预后营养指数与维持性血液透析患者认知损害的相关关系

Association between prognostic nutritional index and cognitive impairment in maintenance hemodialysis patients

目的探讨预后营养指数(prognostic nutritional index, PNI)与维持性血液透析(maintenance hemodialysis, MHD)患者认知损害(cognitive impairment, CI)的关系。方法该研究为多中心横断面研究, 纳入2020年6—10月贵州省18家血液透析中心接受MHD治疗的成年患者为研究对象。采用简易精神状态检查量表评估MHD患者的认知功能, 根据量表得分将患者分为CI组(≤27分)和认知功能正常组(非CI组, >27分), 比较两组基线临床资料的差异。根据血白蛋白和淋巴细胞计数计算PNI, 根据PNI四分位数将患者分为Q1组(PNI<38.0)、Q2组(38.0≤PNI<40.4)、Q3组(40.4≤PNI<43.0)及Q4组(PNI≥43.0)。采用多因素Logistic回归法分析MHD患者PNI与CI发生风险的相关关系, 并进行亚组分析。结果共1 740例MHD患者入选该研究, 男1 021例(62.9%), 女719例(37.1%), 年龄(55±15)岁, CI 411例(23.6%)。CI组患者年龄、女性比例、C反应蛋白、吸烟比例、饮酒比例及糖尿病比例均显著高于非CI组, 受教育程度、血淋巴细胞计数、血前白蛋白、血白蛋白、血肌酐、血尿酸及PNI水平均显著低于非CI组(均P<0.05)。在校正性别、年龄、体重指数、受教育程度、合并症、目前吸烟/饮酒、透析龄及C反应蛋白等混杂因素后, PNI Q1组(PNI<38.0)患者CI发生风险是Q4组(PNI>43.0)的1.88倍(OR=1.88, 95%CI 1.17~2.30, P=0.008)。校正相关混杂因素后的亚组分析结果显示, 年龄与PNI存在交互作用(P交互=0.040), 18~45岁患者中的Q1组CI发生风险是Q4组的3.30倍(OR=3.30, 95%CI 1.19~9.10)。结论低PNI可显著增加MHD患者CI发生的风险, 且在年龄<45岁患者中更加明显。

Objective To explore the relationship between prognostic nutritional index(PNI)and cognitive impairment(CI)in maintenance hemodialysis(MHD)patients.Methods It was a multicenter cross-sectional study that included adult patients who received MHD treatment at 18 hemodialysis centers in Guizhou province from June to October 2020 as the study subjects.Cognitive function was assessed with the mini-mental state examination score.According to the scale score,the patients were divided into CI group(≤27 scores)and non-CI group(>27 scores),and the differences between the two groups were compared.The patients were divided into Q1(PNI<38.0),Q2(38.0≤PNI<40.4),Q3(40.4≤PNI<43.0),and Q4(PNI≥43.0)groups based on the PNI quartiles.The PNI was estimated based on the serum albumin and lymphocyte count.Multivariate logistic regression analysis was used to analyze the correlation between PNI and CI,and subgroup analysis was conducted.Results A total of 1740 MHD patients were enrolled in the study,with 1021 males(62.9%)and 719 females(37.1%).The age was(55±15)years old.There were 411 patients(23.6%)with CI.The age,C-reactive protein,and the proportions of females,current smoking/drinking and diabetes in the CI group were significantly higher than those in the non-CI group,and the education level,blood lymphocyte count,blood prealbumin,serum albumin,serum creatinine,blood uric acid and PNI were significantly lower than those in the non-CI group(all P<0.05).The risk of CI in Q1 group was 1.88 times higher than that of Q4 group after adjusting for confounding factors such as sex,age,body mass index,education level,comorbidities,current smoking/drinking,dialysis age and C-reactive protein(OR=1.88,95%CI 1.17-2.30,P=0.008).Subgroup analysis showed that there was an interaction between age and PNI on CI(P=0.040 for interaction).Q1 group in the patients aged 18 to 45 years old had a higher risk of CI compared to Q4 group(OR=3.30,95%CI 1.19-9.10).Conclusions Low PNI significantly increases the risk of CI in MHD patients,in particularly in the patients aged<45 years old.