终末期肾病患者血液透析间期记忆功能受损的相关危险因素分析  

Analysis on interdialytic abnormal memory function impairment related risk factors in patients with end stage renal disease

作　　者：李楠 孙巨军 刘国 尹阳 任莉 景海宁 高翔 LI Nan;SUN Jujun;LIU Guo;YIN Yang;REN Li;JING Haining;GAO Xiang(Department of Medical Laboratory,Xidian Group Hospital,Xi′an,Shaanxi 710077,China;Department of Nephrology;Department of Medical Laboratory,215 Hospital of Shaanxi Nuclear Industry,Xianyang,Shaanxi 712000,China)

机构地区：[1]西电集团医院医学检验科,陕西西安710077 [2]陕西省核工业二一五医院肾内科,陕西咸阳712000 [3]陕西省核工业二一五医院医学检验科,陕西咸阳712000

出　　处：《检验医学与临床》2020年第20期2933-2936,共4页Laboratory Medicine and Clinic

基　　金：陕西省科技攻关计划项目(2019SF-209)。

摘　　要：目的探讨终末期肾病(ESRD)患者血液透析间期记忆功能异常的相关危险因素。方法收集2018年2月至2019年4月在西电集团医院及陕西省核工业二一五医院血液透析室进行血液透析的ESRD患者90例(ESRD组)及同期健康对照者80例(健康对照组)。所有ESRD患者在血液透析间期收集一般资料,检测尿毒症毒素(血清肌酐、尿素氮、胱抑素C)、血红蛋白、血细胞比容、甲状旁腺激素及电解质(血钾、血钠、血氯、血钙、血磷)水平;应用蒙特利尔认知量表(MoCA)评估研究对象的整体认知功能,使用听觉词语学习测验(AVLT)评估研究对象的瞬时记忆、短期延迟记忆、长期延迟记忆、再认功能;分析可能与血液透析间期记忆功能异常有关的临床危险因素。结果(1)与健康对照组比较,ESRD组在血液透析间期的瞬时记忆、短期延迟记忆及长期延迟记忆得分普遍降低(P<0.05)。(2)ESRD组在血液透析间期的MoCA得分与健康对照组比较,差异无统计学意义(P>0.05)。(3)Pearson相关性分析显示,ESRD组血红蛋白水平与瞬时记忆受损密切相关(r=0.853,P=0.021);肌酐水平与短期延迟记忆减退(r=-0.574,P=0.003)、长期延迟记忆减退(r=-0.566,P=0.004)密切相关;血钙水平与长期延迟记忆减退密切相关(r=-0.566,P=0.001);甲状旁腺激素水平与再认得分密切相关(r=-0.782,P=0.030)。(4)多元逐步回归分析显示,血红蛋白水平是ESRD患者瞬时记忆受损的主要危险因素(R 2=0.737,P<0.01),肌酐水平是ESRD患者短期延迟记忆受损的主要危险因素(R 2=0.524,P<0.01)。结论ESRD患者血液透析间期出现多个维度的记忆功能损伤,并与尿毒症毒素堆积、肾性贫血有关。Objective To investigate the related risk factors of interdialytic memory function abnormality in the patients with end stage renal disease(ESRD).Methods A total of 90 patients with ESRD(ESRD group)and contemporaneous 80 healthy controls(healthy control group)were collected in the hemodialysis room of Xidian Group Hospital and 215 Hospital of Shaanxi Provincial Nuclear Industry from February 2018 to April 2019.The interdialytic general data were collected in all ESRD cases.The uremia toxins(serum creatinine,urea nitrogen,cystatin C),hemoglobin(Hb),hematocrit,parathyroid hormone and electrolytes(blood potassium,natrium,chlorine,calcium,phosphorus)levels were detected.The Montreal cognitive assessment(MoCA)was used to evaluate the overall cognitive function of the subjects,and the auditory verbal learning test(AVLT)was used to evaluate the transient memory,short-term delayed memory,long-term delayed memory and recognition function of the subjects.The clinical risk factors possibly relating with the interdialytic abnormal memory function were analyzed.Results(1)Compared with the healthy control group,the scores of transient memory,short-term delayed memory and long-term delayed memory in the ESRD group were generally decreased(P<0.05).(2)There was no statistically significant difference in the MoCA score during hemodialysis between the ESRD group and the healthy control group(P>0.05).(3)The Pearson correlation analysis showed that the Hb level in ESRD group was closely related to the transient memory impairment(r=0.853,P=0.021).The serum creatinine level was closely related to the short-term delayed hypomnesia(r=-0.574,P=0.003)and long-term delayed hypomnesia(r=-0.566,P=0.004).The serum calcium level was closely related to the long-term delayed hypomnesia(r=-0.566,P=0.001);the parathyroid hormone level was closely related with re-recognition score(r=-0.782,P=0.030).(4)The multiple step regression analysis showed that the Hb level was the main risk factor of transient memory impairment in ESRD patients(R 2=0.737,P<0.

关 键 词：终末期肾病 记忆 贫血 尿毒症毒素 钙磷代谢紊乱 

分 类 号：R446.112[医药卫生—诊断学]