维持性血液透析患者认知功能障碍及相关危险因素分析-现代医学

维持性血液透析患者认知功能障碍及相关危险因素分析

单位：1. 南京市浦口医院/南京医科大学第四附属医院内科, 江苏南京 210036;
2. 东南大学附属中大医院肾内科, 江苏南京 210009

分类号：R692.5

出版年·卷·期（页码）：2019·38·第十一期（1387-1390）

摘要：

目的：探讨维持性血液透析（maintenance hemodialysis，MHD）患者认知功能改变情况及相关危险因素。方法：回顾性分析2016年1月至2017年12月在南京市浦口医院内科接受MHD治疗的85例患者的临床资料，采用蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）对患者的认知功能进行评价，同时收集患者的相关基线资料，包括年龄、透析龄、受教育年限、体质量指数、合并高血压病、合并糖尿病、血红蛋白水平、白蛋白水平、血尿素氮水平、血肌酐水平，分析影响MHD患者认知功能的危险因素。结果：85例行MHD治疗的患者中，存在认知功能障碍的有59例（69.41%），其视空间与执行、定向力、延迟回忆水平，命名、注意、计算、语言、抽象能力，以及MoCA量表总分均较认知功能正常组的患者明显降低（P<0.05）。单因素分析显示年龄、透析龄、受教育年限及合并糖尿病是发生认知功能障碍的危险因素（P<0.05）。多因素分析提示年龄及透析龄是主要影响MHD治疗患者发生认知功能障碍的独立危险因素（P<0.05）。结论：MHD中有较高比例的患者存在认知功能障碍，年龄及透析龄与患者的认知功能障碍密切相关。

Objective: To investigate the cognitive impairment and the related risk factors in maintenance hemodialysis (MHD) patients who had end stage renal disease (ESRD). Methods: 85 patients with ESRD who underwent MHD between January 2016 and December 2017 were recruited in our dialysis center. The cognitive impairment was evaluated by the Montreal cognitive assessment (MoCA) and the clinical data of every patient including age, dialysis age, years of education, body mass index (BMI), hypertension, diabetes, Hb, Alb, BUN and Scr were collected. Cognitive impairment and the related risk factors were analyzed. Results: Among 85 MHD patients, the number of patients with cognitive impairment was 59 (69.41%). The score in visual space and executive function, naming, attention and calculation, language, abstract ability, delay recall, orientation and the total MoCA score in the cognitive impairment group were significantly lower than those of the normal cognitive function group (P<0.05). Univariate analysis showed that age, dialysis age, years of education and diabetes were the risk factors for cognitive impairment (P<0.05). Multivariate analysis showed that age and dialysis age were the independent risk factors (P<0.05). Conclusion: The incidence of cognitive impairment in MHD patients with end stage renal disease is relatively high. Age and dialysis age are independent risk factors for cognitive impairment.

参考文献：

[1] EIRIN A,LERMAN L O.Mesenchymal stem cell treatment for chronic renal failure[J].Stem Cell Res Ther,2014,5:83.
[2] 邓静.慢性肾功能衰竭采用血液透析疗效观察[J/OL].中西医结合心血管病电子杂志,2014(10):15-16.
[3] MOREAU-GAUDRY X,JEAN G,GENET L,et al.A simple protein-energy wasting score predicts survival in maintenance hemodialysis patients[J].J Ren Nutr,2014,24(6):395-400.
[4] 全国儿童常见肾脏病诊治现状调研工作组.慢性肾衰竭肾脏替代治疗现状调查多中心研究[J].中华儿科杂志,2013,51(7):491-494.
[5] FOUQUE D,PELLETIER S,MAFRA D,et al.Nutrition and chronic kidney disease[J].Kidney Int,2011,80(4):348-357.
[6] 王立瑞,李江涛,余晨.比较两种血管通路对维持性血液透析患者贫血的影响[J].中华肾脏病杂志,2016,32(10):779-780.
[7] 董文鹏,王扬威,王瑞霞,等.维持性血液透析患者死亡的相关因素[J].中国老年学杂志,2017,37(5):1207-1209.
[8] GRIVA K,STYGALL J,HANKINS M,et al.Cognitive impairment and 7-year mortality in dialysis patients[J].Am J Kidney Dis,2010,56(4):693-703.
[9] DREW D A,WEINER D E,TIGHIOUART H,et al.Cognitive decline and its risk factors in prevalent hemodialysis patients[J].Am J Kidney Dis,2017,69(6):780-787.
[10] MURRAY A M.Cognitive impairment in the aging dialysis and chronic kidney disease populations:an occult burden[J].Adv Chronic Kidney Dis,2008,15(2):123-132.
[11] SEHGAL A R,GREY S F,DEOREO P B,et al.Prevalence,recognition,and implication of mental impairment among hemodialysis patients[J].Am J Kidney Dis,1997,30(1):41-49.
[12] 黄菲芸,王艳红,李娟娟,等.蒙特利尔认知评估量表在中国中老年人群筛查轻度认知功能障碍中的截断值的系统评价[J].中国循证医学杂志,2017(4):450-457.
[13] 任闯,姚丽,樊星,等.维持性血液透析患者生活质量与矿物质代谢指标的相关性分析[J].中华肾脏病杂志,2016,32(12):893-898.
[14] SHEN Z,RUAN Q,YU Z,et al.Chronic kidney disease-related physical frailty and cognitive impairment:a systemic review[J].Geriatr Gerontol Int,2017,17(4):529-544.
[15] KALLENBERG M H,KLEINVELD H A,DEKKER F W,et al.Functional and cognitive impairment,frailty,and adverse health outcomes in older patients feaching ESRD-A systematic review[J].Clin J Am Soc Nephrol,2016,11(9):1624-1639.
[16] WEINER D E,SELIGER S L.Cognitive and physical function in chronic kidney disease[J].Current Opin Nephrol Hypertension,2014,23(3):291-297.
[17] 姜玲,孔慧,张洁,等.中青年终末期肾脏病维持性血液透析患者认知功能改变及相关影响因素分析[J/OL].中国医学前沿杂志(电子版),2017,9(2):150-153.
[18] NASREDDINE Z S,PHILLIPS N A,BEDIRIAN V,et al.The montreal cognitive assessment,MoCA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.
[19] 贾阳娟,韩凝,王美蓉,等.MoCA与MMSE在急性缺血性卒中后认知障碍评估中的应用[J].中华行为医学与脑科学杂志,2017,26(1):46-50.
[20] KOLLER A C,RITTENBERGER J C,REPINE M J,et al.Comparison of three cognitive exams in cardiac arrest survivors[J].Resuscitation,2017,116:98-104.
[21] 郭健英,李彤,何永成.维持性血液透析患者认知功能障碍及相关危险因素分析[J].中国实用神经疾病杂志,2016,19(11):93-94.
[22] 钟馨,李朝晖,陈瑞娟,等.维持性血液透析患者认知功能障碍相关因素分析[J].临床肾脏病杂志,2015,15(3):175-179.
[23] OWOLABI L F,ABDU A,IBRAHIM A,et al.Related factors and predictors of cognitive dysfunction in chronic kidney disease on maintenance hemodialysis in Nigeria[J].J Neurosci Rural Pract,2016,7(5):S62-S67.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录