血脂和糖化血红蛋白与腹膜透析患者认知功能关系的研究

Correlation of serum lipids and glycosylated hemoglobin with cognitive function in peritoneal dialysis patients

目的 探究影响持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者认知功能的影响因素,评估血脂和糖化血红蛋白(glycosylated hemoglobin,HbA1c)与CAPD患者认知功能之间的关系。方法 纳入2021年1月至2022年12月于河北医科大学第二医院规律腹膜透析3个月以上的患者312例,收集患者的临床资料,采用蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评估患者的整体认知功能,连线测试A(trail making test,TMTA)评估患者的执行功能,探讨血脂、HbA1c等因素与认知功能的关系。结果 (1)我院腹膜透析中心CAPD患者认知障碍(cognitive impairment,CI)的发病率为36.9%。CI组患者的年龄[(56.99±9.80)岁比(44.93±11.64)岁)]、HbA1c[5.50(5.20,6.08)%比5.10(4.80,5.60)%)]、血清钾[4.2(3.9,4.6)mmol/L比4.1(3.8,4.4)mmol/L)]和低密度脂蛋白胆固醇[2.55(2.13,3.04)mmol/L比2.43(2.01,2.70)mmol/L]水平高于非CI组(P<0.05),受教育程度、总铁结合力[50.4(45.0,55.6)μmol/L比52.4(47.2, 59.1)μmol/L]、血清白蛋白[(36.0±3.9)g/L比(37.1±3.8)g/L)]水平均低于非CI组(P<0.05)。(2)血清白蛋白、受教育程度与MoCA评分呈正相关(r=0.126,P=0.025;r=0.216,P<0.001),年龄、HbA1c与MoCA评分呈负相关(r=-0.547,P<0.001;r=-0.264,P<0.001);年龄与TMT-A时间呈正相关(r=0.126,P<0.001),血清钠、受教育程度与TMT-A时间呈负相关(r=-0.157,P=0.046;r=-0.244,P=0.002)。血脂与MoCA评分及TMT-A时间无相关(P>0.05),进一步分析在老年腹膜透析患者中两组间高密度脂蛋白胆固醇差异有统计学意义(P<0.05),而相关分析显示高密度脂蛋白胆固醇与CI无相关(r=0.156,P>0.05)。(3)年龄、受教育程度、血清白蛋白、HbA1c为认知功能的影响因素,血清白蛋白是CAPD患者认知功能的保护因素(OR=0.978,95%CI:0.917~1.040);年龄、受教育程度、HbA1c(OR=1.203,95%CI:1.176~1.230;OR=5.565,95%CI:1.962~15.789;OR=1.694,95%CI:1.348~2.040)是CAPD患者认知功能的危险因素。(4)HbA1c和血清白蛋白的受试者工作特征曲线显示曲线下面积分别为0.651(95%CI:0.570~0.732),0.583(95%CI:0.518~0.648),对CAPD患者发生CI具有预测价值,当HbA1c界定值为5.15%时,约登指数最大(0.315)。血清白蛋白界定值为35.6 g/L时,约登指数最大(0.149)。结论 对于CAPD患者,血脂不是其CI的相关危险因素。HbA1c是影响CAPD患者认知功能的危险因素,监测并控制HbA1c水平可有助于降低CAPD患者发生CI的风险。

Objective To explore the relevant factors affecting cognitive function in continuous ambulatory peritoneal dialysis(CAPD)patients and evaluate the relationship between blood lipids and gly-cosylated hemoglobin and cognitive function in CAPD patients.Methods From January 2021 to Decem-ber 2022,the relevant clinical data were reviewed for 312 clinically stable patients on a regular dialysis for more than 3 months.Overall cognitive function was evaluated by Montreal Cognitive Assessment(MoCA).Trail-Making test A was utilized for evaluating executive functions.Also the relationship was ex-amined between factors such as lipids and glycated hemoglobin and cognitive functions.Results The in-cidence of cognitive impairment in CAPD patients at peritoneal dialysis center of our hospital was 36.9%.Age[(56.99±9.80)years vs(44.93±11.64)years],glycated hemoglobin[5.5(5.2,6.08)%vs 5.1(4.8,5.6)%],serum potassium[4.2(3.9,4.6)mmol/L vs 4.1(3.8,4.4)mmol/L]and low-density lipoprotein cholesterol(HDL-C)[2.55(2.13,3.04)mmol/L vs 2.43(2.01,2.70)mmol/L]were higher in cognitive impairment group than those in non-cognitive impairment group.Education level,total iron binding capacity[50.4(45.0,55.6)μmol/L vs 52.4(47.2,59.1)μmol/L]and serum level of albumin[(36.0±3.9)g/L vs(37.1±3.8)g/L]were lower in cognitive impairment group(P<0.05).Serum albumin and education level were correlated positively with MoCA score(r=0.126,P=0.025;r=0.216,P<0.001).Age and glycat-ed hemoglobin were negatively correlated with MoCA score(r=-0.547,P<0.001;r=-0.264,P<0.001).Age was correlated positively with TMT-A time(r=0.126,P<0.001)while serum sodium and education level were correlated negatively with TMT-A time(r=-0.157,P=0.046;r=-0.244,P=0.002).No cor-relation existed between lipids,MoCA score and TMT-A time(P>0.05).Further analysis revealed a sig-nificant difference in HDL-C between two groups(P<0.05)while correlation analysis indicated that HDL-C was not correlated with CI(r=0.156,P>0.05).Age,education level,serum albumin and HbA1c were the influencing factors of cognitive function.Serum albumin was a protective factor of cognitive function(OR=0.978,95%CI:0.917-1.040).Age,education level and HbA1c(OR=1.203,95%CI:1.176-1.230;OR=5.565,95%CI:1.962-15.789;OR=1.694,95%CI:1.348-2.040)were risk factors for cognitive function.Receiver operating characteristic(ROC)curves of HbA1c and serum albumin showed an area un-der the curve(AUC)of 0.651(95%CI:0.570-0.732)and 0.583(95%CI:0.518-0.648)with predictive values for cognitive impairment.Jordon index was the largest(0.315)when HbA1c definition value was 5.15%.At a defined value of serum albumin 35.6 g/L,Jordon index was the largest(0.149).Conclusions For CAPD patients,blood lipid is not a risk factor for cognitive function.Glycated hemoglobin A1c is a risk factor for cognitive function so that monitoring and controlling its level may low-er the risk of cognitive impairment in CAPD patients.