维持性血液透析患者认知功能障碍的影响因素研究

Study on the influencing factors for cognitive impairment in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者认知功能障碍(cognitive impairment,CI)的影响因素。方法通过便利抽样法选取2023年3—5月浙江中医药大学附属杭州市中医院血液净化中心MHD患者作为研究对象。根据蒙特利尔认知评估基础量表得分,将患者分为CI组(68例)和非CI组(131例),收集一般资料、透析相关资料、生化指标、合并症、睡眠状况及Ishii评分等相关资料,采用Logistic回归分析CI的影响因素,并使用受试者工作特征曲线探讨Ishii评分对CI的预测价值。结果共纳入199例MHD患者,34.2%的患者存在CI。二元Logistic回归分析显示高龄、高Ishii评分、高胆固醇水平、睡眠状况差、低文化程度是CI的独立危险因素(OR值分别为7.694、3.259、1.567、1.085、0.318,95%CI分别为2.484~23.830、1.417~7.494、1.084~2.265、1.016~1.159、0.148~0.684,P值分别为<0.001、0.005、0.017、0.015、0.003)。进一步做Ishii评分的受试者工作特征曲线,结果显示其预测总体、男性、女性MHD患者CI的最佳临界值分别为98.03、105.17、125.49分,曲线下面积分别为0.809、0.813、0.802,敏感度分别为85.30%、80.00%、68.40%,特异性分别为63.40%、72.60%、79.30%。结论CI在MHD患者中患病率高,受多种因素影响,高Ishii评分是MHD患者CI的独立危险因素,对CI有较好的预测价值。

Objective To explore the influencing factors for cognitive impairment(CI)in patients with maintenance hemodialysis(MHD).Methods The MHD patients in the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University from March to May 2023 were selected as the study subjects by convenient sampling method.Patients were divided into CI group(68 cases)and non-CI group(131 cases)according to the score of the Montreal Basic Cognitive Assessment Scale.General information,dialysis data,laboratory results,comorbidities,sleep status and Ishii score were collected.The influencing factors for CI were analyzed by logistic regression.The predictive value of Ishii score on CI was evaluated by using the receiver operating characteristic(ROC)curve.Results A total of 199 MHD patients were included in this study,and 34.2%of the patients had CI.Binary logistic regression showed that older age,higher Ishii score,higher cholesterol level,poor sleep status and lower education level were the independent risk factors for CI(OR=7.694,3.259,1.567,1.085 and 0.318,respectively;95%CI:2.484~23.830,1.417~7.494,1.084~2.265,1.016~1.159 and 0.148~0.684,respectively;P<0.001,0.005,0.017,0.015 and 0.003,respectively).Further study on the ROC curve of Ishii score showed that the optimal critical values for predicting CI in MHD patients,male and female MHD patients were 98.03,105.17 and 125.49 points,respectively;the areas under the curve were 0.809,0.813 and 0.802,respectively;the sensitivities were 85.30%,80.00%,68.40%,respectively and the specificities were 63.40%,72.60%,79.30%,respectively(P<0.001).Conclusions The prevalence of CI in MHD patients is higher.CI is affected by many factors.High Ishii score is an independent risk factor for CI,and is a useful indicator for the prediction of CI in MHD patients.