维持性血液透析患者认知功能障碍的相关因素分析

Related factors of cognitive impairment in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者出现认知功能障碍(CI)的相关影响因素。方法纳入行MHD的患者115例,收集其一般资料及临床相关指标。应用国际公认的蒙特利尔认知评价基础量表(MoCA-B)和简易精神状态评价量表(MMSE)分别对患者的认知功能进行评分,并根据评分结果将患者分为认知功能正常(CN)组和认知功能障碍(CI)组。同时应用改良主观全面营养评价量表(SGA)评估患者营养状态,分析比较2组患者上述指标的差异及其和CI的关系。结果采用2种评分结果均显示:和CN组相比CI组年龄大,教育龄短,透析前后脉压和脉压变异系数大,患糖尿病、动脉钙化、营养不良比例高,差异均有统计学意义(P<0.05);MoCA-B评分显示CI组血红蛋白、前白蛋白较CN组明显降低,差异有统计学意义(P<0.05);MMSE评分显示CI组白蛋白、前白蛋白明显降低,超敏C反应蛋白明显升高,较CN组差异均有统计学意义(P<0.05)。采用多因素logistic回归分析显示年龄(OR=1.07、1.07)、教育龄(OR=0.82、0.79)、动脉钙化(OR=3.98、14.92)、营养不良(OR=1.39、1.36)均是发生CI的独立危险因素(P<0.05)。结论MHD患者的年龄、教育龄、透析中血压变化、贫血、炎症、动脉钙化、糖尿病、营养不良均是发生CI的影响因素,其中年龄、教育龄、动脉钙化、营养不良是其独立危险因素。

Objective To investigate the related factors of cognitive impairment(CI)in Maintenance Hemodialysis(MHD)patients.Methods A total of 115 patients with MHD were enrolled.The general data and the clinical parameters were collected.The cognitive function was assessed by the Montreal Cognitive Assessment Basic(MoCA-B)and Mini-mental State Examination(MMSE).The patients were divided into cognitively normal(CN)group and CI group according to the scores.The nutritional state was assessed by the modified subjective global assessment(SGA).The relation between the two groups was analyzed.Results Compared to the CN group,the patients in the CI group were older,and had shorter duration of education,and had higher pulse pressure and more increased coefficient of variation before and after dialysis,and had higher incidence of diabetes,arteriosteogenesis and malnutrition,the difference was statistically significant(P<0.05).The MoCA-B score showed that the hemoglobin and serum prealbumin levels in the CI group were decreased significantly than those in the CN group,the difference was statistically significant(P<0.05).MMSE score revealed that compared to CN group,serum prealbumin,serum albumin were decreased significantly and hypersensitive C-reactive protein were increased significantly,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis shows that age(OR=1.07,1.07),duration of education(OR=0.82,0.79),arterial calcification(OR=3.98,14.92),malnutrition(OR=1.39,1.36)were independent risk factors for CI(P<0.05).Conclusion Age,duration of education,changes in blood pressure during dialysis,anemia,inflammation,arterial calcification,diabetes mellitus and malnutrition are all the influencing factors of CI in MHD patients.Among them,the age,duration of education,arterial calcification and malnutrition are independent risk factors for CI.