维持性血液透析患者认知损害的发病情况及预后相关危险因素  

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

作　　者：娜孜亚·斯加克 阿依加肯·卡司木马力 周玮玮 刘晓云 赵文梅 玛伊努尔·阿卜拉 潘明珍 谢可炜[2] 徐辰祺 金海姣 顾乐怡 陆任华[1,2] Naziya·Sijiake;Ayijiaken·Kasimumali;Zhou Weiwei;Liu Xiaoyun;Zhao Wenmei;Mayinuer·Abula;Pan Mingzhen;Xie Kewei;Xu Chenqi;Jin Haijiao;Gu Leyi;Lu Renhua(Department of Nephrology,Kashgar Prefecture Second People's Hospital,Kashgar of Xinjiang Uygur Autonomous Region 844000,China;Department of Nephrology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]新疆维吾尔自治区喀什地区第二人民医院肾病科,喀什地区844000 [2]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《中华肾脏病杂志》2019年第10期741-751,共11页Chinese Journal of Nephrology

基　　金：新疆维吾尔自治区自然科学基金面上项目(2016D01C094).

摘　　要：目的探索维持性血液透析(maintenance hemodialysis,MHD)患者并发认知损害(cognitive impairment,CI)的发病情况、危险因素以及预后情况,为临床更好地认识和预防该并发症、改善MHD患者的预后提供依据。方法选取2000年1月至2014年7月在上海交通大学医学院附属仁济医院进行MHD(≥3月)、年龄≥18岁,并能够自愿配合进行认知功能蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评分的患者。排除病历资料丢失或不全以及不能配合完成研究的患者。根据MoCA评分将患者分成两组:认知损害组(MoCA<26)和非认知损害组(MoCA≥26),共随访3年,分别对两组的人口学资料、既往病史、血液透析资料、实验室检查和患者预后进行比较。应用多因素Logistic回归分析寻找MHD并发认知损害的危险因素,应用Kaplan-Meier生存曲线和Cox回归模型进行预后分析。结果共有219例MHD患者完成MoCA评分并符合纳入标准,年龄(60.07±12.44)岁,男性130例(59.4%),男女比为1.46∶1,认知损害发病率为51.6%,患者透析龄(100.79±70.23)个月。认知损害组(n=113)与非认知损害组(n=106)间年龄、透后收缩压、透前舒张压、透后舒张压、血小板、单室模型尿素清除指数(spKt/V)及教育程度<12年、糖尿病史、无尿患者比例的差异均有统计学意义(均P<0.05)。多因素Logistic逐步回归分析结果提示,教育程度<12年(OR=3.428,95%CI 1.919~6.125,P<0.001)、透后舒张压<73 mmHg(OR=2.234,95%CI 1.253~3.984,P=0.006)和spKt/V<1.72(OR=1.982,95%CI 1.102~3.564,P=0.022)是MHD患者发生认知损害的独立危险因素。Kaplan-Meier生存曲线分析提示,在3年随访期间MHD伴有认知损害患者生存率低于非认知损害患者(χ2=3.977,P=0.046)。多因素Cox回归模型分析显示,认知损害是MHD患者死亡的独立危险因素(RR=2.661,95%CI 0.967~7.321,P=0.058)。结论认知损害是MHD患者常见的并发症之一,也是MHD患者死亡的独立危险因素。MHD伴Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014,≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA<26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status<12 years, history of diabetes and anuria (all P<0.05);however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P<0.05). Multivariate logistic regression analysis showed that education status<12 years (OR=3.428, 95%CI 1.919-6.125, P<0.001), post-dialysis diastolic pressure<73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V<1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the ind

关 键 词：肾透析 认知功能障碍 发病率 预后 危险因素 

分 类 号：R4[医药卫生—临床医学] R69