脑小血管病总负荷与慢性肾病腹膜透析患者认知功能的相关性分析

目的 探讨脑小血管病(CSVD)负荷与慢性肾病腹膜透析(PD)患者认知功能的相关性。方法 回顾性分析2018年1月至2022年12月慢性肾病行PD的患者115例,磁共振评估CSVD影像学标志物并记录总负荷(0~4分),根据CSVD总负荷评分结果分为高、低负荷组,比较两组患者的性别、年龄、基础疾病、吸烟、饮酒情况,相关生化检验指标及PD相关指标等,采用简易智能精神状态量表(MMSE)和数字符号转化测验(DST)测定患者认知功能并记录,分析两者相关性。结果 与低负荷组相比,高负荷组患者PD病程更久,血尿素氮、肌酐、CRP升高,白蛋白、总尿素清除指数(Kt/V)、残肾Kt/V、总肌酐清除率、残余肾功能下降,差异均有统计学意义(P<0.05);随着CSVD负荷的增加,患者的MMSE及DST评分均有不同程度损害,高负荷组认知功能障碍及痴呆更多见(P<0.05);相关分析显示,CSVD负荷总分,脑白质高信号(WMHs)、扩大的血管周围间隙(EPVS)与MMSE总分、各部分评分及DST评分呈负相关性,脑室周围WMHs与MMSE总分及DST评分呈负相关,脑微出血数与MMSE总分呈负相关(P<0.05)。结论 CSVD负荷与慢性肾病PD患者的认知功能相关,高CSVD负荷的PD患者更易出现认知功能障碍。

Objective To investigate the correlation between cerebral small vessel disease(CSVD)burden and cognitive function in peritoneal dialysis(PD)patients with chronic kidney disease.Methods A retrospective analysis was performed for 115 PD patients with chronic kidney disease who were admitted to the General Hospital of Shaoxing Second Hospital from January 2018 to December 2022,and the CSVD markers were evaluated by magnetic resonance imaging and the total burden(0~4 points)was recorded.They were divided into high and low load groups according to the CSVD total burden score results.the gender,age,underlying health conditions,smoking history,drinking history,blood testing results and PD related indicators of the two groups were compared.Cognitive function was measured and recorded using the Mini-Smart Mental State Scale(MMSE)and the Digital Sign Conversion Test(DST).Correlation between CSVD burden and cognitive function in these patients was analyzed.Results Compared with the low-load group,the patients in the high-load group had a longer duration of PD,increased blood urea nitrogen,creatinine and C-reactive protein(CRP),decreased albumin,total urea clearance index(Kt/V),residual renal Kt/V,total creatinine clearance and residual renal function,all of which were statistically different(P<0.05).With the increase of CSVD burden,MMSE and DST scores were impaired to varying degrees,cognitive dysfunction and dementia were more common in the high-load group(P<0.05).The correlation analysis showed that the total CSVD burden score,white matter hyperintensity(WMHs),enlarged perivascular space(EPVS)were negatively correlated with the total score of MMSE,the score of each part and the DST score,periventricular WMHs were negatively correlated with the total score of MMSE and DST score,and the number of cerebral microhemorrhages was negatively correlated with the total score of MMSE(all P<0.05).Conclusion CSVD burden is related to cognitive function in PD patients with chronic kidney disease,and PD patients with high CSVD burden are more likely to have cognitive dysfunction.