相位滞后指数与老年血液透析患者认知功能障碍的关系  

Relationship between phase lag index and cognitive dysfunction in elderly hemodialysis patients

作　　者：王敏 李作林[2] WANG Min;LI Zuo-lin(Department of Nephrology,Ma'anshan Shiqiye Hospital,Ma'anshan 243000,China;Department of Nephrology,Zhongda Hospital Affiliated to Southeast University,Nanjing 210000,China)

机构地区：[1]马鞍山十七冶医院肾内科,马鞍山243000 [2]东南大学附属中大医院肾脏科,南京210000

出　　处：《中国血液净化》2023年第12期905-908,924,共5页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(82000648)。

摘　　要：目的 探讨相位滞后指数(phase lag index,PLI)与老年维持性血液透析(maintenance hemodialysis,MHD)患者认知功能障碍(cognitive impairment,CI)的关系。方法 选取2019年8月—2023年6月于马鞍山十七冶医院进行规律血液透析的100例老年患者(年龄≥60岁),根据蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)得分分为CI组(n=61)和无CI(no cognitive impairment,NCI)组(n=39)。所有患者均接受脑电图(electroencephalogram,EEG)检测,计算PLI。比较2组患者一般资料、不同频段的PLI,采用Pearson相关性分析PLI与MoCA评分之间的关系,采用多因素Logistic回归分析老年MHD患者发生CI的危险因素,采用受试者工作特征(ROC)曲线分析PLI对老年MHD患者CI的预测价值。结果 CI组α频段的PLI明显低于NCI组,差异有统计学意义(t=7.585,P<0.001)。2组α频段C3-P3、C4-P8、F3-C5、F4-P3、F8-P8、P4-CP3、CP3-O1、CP5-O2电极的PLI比较,差异均有统计学意义(t=10.692、6.485、5.507、7.505、7.342、14.720、8.413、6.947,均P<0.001)。相关性分析显示:CI组患者α频段PLI与MoCA评分呈正相关(r=0.486,P=0.013)。多因素Logistic回归分析显示:MoCA得分(OR=11.512,95%CI:2.159~61.389,P=0.008)、α频段PLI(OR=5.669,95%CI:1.595~20.149,P=0.023)是老年MHD患者发生CI的危险因素。ROC曲线分析显示:α频段PLI预测老年MHD患者发生CI的曲线下面积(areas under curve,AUC)为0.818(95%CI:0.747~0.888),灵敏度、特异度分别为78.46%、64.62%。结论 α频段PLI水平的降低与老年MHD患者认知功能的下降存在密切关联,其预测老年MHD患者发生CI的效能良好,对临床评估CI具有一定的指导意义。Objective To investigate the relationship between phase lag index(PLI)and cognitive impairment(CI)in elderly maintenance hemodialysis(MHD)patients.Methods A total of 100 elderly patients undergoing regular hemodialysis in our hospital from August 2019 to June 2023 were selected and divided into CI group(n=61)and non-CI group(n=39)according to the Montreal Cognitive Assessment(MoCA)score.All patients underwent electroencephalogram(EEG)examination and PLI was calculated.The clinical data and PLI of various frequency bands were compared between the two groups.Pearson correlation was used to analyze the relationship between PLI and MoCA score.Multivariate logistic regression was used to analyze the risk factors for CI in elderly MHD patients.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of PLI for CI in elderly MHD patients.Results Theαband PLI was significantly lower in CI group than in non-CI group(t=7.585,P<0.001).There were statistically significant differences inαband PLI from C3-P3,C4-P8,F3-C5,F4-P3,F8-P8,P4-CP3,CP3-O1 and CP5-O2 electrode pairs between the two groups(t=10.692,6.485,5.507,7.505,7.342,14.720,8.413 and 6.947 respectively;P<0.001).Correlation analyses showed that there was a positive correlation betweenα-band PLI and MoCA score in CI group(R=0.486,P=0.013).Multivariate logistic regression showed that MoCA score(OR=11.512,95%CI:2.159~61.389,P=0.008)andα-band PLI(OR=5.669,95%CI:1.595~20.149,P=0.023)were the risk factors for CI in elderly MHD patients.ROC curve analyses showed that the area under the curve(AUC)ofα-band PLI in predicting CI in elderly MHD patients was 0.818(95%CI:0.747~0.888),with the sensitivity and specificity of 78.46%and 64.62%respectively.Conclusion The decrease ofα-band PLI is closely related to the decline of cognitive function in elderly MHD patients.α-band PLI has a better efficacy in predicting CI in elderly MHD patients and has the significance of guidance for clinical evaluation of CI.

关 键 词：维持性血液透析 认知功能障碍 相位滞后指数 

分 类 号：R459.5[医药卫生—治疗学]