维持性血液透析患者的脑部损害  

Brain magnetic resonance and cognitive function changes in maintenance hemodialysis patients

作　　者：郑可[1] 侯波[2] 有慧[2] 袁晶[3] 王海云[1] 王颖[1] 叶文玲[1] 秦岩[1] 宋丹[1] 李蕾[1] 陈之淳 祝丽丽[1] 周紫娟[1] 杨薇[1] 赵海银[1] 陈丽萌[1] 朱以诚[1] 李明喜[1] 崔丽英[3] 冯逢[2] 李雪梅[1] 

机构地区：[1]北京协和医院肾内科,100730 [2]北京协和医院放射科,100730 [3]北京协和医院神经科,100730

出　　处：《中华肾脏病杂志》2015年第4期277-282,共6页Chinese Journal of Nephrology

基　　金：国家科技支撑计划（2011BAI10B02;2012BAJ18B03）;首都发展基金（2011-4001-08）

摘　　要：目的了解规律性血液透析（血透）患者脑部损害情况，包括脑血管病变及种类与认知功能的改变，分析其潜在的影响因素。方法病例来自北京协和医院的血透患者230例，最终人组117例。采用横断面调查方法。调查和分析患者人口学、透析充分性、头颅磁共振图像（MRI）、磁共振血管成像（MRA）等资料。应用简易精神状态检查量表（C—MMSE）及蒙特利尔认知评估量表（C-MoCA量表）评估患者的认知状况。Spearman分析、logistic回归或多元线性回归法分析患者脑部损害的影响因素。结果患者平均年龄（56．0±12．5）岁，透析龄（73．5±60．8）个月。既往有脑梗死及脑出血病史者均为5．1％；透析中出现需要处理的低血压者占16．2％；单池尿素清除率（spKt／V）为（1．45±0．25）。头部核磁检查结果：脑动脉狭窄者占12．0％，皮层梗死者5．1％，慢性期血肿7．7％，腔梗者占39．3％，微出血占47．0％，脑白质异常信号者52．1％。C-MMSE评分异常者占20．9％，C-MOCA评分异常者占65．2％。多元线性回归分析显示，年龄（b=0．059，P〈0．01）及透析龄（b=0．005，P〈0．05）是脑白质病变（WMLs）的影响因素。透析中低血压是血透患者腔梗（b=2．123，P〈0．01）、微出血（b=3．531，P〈0．01）的独立危险因素。血清白蛋白水平低是透析患者认知评分下降的独立危险因素（b=0．314，P〈0．05）。logistic回归分析显示，透析前收缩压（SBP）是皮层梗死的独立危险因素[OR=1．088，95％CI（1．018～1．152），P〈0．05]。性别、透析年限、透析前血清总二氧化碳（TC02）与慢性期血肿密切相关。结论血透患者脑白质病变重、脑微出血及腔隙性梗塞等患病率高，认知能力下降。WMLs与透析龄相关；腔梗及微出血病灶与透析中低血压相关；腔隙性梗塞、WMLs及营养状况与患者认知能力下Objective To investigate cerebrovascular lesions on maintenance hemodialysis （MHD） patients, including types of cerebrovascular disease, and cognitive function changes. Methods A cross-sectional study was applied. A total of 270 MHD patients at hemodialysis center of Peking Union Medical College Hospital were screened, and finally 117 cases were enrolled. Demographic information, aboratory data, MRI and MRA data were collected and assessed. Cognitive function was evaluated with C- MMSE （Chinese mini mental test examination） and C- MoCA （Chinese montreal cognitive assessment）. The related factors were selected by Spearman correlation analysis, multiple linear regression and logistic regression analysis. Results The patients＂ average age was （56.0± 12.5） years, average hemodialysis age was （73.5±60.8） months. Only 5.1% patients had clinical history of cerebral infarction or hemorrhage. Prehemodialysis blood pressure was （142.7/80.3± 18.2/12.9） mmttg, Post-hemodialysis blood pressure was （130.2/79.1±23.4/14.9） mmHg. A total of 18.8% patients had intra-hemodialysis hypotension, spKt/V was （1.45±0.25）. MR results showed that 12.0% patients had cerebral artery stenosis, 5.1% patients had cortical infarcts, 39.3% patients had lacunar infarcts, 47.0% patients had microbleeds, 7.7% patients had chronic hematoma, 52.1% patients had abnormal brain whiter matter lesions （WMLs）. In cognitive function evaluation, 20.9% patients had abnormal C-MMSE scores, but 65.2% patients had abnormal C-MoCA results. Multiple linear regression showed age （b=0.059, P 〈 0.01）, dialysis age （b=0.005, P 〈 0.05） were associated with WMLs in MHD patients. Intra-hemodialysis hypotension was an independent risk factor of lacunar infarcts （b=2.123, P 〈 0.01） and microbleeds （b=3.531, P 〈 0.01）. Low serum albumin level was an independent risk factor of cognitive decline （b=0.314, P 〈 0.05）. Logistic regression analysis showed pre- hemodialysis systolic blood pressure was an inde

关 键 词：肾透析 脑血管障碍 神经行为学表现 

分 类 号：R459.5[医药卫生—治疗学]