维持性血液透析患者认知功能障碍的相关因素分析

Analysis of related factors of cognitive dysfunction in maintenance hemodialysis patients

目的探讨认知功能障碍(cognitive impairment,CI)在维持性血液透析(maintenance hemodialysis,MHD)患者中的发生率及相关危险因素。方法选取2020年12月—2022年6月在郑州市第三人民医院接受MHD的60例终末期肾病患者,对其实施蒙特利尔认知评估量表(Montreal Cognitive assessment,MoCA),根据患者得分分为观察组(认知功能障碍)39例和对照组(认知功能正常)21例。对所有患者在实施透析治疗基础上,采集患者人口学、社会学、实验室检查指标,并由患者或其家属填写汉密尔顿抑郁量表-17(HAMD17)和焦虑自评量表(SAS),对收集结果进行非条件logistic回归分析。结果60例MHD患者中,并发CI患者39例,MoCA平均得分(21.58±7.11)分,发生率为65%(39/60);观察组患者有抑郁症状的有21例,占观察组总人数的53.85%(21/39),有焦虑症状的患者有22例,占比56.41%(22/39);对照组有抑郁症状患者5例,占比23.81%(5/21),有焦虑症状4例,占比19.05%(4/21)。观察组男性患者比例、年龄、透析月龄高于对照组(P<0.05);组间主要陪护人员差异无意义(P>0.05);观察组具有焦虑、抑郁患者人数和占比显著高于对照组,差异具有统计学意义(P<0.05);经非条件logistic回归分析,透析时长、焦虑、抑郁、年龄及受教育程度、血红蛋白水平与MHD认知功能障碍相关。结论年龄、透析时长、焦虑、抑郁可能是危险因素,受教育程度和血红蛋白水平可能是保护因素。此外其他因素可能与MHD患者并发认知功能障碍无关。

Objective To investigate the incidence and risk factors of cognitive impairment(CI)in maintenance hemodialysis(MHD)patients.Methods Totally 60 patients with end-stage renal disease who received MHD in our hospital from December 2020 to June 2022 were selected.They were assessed with Montreal Cognitive Assessment(MoCA).According to their scores,the patients were divided into an observation group(39 patients with cognitive dysfunction)and a control group(21 patients with normal cognitive function).On the basis of dialysis treatment for all patients,collect Demography,sociological and laboratory examination indicators of the patients,and fill in HAMD17 and SAS scales by the patients or their families,and conduct unconditional logistic regression analysis on the collected results.Results Among the 60 MHD patients,39 had CI,and the mean MoCA score was(21.58±7.11),with an incidence of 65%(39/60).In the observation group,21 patients had depression symptoms,accounting for 53.85%(21/39),and 22 patients had anxiety symptoms,accounting for 56.41%(22/39).In the control group,5 patients had depressive symptoms,accounting for 23.81%(5/21),and 4 patients had anxiety symptoms,accounting for 19.05%(4/21).The proportion,age and dialysis months of male patients in observation group were higher than those in control group(P<0.05).There was no significant difference in the main escorts between the groups(P>0.05).The number and proportion of anxiety and depression patients in the observation group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).By unconditional logistic regression analysis,dialysis duration,anxiety,depression,age and education level,hemoglobin level were correlated with MHD cognitive dysfunction.Conclusion Age,dialysis duration,anxiety,and depression may be risk factors,while education level and hemoglobin level may be protective factors.In addition,other factors may not be related to cognitive dysfunction in MHD patients.