透析中低血压对维持性血液透析患者脑组分及认知、情绪及生活能力的影响  

Effect of intradialytic hypotension on brain components,cognition,emotion,and life ability in maintenance hemodialysis patients

作　　者：胡蓉蓉[1] 钱玉珺 林天烨 韩菲[2] 袁晶[2] 冯逢[3] 朱以诚[2] 李雪梅[1] 郑可[1] Hu Rongrong;Qian Yujun;Lin Tianye;Han Fei;Yuan Jing;Feng Feng;Zhu Yicheng;Li Xuemei;Zheng Ke(Department of Nephrology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Nephrology,Jiangsu Province Hospital(The First Affiliated Hospital of Nanjing Medical University),Nanjing 210006,China;Department of Radiology,Beijing Cancer Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医院肾内科,北京100730 [2]中国医学科学院,北京协和医院神经内科,北京100730 [3]中国医学科学院,北京协和医院放射科,北京100730 [4]南京医科大学第一附属医院(江苏省人民医院)肾内科,南京210006 [5]北京大学肿瘤医院医学影像科,北京100730

出　　处：《中华肾脏病杂志》2024年第10期771-779,共9页Chinese Journal of Nephrology

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-B-021)。

摘　　要：目的探讨透析中低血压对维持性血液透析患者脑组分体积的影响,继而探讨透析中低血压与抑郁、认知功能改变的关系。方法本研究为横断面观察性研究,回顾性收集2013年7月至2014年7月北京协和医院规律血液透析的患者临床资料。根据是否存在透析中低血压分为低血压组和无低血压组。全部患者完成头颅3.0 T核磁共振检查并提取脑各个组分体积分析结果,采用中文版简易精神状态检查量表(C⁃MMSE)和中文版蒙特利尔认知评估量表(C⁃MoCA)进行总体认知功能测评,使用汉密顿抑郁量表17项版(HAMD_17)评估抑郁状态,通过阿尔茨海默病协作研究日常生活能力评估问卷评估生活能力。此外,使用费城词语学习测验测评患者记忆,使用波士顿命名测验测评语言能力,使用连线测验A与B测评执行能力,使用斯特鲁普测验C评估注意力。比较两组患者的脑组分体积、情绪及生活能力和认知功能差异,采用多因素线性回归分析探讨透析中低血压与脑组分体积(因变量)的相关性。结果本研究共纳入119例患者,其中22例(18.5%)存在透析中低血压。透析中低血压组的杏仁核、楔叶和后扣带回体积均显著低于无低血压组[(1.6±0.2)mm^(3)比(1.7±0.2)mm^(3),t=2.674,P=0.009;(6.9±0.8)mm^(3)比(7.4±1.0)mm^(3),t=2.187,P=0.031;(6.9±0.8)mm^(3)比(7.4±0.9)mm^(3),t=2.252,P=0.024],两组间脑灰质、白质及其他脑组分体积差异虽有类似趋势但差异均无统计学意义。低血压组腔隙性脑梗死、脑微出血更常见,两组间日常生活能力评分类似[(65.51±11.52)比(65.71±11.53),Z=-0.456,P=0.648],HAMD_17诊断抑郁的比例相当,低血压组C⁃MMSE、C⁃MoCA评估诊断认知障碍的患者比例更高,但差异无统计学意义。单变量线性回归分析显示,透析中低血压与控制情绪的脑部核团杏仁核、楔叶和后扣带回体积呈负相关(B=-0.117,95%CI-0.203~-0.030,P=0.009;B=-0.484,95%CI-0.923~-0.046Objective To explore the impact of intradialytic hypotension(IDH)on brain component volume,as well as its relationship with depression and cognitive function changes in maintenance hemodialysis patients.Method It was a cross-sectional observational study.Clinical data of 119 patients under maintenance hemodialysis in Peking Union Medical College Hospital from July 2013 to July 2014 were collected,retrospectively.Patients were divided into IDH group and non-IDH group.3.0T Magnetic resonance imaging examination of the head for all patients was completed and the results of volume analysis of each component of the brain were extracted.Cognitive function was assessed by the Chinese version of the simplified mental state examination scale(C-MMSE)and the Chinese version of the Montreal cognitive assessment scale(C-MoCA).Depressive status was assessed by the Hamilton depression scale 17(HAMD_17)and living ability was assessed by the Alzheimer's disease collaborative study-daily living ability assessment questionnaire.In addition,the Philadelphia word learning test was used to measure memory,the Boston naming test to measure language,the connection test A and B to measure executive ability,and the Stroup test C to measure attention.The differences in brain component volume,cognitive function,emotion,and life ability between two groups of patients were compared,and the correlation between IDH and brain component volume was explored by regression analysis.Result A total of 119 patients were included in this study,of whom 22(18.5%)had hypotension during dialysis.The volumes of amygdala,cuneiform lobe,and posterior cingulate gyrus in IDH group were significantly smaller than those in the non-hypotension group[(1.6±0.2)mm^(3) vs.(1.7±0.2)mm^(3),t=2.674,P=0.009;(6.9±0.8)mm^(3) vs.(7.4±1.0)mm^(3),t=2.187,P=0.031;(6.9±0.8)mm^(3) vs.(7.4±0.9)mm^(3),t=2.252,P=0.024].The differences of gray matter,white matter volume between the two groups showed a similar trend but did not reach statistical significance.And lacunar infarction

关 键 词：肾透析 脑 认知障碍 低血压 

分 类 号：R692.5[医药卫生—泌尿科学]