中老年维持性血液透析患者认知功能损伤特征的横断面研究  

A cross-sectional study on the characteristics of cognitive impairment in middle-aged and elderly patients undergoing maintenance hemodialysis

作　　者：郭一丹 张春霞 田茹 叶鹏鹏 李国刚 李新[4] 卢方平 马迎春 孙懿[7] 王玉柱[8] 肖跃飞[9] 张启蒙 赵海丹 赵雪峰 罗洋 Guo Yidan;Zhang Chunxia;Tian Ru;Ye Pengpeng;Li Guogang;Li Xin;Lu Fangping;Ma Yingchun;Sun Yi;Wang Yuzhu;Xiao Yuefei;Zhang Qimeng;Zhao Haidan;Zhao Xuefeng;Luo Yang(Department of Nephrology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100053,China;Department of Nephrology,Beijing Shijingshan Hospital,Beijing 100047,China;Department of Nephrology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100032,China;Department of Nephrology,Beijing Huaxin Hospital,the First Hospital of Tsinghua University,Beijing 100084,China;Department of Nephrology,China Rehabilitation Research Center Beijing Boai Hospital,Beijing 100029,China;Department of Nephrology,Beijing Fuxing Hospital,Capital Medical University,Beijing 100036,China;Department of Nephrology,Beijing Haidian Hospital,Beijing 100058,China;Department of Nephrology,Aerospace Central Hospital,Beijing 100042,China;Department of Nephrology,Beijing Zhongguancun Hospital,Beijing 100586,China;Department of Nephrology,Peking University Shougang Hospital,Beijing 100574,China;Department of Nephrology,Nankou Hospital of Beijing Changping District,Beijing 100024,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京100038 [2]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100053 [3]北京石景山医院肾内科,北京100047 [4]首都医科大学附属北京朝阳医院肾内科,北京100032 [5]清华大学第一附属医院(北京华信医院)肾内科,北京100084 [6]中国康复中心北京博爱医院肾内科,北京100029 [7]首都医科大学附属北京复兴医院肾内科,北京100036 [8]北京市海淀医院肾内科,北京100058 [9]北京航天中心医院肾内科,北京100042 [10]北京市中关村医院肾内科,北京100586 [11]北京大学首钢医院肾脏科,北京100574 [12]北京市昌平区南口医院肾脏科,北京100024

出　　处：《中华肾脏病杂志》2021年第8期632-638,共7页Chinese Journal of Nephrology

基　　金：北京市科学技术委员会国家重大研发计划匹配项目(Z161100002616005)。

摘　　要：目的:探讨中老年维持性血液透析(hemodialysis,HD)患者认知功能损伤的临床特征及其相关影响因素。方法:本研究采用横断面分析方法,选取2017年4月至2017年6月期间在北京市11家透析中心的HD患者为研究对象,收集患者的临床资料。采用包括记忆力、执行功能、注意力、语言功能及视空间功能5个认知域的神经心理学量表评估患者认知功能,根据《精神障碍诊断与统计手册》第5版诊断标准判定患者是否存在认知功能损伤,并按照认知功能评估结果将患者分为认知功能正常组与认知功能损伤组,比较两组患者临床资料的差异。采用多因素Logistic回归方法分析认知功能损伤发生的影响因素。结果:本研究共纳入613例维持性HD患者,其中认知功能损伤组496例(80.91%)。各认知域损伤中以注意力损伤(81.05%)和记忆力损伤(63.51%)最常见,有2个及以上认知域联合损伤患者的比例占79.23%。与认知功能正常组比较,认知功能损伤组患者的年龄较大,高血压史、糖尿病史及脑卒中史比例较高,透析龄较长,受教育程度和尿素清除指数(Kt/V)较低(均P<0.05)。多因素Logistic回归分析结果显示,年龄增长(OR=1.110,95%CI 1.072~1.150,P<0.001)、受教育>12年(以受教育<6年为参照,OR=0.323,95%CI 0.115~0.909,P=0.032)、有糖尿病病史(OR=2.151,95%CI 1.272~3.636,P=0.004)、有脑卒中病史(OR=2.546,95%CI 1.244~5.210,P=0.011)、透析龄增加(OR=1.016,95%CI 1.010~1.022,P<0.001)、Kt/V下降(OR=0.008,95%CI 0.002~0.035,P<0.001)、全段甲状旁腺素水平升高(OR=1.002,95%CI 1.002~1.003,P=0.012)是认知功能损伤的独立影响因素。结论:中老年维持性HD患者认知功能损伤呈现出高患病率、认知域联合损伤的特征,以注意力损伤和记忆力损伤最为常见。年龄增长、透析龄增加、糖尿病病史、脑卒中病史及血清全段甲状旁腺素水平升高、Kt/V下降以及受教育程度低是患者发生认知功能损�Objective To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis(HD).Methods A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017.A neuropsychological battery covering domains of attention/processing speed,executive function,memory,language,and visuospatial function was applied in cognitive function assessment.Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria(DSM-V).Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment.Results A total of 613 HD patients were included in the study,and the prevalence of cognitive impairment was 80.91%(496/613).Attention impairment(81.05%)and memory impairment(63.51%)were the most common impaired domains,and 79.23%was concomitant impairment across two or more cognitive domains among those with cognitive impairment.Compared with the patients in the normal cognitive function group,the patients in the cognitive impairment group had senior age,longer dialysis vintage,higher proportion of diabetes,hypertension,and stroke,higher level of serum intact parathyroid hormone(iPTH),lower education level,and lower urea clearance index(Kt/V)(all P<0.05).Factors were independently associated with cognitive impairment including increasing age(OR=1.110,95%CI 1.072-1.150,P<0.001),education time>12 years(with education time<6 years as reference,OR=0.323,95%CI 0.115-0.909,P=0.032),history of diabetes(OR=2.151,95%CI 1.272-3.636,P=0.004),history of stroke(OR=2.546,95%CI 1.244-5.210,P=0.011),increased dialysis vintage(OR=1.016,95%CI 1.010-1.022,P<0.001),reduced Kt/V(OR=0.008,95%CI 0.002-0.035,P<0.001),and increased iPTH level(OR=1.002,95%CI 1.002-1.003,P=0.012).Conclusions The prevalence of cognitive impairment in

关 键 词：肾透析 认知功能障碍 患病率 危险因素 

分 类 号：R459.5[医药卫生—治疗学]