老年血液透析患者昼夜血压变异度与认知功能相关性的临床研究  

Association between cognitive impairments and blood pressure variability during the day/night cycle in elderly patients treated with hemodialysis

作　　者：郭一丹[1] 张春霞[1] 罗洋[1] Guo Yidan;Zhang Chunxia;Luo Yang(Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China)

机构地区：[1]首都医科大学附属北京世纪坛坛医院肾内科,100038

出　　处：《中华老年医学杂志》2018年第6期612-615,共4页Chinese Journal of Geriatrics

基　　金：北京市科学技术委员会课题(161100002616005)

摘　　要：目的探讨老年血液透析患者（HD）认知功能与昼夜血压变异度的关系。方法通过蒙特利尔认知量表（ MoCA）筛查患者认知功能，同时监测患者24 h动态血压变化并计算昼夜间血压变异度，比较认知功能的相关指标并通过多因素Logistic回归方法分析认知功能损伤与昼夜血压变异度的关系。结果106例老年HD患者，平均年龄（73.1±12.9）岁，认知功能损伤者69例，认知功能损害患病率为63.4%。认知功能损伤患者与认知功能正常患者24 h平均收缩压为（151.3±20.1）mmHg和（131.1±11.7 ）mmHg（1 mmHg＝0.133 kPa）（t＝5.36，P〈0.05）；昼间平均收缩压为（167.6±28.2）mmHg和（139.1±14.2）mmHg（t＝4.98，P〈0.05）；夜间平均收缩压为（139.9±18.5）mmHg和（100.2±11.3）mmHg（t＝6.21, P〈0.05），昼夜间收缩压变异度为（8.2±1.6）%和（19.9±2.9）%（χ^244.67，P〈0.05）。多因素Logistic回归显示，年龄、教育程度、贫血、糖尿病均与认知功能损伤相关，其比值比（OR）及95%可信区间（CI）分别为：1.5（1.1～2.2）、1.8（1.4～2.5）、1.7（1.1～2.6）、2.1（1.7～3.1）（P〈0.05）；昼夜间收缩压变异度也与认知功能损伤相关，其OR（95%CI）为1.4（1.1～1.9）（P〈0.05）。结论老年血液透析患者认知功能损伤与年龄、教育程度、高血压、糖尿病相关，昼夜间收缩压变异度也是认知功能损伤发生的独立风险因素。ObjectiveTo investigate the relationship between cognitive impairments in elderly patients receiving hemodialysis and blood pressure variability during the day/night cycle.MethodsA cross-sectional study was performed in 106 hemodialysis patients to evaluate cognitive function with Montreal Cognitive Assessment （MoCA） and blood pressure variability with a 24 h ambulatory blood pressure monitor.A multi-Logistic regression was conducted to analyze potential risk factors associated with cognitive impairments.ResultsA hundred and six patients had an average age of（73.1±12.9）years.Sixty-nine out of 106 （63.4%） suffered cognitive impairments with MoCA scores lower than 26.Measurements for patients with cognitive impairments versus patients without cognitive impairments included twenty-four-hour ambulatory blood systolic pressure[（151.3±20.1）mmHg vs.（131.1±11.7）mmHg, P〈0.05], day-time average systolic blood pressure[（167.6±28.2）mmHg vs.（139.1±14.2）mmHg, P〈0.05], night-time average systolic blood pressure[（139.9±18.5）mmHg vs.（100.2±11.3）mmHg, P〈0.05], difference in systolic blood pressure between day and night[（167.6±28.2）mmHg vs.（139.1±14.2）mmHg, P〈0.05], and coefficient of variation of systolic blood pressure[（8.2±1.6）% vs.（19.9±2.9）%, χ^244.67, P〈0.05]. Multi-logistic regression analysis showed that age （OR： 1.5, 95%CI： 1.1-2.2, P〈0.05）, education level （OR： 1.8, 95%CI： 1.4-2.5, P〈0.05）, anemia （OR： 1.7, 95%CI： 1.1-2.6, P〈0.05）, and diabetes （OR： 2.1, 95%CI： 1.7-3.1, P〈0.05） were associated with cognitive impairments.Moreover, the coefficient of variation of systolic blood pressure was also independently correlated with cognitive impairments （OR： 1.4, 95%CI： 1.1-1.9, P〈0.05）.ConclusionsCognitive impairment has a high prevalence among elderly hemodialysis patients and is associated with anemia, age, education level, hypertension and diabetes.Besides, the coefficient of variation of low systolic blo

关 键 词：肾透析 认知功能 血压变异度 

分 类 号：R692.5[医药卫生—泌尿科学]