组合型人工肾对维持性血液透析患者认知功能障碍的影响  

Impact of combined artificial kidney on cognitive dysfunction in patients undergoing maintenance hemodialysis

作　　者：王茂竹 向旭 华微 谌玲 唐露瑶 张妮 肖玲亮 Wang Maozhu;Xiang Xu;Hua Wei;Chen Ling;Tang Luyao;Zhang Ni;Xiao Lingliang(Department of Nephrology,The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College,Chongqing 400000,China)

机构地区：[1]重庆医药高等专科学校附属第一医院肾脏内科,重庆400000

出　　处：《保健医学研究与实践》2024年第8期98-103,共6页Health Medicine Research and Practice

基　　金：重庆市教育委员会科学技术研究项目青年项目(KJQN202302834);重庆医药高等专科学校附属第一医院科技孵化基金项目(022-2023MS09);重庆医药职业教育集团项目(CQZJ202339)。

摘　　要：目的 探究组合型人工肾对维持性血液透析患者认知功能障碍的影响,以期为临床治疗提供参考。方法 本研究选取2020年1月—2023年1月重庆医药高等专科学校附属第一医院收治的规律血液透析患者90例作为研究对象。采用随机数字表法将患者分为对照组与研究组,每组45例。对照组患者透析方式:每周2次血液透析(HD)+1次血液透析滤过(HDF);研究组患者透析方式:每周2次HD+每周1次HDF+每月1次[HD+血液灌流(HP)]。比较2组患者首次透析前和透析6个月时的肌酐、尿素氮、β_(2)-微球蛋白、尿酸、甲状旁腺激素、同型半胱氨酸(Hcy)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平及蒙特利尔认知评估量表(MOCA)、简易智力状态检查量表(MMSE)评分。结果 透析前,2组患者肌酐、尿素氮、甲状旁腺激素、尿酸、β_(2)-微球蛋白、Hcy水平比较,差异无统计学意义(P>0.05)。透析6个月时,2组患者肌酐、尿素氮、β_(2)-微球蛋白、甲状旁腺激素、Hcy水平较透析前降低(P<0.05);透析6个月时,研究组患者β_(2)-微球蛋白、甲状旁腺激素、Hcy水平均低于对照组,差异均有统计学意义(P<0.05)。透析前,2组患者MOCA、MMSE评分比较,差异无统计学意义(P>0.05)。透析6个月时,2组患者MOCA、MMSE评分均高于透析前,且研究组高于对照组,差异均有统计学意义(P<0.05)。透析前,2组患者CRP、IL-6水平比较,差异无统计学意义(P>0.05)。透析6个月时,2组患者CRP、IL-6水平均低于透析前,且研究组低于对照组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:透析6个月时,患者MOCA评分、MMSE评分与其肌酐、尿素氮、尿酸水平无相关性,与β_(2)-微球蛋白、甲状旁腺激素、Hcy、CRP、IL-6水平呈负相关。结论 与接受HD联合HDF治疗的患者相比较,接受HD、HDF联合HP的患者在透析6个月时表现出更好的认知功能,这与其具有更低的甲状旁腺激素、β_(2)-�Objective To explore the impact of combined artificial kidney on cognitive dysfunction in patients undergoing maintenance hemodialysis,aiming to provide a reference for clinical treatment.Methods This study selected 90 regular hemodialysis patients admitted to the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College from January 2020 to January 2023 as the participants.Patients were randomly assigned to a control group(n=45)and an observation group(n=45)using the random number table method.The control group received hemodialysis(HD)twice a week plus hemodiafiltration(HDF)once a week;the observation group received HD twice a week,HDF once a week,and HD plus hemoperfusion(HP)once a month.The levels of creatinine,urea nitrogen,β_(2)-microglobulin,uric acid,parathyroid hormone,homocysteine(Hcy),C-reactive protein(CRP),interleukin-6(IL-6),and the scores of the Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were compared before the first dialysis and at 6 months of dialysis between the two groups.Results Before dialysis,no significant difference was observed in creatinine,urea nitrogen,parathyroid hormone,uric acid,β_(2)-microglobulin,and Hcy levels between the two groups(P>0.05).At 6 months of dialysis,the levels of creatinine,urea nitrogen,β_(2)-microglobulin,parathyroid hormone,and Hcy in both groups were decreased significantly compared to before dialysis(P<0.05).At 6 months,the levels ofβ_(2)-microglobulin,parathyroid hormone,and Hcy in the observation group were all significantly lower than in the control group(P<0.05).Before dialysis,no significant difference was observed in MOCA and MMSE scores between the two groups(P>0.05).At 6 months of dialysis,the MOCA and MMSE scores in both groups were higher than before dialysis,and the observation group's scores were higher than the control group's,with statistically significant differences(P<0.05).Before dialysis,no statistically significant difference was found in CRP and IL-6 levels between the two groups(P>0.05).A

关 键 词：组合型人工肾 维持性血液透析 认知障碍 蒙特利尔认知评估量表 简易智力状态检查量表 

分 类 号：R692.5[医药卫生—泌尿科学]