中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (11): 600-604.doi: 10.3969/j.issn.1671-4091.2016.11.005

• 临床研究 • 上一篇    下一篇

腹膜透析患者营养不良-炎症-心血管疾病和认知功能的关系

段丽萍1,郑朝霞1,吕宁1,杨立娟1,杨志凯2,董捷2   

  1. 1. 邯郸市中心医院肾内一科
    2. 北京大学第一医院肾内科腹膜透析中心
  • 收稿日期:2016-05-09 修回日期:2016-08-08 出版日期:2016-11-12 发布日期:2016-11-12
  • 通讯作者: 董捷 dongjie@medmail.com.cn E-mail:jie.dong@bjmu.edu.cn

The association of malnutrition, inflammation and cardiovascular disease with cognitive function in peritoneal dialysis patients

  • Received:2016-05-09 Revised:2016-08-08 Online:2016-11-12 Published:2016-11-12

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摘要： 目的探讨腹膜透析患者存在的营养不良、炎症状态、心血管疾病(动脉硬化)综合征(malnutrition-inflammation-atherosclerosis，MIA 综合征)，与认知功能的关系。方法临床稳定的透析龄大于3 月的腹膜透析患者240 例，调查其总认知功能和特异认知功能。记录患者一般情况及生化指标，根据是否白蛋白≤35g/L、超敏-C 反应蛋白≥3mg/L,判断是否存在营养不良、炎症状态，结合有无心血管病，将患者分为3 组，即3 个因素均无者，为MIA0 组；3 个因素中具备任何1 种者，为MIA1 组；3 个因素中具备任意2 种或2 种以上者，为MIA2 组。结果①本组患者中营养不良者36 例(15.0%)，慢性炎症者114例(47.5%)，心血管疾病者86 例(35.8%)。MIA0，MIA1 和MIA2 组分别为79 例(32.9%)、87 例(36.3%)、74 例(30.8%)。总认知障碍发生率在3 组分别为6 例(7.6%)、16 例(18.4%)、15 例(20.3%)。在修正的简易智力状态检查量表得分(t=3.629，P＜0.001；t=-2.518，P=0.013)、认知障碍(χ2=5.184，P=0.023；χ2=4.197，P=0.040)、执行能力障碍(χ2=14.574，P＜0.001；χ2=6.817，P=0.009)、连线试验B(χ2=9.317，P=0.002；χ2=4.236，P=0.040)方面，MIA2 及MIA1 组均较MIA0 组差；在连线试验A(χ2=7.281，P=0.007; χ2=15.028，P＜0.001)及视觉空间能力得分(t=2.122，P=0.035；t=2.893，P=0.004)方面，MIA2 组较MIA1 及MIA0 组均差；在即刻记忆得分方面，MIA2 组较MIA0 组差(t=2.071，P=0.040)。结论腹膜透析患者中MIA 综合征和认知障碍密切相关，而罹患MIA 综合征2 种以上危险因素者较合并0～1 个危险因素患者认知障碍的发生率更高、程度更重。

关键词: 腹膜透析, 炎症状态, 营养不良, 心血管疾病, 认知功能

Abstract: Objective This study was to explore the association of malnutrition - inflammation - atherosclerosis syndrome (MIA) with cognitive function in peritoneal dialysis (PD) patients. Methods A total of 240 clinically stable patients who performed PD for at least 3 months were enrolled. The global cognitive function and specific cognitive functions were investigated. Demographic and biochemical data were recorded. Serum albumin ≤35g/L and high sensitive C-reactive protein ≥3mg/L were used to diagnose malnutrition and inflammation respectively in these patients. MIA0 referred to those without any of the 3 abnormalities, and MIA1 and MIA2 referred to those with one and 2～3 abnormalities respectively. Results The prevalence of malnutrition, inflammation and cardiovascular disease was 15.0% (n=36), 47.5% (n=114), and 35.8% (n=86) respectively. The numbers of patients in MIA0, MIA1, and MIA2 group were 79 (32.9%), 87 (36.3%), and 74 (30.8%) respectively. The prevalence of global cognitive impairment was 6 (7.6%), 16 (18.4%), and 15 (20.3%) in MIA0, MIA1, and MIA2 groups respectively. As compared to MIA0 group, patients in MIA2 and MIA1 groups had significantly lower 3MS scores (t=3.629, P＜0.001; t=-2.518, P=0.013), higher prevalence
of cognitive impairment (χ2=5.184, P=0.023; χ2=4.197, P=0.040) and executive dysfunction (χ2=14.574, P＜0.001; χ2=6.817, P=0.009), and longer time on completing trails B (χ2=9.317, P=0.002; χ2=4.236, P=0.040). The time on completing trails A (χ2=7.281, P=0.007; χ2=15.028, P＜0.001) was longer and the scores of visuospatial skills (t=2.122, P=0.035; t=2.893, P=0.004) were lower in MIA2 group than in MIA1 and MIA0 groups. The scores of immediate memory were lower in MIA2 group than in MIA0 group (t=2.071, P=0.040). Conclusion The MIA syndrome was closely associated with cognitive impairment in PD patients. Patients with two factors of MIA were prone to have severer cognitive impairment than those without MIA or with one factor of MIA.

Key words: Peritoneal dialysis, Malnutrition, Inflammation, Cardiovascular disease, Cognitive function