serum CRP levels between the two groups(P>0.05).Correlation analysis showed that serum ADPN levels in MHD patients were negatively correlated with serum IL-6 levels(rs=-0.347,P<0.05),but not correlated with serum TNF-αand CRP levels(both P>0.05).Multivariate Logistic regression analysis showed that high serum TNF-αlevel(OR=1.062,95%CI:1.008-1.119,P<0.05)was an independent risk factor for cognitive dysfunction in MHD patients,while high serum phosphorus level(OR=0.197,95%CI:0.054-0.715,P<0.05)and high serum adiponectin level(OR=0.867,95%CI:0.766-0.982,P<0.05)were protective factors for cognitive function in MHD patients.Conclusion Among MHD patients with cognitive dysfunction,the levels of serum inflammatory indexes TNF-αand IL-6 are higher,and the level of ADPN is lower.High serum TNF-αlevel is an independent risk factor for cognitive dysfunction in MHD patients,and high serum ADPN level is an independent protective factor.