老年血液透析患者三酰甘油-葡萄糖指数与认知功能障碍的相关性

Correlation between triglyceride-glucose index and cognitive dysfunction in elderly hemodialysis patients

目的探讨老年血液透析患者三酰甘油-葡萄糖(triglyceride-glucose,TyG)指数与认知功能障碍的相关性。方法选择2020年1月—2020年6月的老年血液透析患者204例,根据中文版蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分将患者分为认知正常组67例(MoCA评分≥26分)和认知障碍组137例(MoCA评分<26分)。采用医院信息管理系统收集患者资料,其中包括TyG,采用多因素Logistic回归分析探究TyG指数与老年血液透析患者患者认知功能障碍的关系,采用ROC曲线用于评估TyG指数对认知功能障碍的预测能力。结果认知正常组较认知障碍组患者糖尿病、脑卒中、透析时间、受教育程度、TyG指数间差异具有统计学意义(χ^(2)/t=9.566、23.511、7.122、8.058、6.003,P=0.002、<0.001、<0.001、<0.001、<0.001)。多因素Logistic回归分析结果显示结果显示糖尿病(OR=1.713,95%CI:1.512~2.013,P<0.001)、脑卒中(OR=2.023,95%CI:1.647~2.216,P<0.001)、透析时间(OR=1.527,95%CI:1.376~1.786,P<0.001)、受教育程度(OR=0.613,95%CI:0.472~0.874,P<0.001)、TyG指数(OR=1.476,95%CI:1.309~1.738,P<0.001)是认知功能障碍的影响因素。ROC曲线分析显示糖尿病预测老年透析患者认知功能障碍曲线下面积为0.774,TyG指数预测老年透析患者认知功能障碍曲线下面积为0.855,95%CI:为0.752~0.957,最大约登指数为0.515,当取值为9分时,获得最佳截断值,此时敏感度为81.25%、特异度为79.12%。根据ROC曲线得出的最佳截断值可分为TyG<9亚组(n=55)和TyG≥9亚组(n=149),TyG<9亚组患者再次入院率、感染发生率均低于TyG≥9亚组患者(χ^(2)=6.305、6.845,P=0.012、0.009)。结论在临床实践中,TyG指数升高是老年血液透析患者认知功能障碍发生的独立风险因素,该指标对认知功能障碍具有较佳的预测作用。

Objective To investigate the correlation between triglyceride-glucose index(TyG)and cognitive impairment in elderly hemodialysis patients.Methods A total of 204 elderly hemodialysis patients from January 2020 to June 2020 were enrolled in this study.According to score of the Montreal Cognitive Assessment(MoCA)Chinese version,patients were divided into a normal group(MoCA score≥26 points,n=67)and an obstacle group(MoCA score<26 points,n=137).Clinical data including TyG were collected from the hospital information management system.Multivariate logistic regression was used to explore the relationship between TyG and cognitive impairment in elderly hemodialysis patients.ROC curve was used to evaluate the predictive ability of TyG for cognitive impairment.Results There were no statistical differences in age,gender,hypertension,BMI and TC between the two groups(χ^(2)/t=0.593,0.496,0.027,0.581 and 0.245 respectively;P=0.554,0.481,0.869,0.562 and 0.806 respectively).Diabetes,stroke,dialysis age,education level and TyG were significantly different between normal group and obstacle group(χ^(2)/t=9.566,23.511,7.122,8.058 and 6.003 respectively;P=0.002,<0.001,<0.001,<0.001 and<0.001 respectively).Multivariate logistic regression showed that diabetes(OR=1.713,95%CI:1.512~2.013,P<0.001),stroke(OR=2.023,95%CI:1.647~2.216,P<0.001),dialysis age(OR=1.527,95%CI:1.376~1.786,P<0.001),education level(OR=0.613,95%CI:0.472~0.874,P<0.001),and TyG(OR=1.476,95%CI:1.309~1.738,P<0.001)were the influencing factors for cognitive dysfunction.ROC curve analysis showed that the area under the curve of cognitive dysfunction in elderly hemodialysis patients predicted by diabetes was 0.774,the area under the curve of cognitive dysfunction in elderly dialysis patients predicted by TyG was 0.855(95%CI:0.752~0.957),and the maximum Yodon index was 0.515;when TyG was set at 9 points,the optimal cutoff value was obtained,with the sensitivity of 81.25,and the specificity of 79.12.According to the optimal cutoff value from ROC curve,patients were subdivided into TyG<9 group(n=55)and TyG≥9 group(n=149).The readmission rates were 40.00%(22/55)and 59.73%(89/149)in TyG<9 group and TyG≥9 group respectively(χ^(2)=6.305,P=0.012),and the infection rates were 20.00%(11/55)and 37.11%(59/149)in TyG<9 group and TyG≥9 group respectively(χ^(2)=6.845,P=0.009).Conclusion The increase of TyG is an independent risk factor for cognitive dysfunction,and has a better predictive value for cognitive dysfunction in elderly hemodialysis patients.