终末期肾病患者尿毒症毒素对认知功能的影响:抑郁的中介效应  

Impact of uremic toxins on cognitive function in end-stage renal disease patients:the mediating effect of depression

作　　者：刘颖[1] 穆俊娅 张明[2] 罗诏耀 欧阳远朔 陈青娟 李毅[4] 陈伟 LIU Ying;MU Junya;ZHANG Ming;LUO Zhaoyao;OUYANG Yuanshuo;CHEN Qingjuan;LI Yi;CHEN Wei(Department of Oncology,No.3201 Hospital of Xi’an Jiaotong University Health Science Center,Hanzhong 723000;Department of Medical Imaging,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Human Anatomy,Histology and Embryology,School of Basic Medical Sciences of Xi’an Jiaotong University Health Science Center,Xi’an 710061;Department of Nephrology,No.3201 Hospital of Xi’an Jiaotong University Health Science Center,Hanzhong 723000,China)

机构地区：[1]西安交通大学医学部附属三二○一医院肿瘤内科,陕西汉中723000 [2]西安交通大学第一附属医院影像科,陕西西安710061 [3]西安交通大学医学部基础医学院人体解剖与组织胚胎学系,陕西西安710061 [4]西安交通大学医学部附属三二○一医院肾病内科,陕西汉中723000

出　　处：《西安交通大学学报（医学版）》2024年第4期621-628,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金面上项目(No.82071879);陕西省自然科学基础研究项目(No.2023-JC-QN-0984);西安交通大学第一附属医院临床研究项目(No.XJTU1AF-CRF-2023-021)。

摘　　要：目的 探索抑郁在终末期肾病(end-stage renal disease, ESRD)患者尿毒症毒素与认知功能之间的中介作用,为临床早期干预提供依据。方法 回顾性纳入2018年8月—2021年10月在西安交通大学第一附属医院肾内科确诊的未透析的ESRD患者49例及健康对照(healthy control, HC)50例,收集患者的一般资料,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)、华山版听觉词语学习测验(Auditory Verbal Learning Test-Huashan Version, AVLT-H)、数字连线测试A(Trail Making Test A,TMT-A)、贝克抑郁量表(Beck Depression Inventory, BDI)、贝克焦虑量表(Beck Anxiety Inventory, BAI)收集两组的认知功能和焦虑抑郁资料,采用ESRD组的血清学指标阐明尿毒症毒素对认知功能的影响,应用PROCESS v3.4.1探索尿毒症毒素、抑郁、认知功能三者的关系及抑郁的中介效应。结果 ESRD组和HC组在MoCA总分(P<0.001)、AVLT-H(词语学习、短期延迟、长期延迟P<0.001,词语再认P=0.001)、TMT-A(P<0.001)、BDI(P<0.001)、BAI(P=0.009)的比较均有统计学差异。胱抑素C是AVLT-H短期延迟的负向影响因素(B=-0.834,P=0.019),BDI是AVLT-H长期延迟(B=-0.102,P=0.002)、AVLT-H词语再认(B=-0.071,P<0.001)、MoCA总分(B=-0.135,P=0.002)的负向影响因素。BDI在胱抑素C对AVLT-H短期延迟(总效应c=-0.334 6,直接效应c′=-0.223 5,中介效应a×b=-0.111 0,中介效应占比33.2%)和AVLT-H长期延迟的影响中起部分中介效应(总效应c=-0.318 7,直接效应c′=-0.218 8,中介效应a×b=-0.099 9,中介效应占比31.3%)。结论 ESRD患者存在认知功能下降及焦虑、抑郁情绪;胱抑素C和抑郁均为ESRD患者认知功能下降的负向影响因素;胱抑素C通过抑郁间接影响ESRD患者的认知功能。Objective To explore the mediating role of depression between uremic toxins and cognitive function in end-stage renal disease(ESRD)patients,so as to provide a basis for early clinical intervention.Methods A retrospective study involved 49 predialysis ESRD patients diagnosed in the Nephrology Department of The First Affiliated Hospital of Xi’an Jiaotong University between August 2018 and October 2021,along with 50 healthy controls(HC).General information of the two groups was collected.Montreal Cognitive Assessment(MoCA),Auditory Verbal Learning Test-Huashan Version(AVLT-H),Trail Making Test A(TMT-A),Beck Depression Inventory(BDI),and Beck Anxiety Inventory(BAI)were used to collect data on cognitive function,anxiety,and depression in both groups.Serological indicators in the ESRD group were used to clarify the impact of uremic toxins on cognitive function.PROCESS v3.4.1 was applied to explore the relationship between uremic toxins,depression,and cognitive function,as well as the mediating effect of depression.Results Significant differences were found between the ESRD group and the HC group in MoCA total score(P<0.001),AVLT-H(word learning;short-term delay;long-term delay,P<0.001;word recognition,P=0.001),TMT-A(P<0.001),BDI(P<0.001),and BAI(P=0.009).Cystatin C was a negative influencing factor for short-term delay in AVLT-H(B=-0.834,P=0.019),while BDI was a negative influencing factor for long-term delay in AVLT-H(B=-0.102,P=0.002),word recognition in AVLT-H(B=-0.071,P<0.001),and MoCA total score(B=-0.135,P=0.002).BDI partially mediated the effect of cystatin C on short-term delay in AVLT-H(total effect,c=-0.3346;direct effect,c′=-0.2235;mediating effect,a×b=-0.1110;and mediating effect proportion,33.2%)and long-term delay in AVLT-H(total effect,c=-0.3187;direct effect,c′=-0.2188;mediating effect,a×b=-0.0999;and mediating effect proportion,31.3%).Conclusion ESRD patients experience cognitive decline as well as anxiety and depression.Cystatin C and depression are both negative influencing factors for cognit

关 键 词：终末期肾病(ESRD) 认知功能 尿毒症毒素 胱抑素C 抑郁 

分 类 号：R692.5[医药卫生—泌尿科学]