高磷血症对腹膜透析患者认知障碍影响的研究

The correlation between hyperphosphatemia and cognitive impairment in continuous ambulatory peritoneal dialysis patients

目的探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者高磷血症与认知障碍之间的相关性。方法纳入河北医科大学第二医院肾内科2021年1月—2022年12月长期规律门诊随访的CAPD患者。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评估患者整体认知功能;通过测试A(trail-making test forms A,TA)评估患者执行功能。采用SPSS 26.0进行统计处理。结果312例CAPD患者认知障碍患病率为36.9%。单因素相关性分析显示:高磷血症(OR=2.333,95%CI:1.456~3.736,P<0.001)、年龄(OR=0.830,95%CI:1.076~1.135,P<0.001)与整体认知功能相关。血清白蛋白(OR=0.869,95%CI:0.770~0.982,P=0.024)和年龄(OR=1.073,95%CI:1.024~1.124,P=0.003)与执行功能相关。血钙(OR=0.218,95%CI:0.048~0.999,P=0.050)、全段甲状旁腺激素(OR=1.000,95%CI:0.999~1.001,P=0.484)与整体认知功能无显著相关性。多因素回归分析结果显示:对人口学、临床及实验室混杂因素进行校正后,高磷血症仍与认知障碍相关(95%CI:3.272~17.741,P<0.001),高磷血症的CAPD患者认知障碍的发生率为非高磷血症患者的7.62倍。ROC曲线结果显示:当血磷取值为1.66时,约登指数最大值为0.30,灵敏度为75.7%,特异度为54.1%。结论在CAPD患者中,血磷水平影响患者的整体认知,高磷血症是腹膜透析患者认知障碍的独立危险因素,血磷水平大于1.66 mmol/L明显增加患者认知障碍的风险。

Objective To investigate the association between hyperphosphatemia and cognitive impairment in patients on continuous ambulatory peritoneal dialysis(CAPD).Methods This is a single-centered study recruited a total of 312 CAPD patients from the Second Hospital of Hebei Medical University in the period of January 2021 to December 2022.Their general cognitive function was examined using the Montreal Cognitive Assessment(MoCA),and their executive function was assessed by Test A(Trail-Making Test forms A,TA).Results were statistically processed by SPSS 26.0.Results①Among the 312 CAPD patients,the prevalence of cognitive impairment was 36.9%.②Univariate correlation analysis showed that hyperphosphatemia(OR=2.333,95%CI:1.456~3.736,P<0.001)and age(OR=0.830,95%CI:1.076~1.135,P<0.001)were correlated with general cognitive function,and serum albumin(OR=0.869,95%CI:0.770~0.982,P=0.024)and age(OR=1.073,95%CI:1.024~1.124,P=0.003)were correlated with executive function.There were no significant correlation between serum levels of calcium(OR=0.218,95%CI:0.048~0.999,P=0.050)and iPTH(OR=1.000,95%CI:0.999~1.001,P=0.484)and general cognitive and executive functions.③Multivariate regression analysis suggested that hyperphosphatemia was significantly associated with cognitive impairment(95%CI:3.272~17.741,P<0.001)after adjustments for demographic,clinical and laboratory confounding factors.The incidence of cognitive impairment in CAPD patients with hyperphosphatemia was 7.62 times higher than that in the patients without hyperphosphatemia.④ROC curve indicated that when blood phosphorus was set at 1.66mmol/L,the maximum value of Youdon index was 0.30,the sensitivity was 75.7%,and the specificity was 54.10%.Conclusions In CAPD patients,serum phosphorus level affects general cognition of the patients,and hyperphosphatemia is an independent risk factor for cognitive impair-ment in CAPD patients.If serum phosphorus level increases to>1.66 mmol/L,the risk of cognitive impairment increases significantly.