机构地区:[1]邯郸市中心医院肾内一科,河北邯郸056001 [10]《中国血液净化杂志》 [11]《中华肾脏病杂志》 [12]北京血液透析质量控制中心 [13]中华医学会肾脏病分会血液净化学组 [2]北京大学第一医院肾内科,北京大学肾脏病研究所,卫生部重点实验室,教育部慢性肾脏病防治重点实验室,北京100034 [3]Peritoneal Dialysis International [4]国际腹膜透析学会教育委员会 [5]中国非公医院协会肾脏病和透析专委会腹膜透析学组 [6]北京医学会腹膜透析专委会 [7]北京医学会血液净化分会 [8]北京医师协会 [9]北京医学会临床营养分会
出 处:《北京大学学报(医学版)》2019年第3期510-518,共9页Journal of Peking University:Health Sciences
摘 要:目的:探讨腹膜透析(peritoneal dialysis, PD)患者存在的营养不良-炎症状态-心血管疾病(动脉硬化)(malnutrition-inflammation-atherosclerosis,MIA)综合征与认知功能恶化的关系。方法:采用前瞻性纵向队列研究,于2013年3—11月,对符合入选标准的腹膜透析患者完成总体和特定认知功能测定,结合基线是否有心血管疾病病史,白蛋白≤35 g/L,超敏C-反应蛋白(high-sensitive C-reactive protein, hs-CRP)≥3 mg/L,将患者分为MIA0(全为否)、MIA1(1项为是)、MIA2(≥2项为是)3个组,并于随访2年后对患者重复认知功能测定。采用卡方检验、单因素方差分析、Kruskal-Wallis H 检验比较基线及2年后组间一般资料、生化指标,以及总体和特定认知功能参数。进一步的组间多重两两比较采用Bonferroni方法调整显著性值。以每一项总体和特异认知功能得分差值为因变量,以年龄、性别、教育水平、体重指数、抑郁分数、糖尿病、血钠和MIA(MIA0为对照,MIA1和MIA2为哑变量)为自变量,以多元线性回归分析影响认知功能恶化的因素,每一项认知领域的分析都以其相应的基线参数进行校正。结果:随访2年后,认知障碍(cognitive impairment, CI)的发生率从20.0%上升到24.7%。MIA2和MIA1组修正的简易智力状态检查量表(the modified mini-mental state examination, 3MS)得分下降绝对值明显高于MIA0组(-3.9± 12.0 vs. 1.1±6.7, P <0.01;-2.3±11.8 vs. 1.1±6.7, P <0.05),而特定认知功能测定包括执行功能(连线试验A和B, P= 0.401 ,P= 0.176)、即时记忆( P= 0.437)、延迟记忆( P= 0.104)、视觉空间能力( P= 0.496)和语言能力( P= 0.171)的变化3组间差异无统计学意义。经多元线性回归分析,年龄、教育水平、糖尿病、抑郁等均是一项或多项认知功能恶化的危险因素,存在MIA综合征一项因素是整体认知恶化的独立危险因素( P= 0.022 ),存在MIA综合征两项及以上因素者不仅是整体认知恶化的独立危�Objective: To investigate the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and deterioration of global and specific domains of cognitive function in peritoneal dialysis (PD) patients. Methods: This was a multi-center prospective cohort study. The PD patients who met the inclusion criteria were examined with general and specific cognitive function between March 2013 and November 2013. The patients were divided into MIA0, MIA1 and MIA2 groups, according to items of “Yes” for whether or not having cardiovascular disease, serum albumin≤35 g/L or high-sensitive C-reactive protein (hs-CRP)≥3 mg/L. After 2 years, the patients maintained on PD would be repeatedly measured with cognitive function. The Chi-square test, One-way ANOVA, Kruskal-wallis H rank sum test were used to compare the differences of clinical characteristics, biochemical data, and global and specific cognitive function parameters among the three groups at baseline, and two years later, respectively. The Bonferroni method was applied to adjust the significance level for further comparison between each two different groups. The change of score in each cognitive parameter of global and specific domains was used as dependent variable. Age, gender, education level, depression index, body-mass index, diabetes mellitus, serum sodium levels and MIA (MIA0 was control, MIA1 and MIA2 as dummy variables) were all included in the multivariable linear regression models to analyze the risk factors of the deterioration of cognitive function. The analysis for each cognitive domain was adjusted for the baseline score of the corresponding cognitive parameter. All the analyses were performed using SPSS for Windows, software version 25.0 (SPSS Inc., Chicago, IL). Results: Over two-year follow up, the prevalence of cognitive impairment increased from 20.0% to 24.7%, absolute decrease of 3MS scores were more significantly decreased in MIA2 (-3.9±12.0 vs. 1.1±6.7, P <0.01) and MIA1 group (-2.3±11.8 vs. 1.1± 6.7, P <0.05) than those
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