中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (12): 888-892.doi: 10.3969/j.issn.1671-4091.2022.12.006

• 临床研究 • 上一篇    下一篇

接受不同透析方式的终末期肾病患者合并认知功能障碍的多因素分析

霍 迪    姚雅茹    陈卫东    刘 磊   

  1. 233099 蚌埠，1蚌埠医学院第一附属医院肾内科
  • 收稿日期:2022-07-11 修回日期:2022-09-27 出版日期:2022-12-12 发布日期:2022-12-12
  • 通讯作者: 刘磊 E-mail:bbmcll@163.com

Multivariate analysis on cognitive impairment in patients with end-stage renal disease receiving different dialysis methods 

HUO Di, YAO Ya-ru, CHEN Wei-dong, LIU Lei   

  1. Department of Nephrology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
  • Received:2022-07-11 Revised:2022-09-27 Online:2022-12-12 Published:2022-12-12
  • Contact: 233099 蚌埠，1蚌埠医学院第一附属医院肾内科 E-mail:bbmcll@163.com

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摘要： 目的  分析接受不同透析方式的终末期肾病患者发生认知障碍(cognitive impairment，CI)的危险因素。 方法  选取2021年11月～2022年4月在蚌埠医学院第一附属医院规律行维持性血液透析(maintenance hemodialysis，MHD)患者93例，腹膜透析(peritoneal dialysis，PD)患者50例。根据《蒙特利尔认知评估量表》评估得分，将患者分为MHD患者CI组、MHD患者无CI组、PD患者CI组、PD患者无CI组，分析其间CI的相关危险因素。  结果  本研究共入组143例患者，男性70例(48.95%)，年龄(52.25±11.37)岁，合并CI75例，患病率为52.45%。多因素Logistic回归分析显示年龄、血小板/淋巴细胞比值(PLR)、胱抑素C、血清同型半胱氨酸(Hcy)是MHD患者发生CI的独立危险因素(OR值分别为1.080、1.017、1.749、1.167，95%CI分别为1.001～1.166、1.003～1.030、1.205～2.541、1.003～1.358， P值分别为0.047、0.013、0.003、0.046)；而年龄、血红蛋白、PLR、25羟-维生素-D是PD患者发生CI的独立危险因素(OR值分别为1.253、0.907、1.027、0.696，95%CI分别为1.042～1.507、0.830～0.992、1.001～1.054、0.491～0.989，P值分别为0.016、0.032、0.044、0.043)。受试者工作特征曲线分析提示年龄、PLR以及两者联合模型对MHD及PD患者发生认知功能障碍均有较好的预测效能，其中联合模型预测效能最高(MHD患者中AUC分别为0.714、0.723、0.798，95% CI分别为0.611～0.817、0.620～0.826、0.711～0.886，P值均P＜0.001；PD患者中AUC分别为0.684、0.810、0.849，95%CI分别为0.533～0.836、0.679～0.941、0.736～0.962，P值分别为0.027、＜0.001、＜0.001)。 结论  MHD患者中年龄、PLR、胱抑素C、Hcy是发生CI的独立危险因素，PD患者中年龄、PLR、血红蛋白、25羟-维生素-D是发生CI的独立危险因素，在临床治疗过程中应密切关注上述因素，早期实施干预措施，进而延缓或者避免患者发生认知功能障碍。

关键词: 终末期肾病, 认知障碍, 维持性血液透析, 腹膜透析

Abstract: Objective  To analyze the risk factors of cognitive impairment (CI) in patients with end-stage renal disease and receiving different dialysis methods.  Methods  A total of 93 patients on maintenance hemodialysis (MHD) and 50 patients on peritoneal dialysis (PD) treated in the First Affiliated Hospital of Bengbu Medical College from November 2021 to April 2022 were recruited as the research subjects. According to the scores of Montreal cognitive assessment, the patients were divided into CI group of MHD patients, non-CI group of MHD patients, CI group of PD patients, and non-CI group of PD patients. CI and related risk factors was analyzed between the groups.  Results  A total of 143 patients were enrolled in this study, 70 (48.95%) were males, and the mean age was 52.25±11.37 years old. A total of 75 patients had CI, with a prevalence rate of 52.45%. Multivariate logistic regression showed that age, platelet/lymphocyte ratio (PLR), cystatin C, and homocysteine (Hcy) were the independent risk factors for CI in MHD patients (OR=1.080, 1.017, 1.749 and 1.167 respectively; 95% CI：1.001～1.166, 1.003～1.030, 1.205～2.541 and 1.003～1.358 respectively; P=0.047, 0.013, 0.003 and 0.046 respectively); while age, hemoglobin, PLR, and 25-hydroxy-vitamin-D were the independent risk factors for CI in PD patients (OR=1.253, 0.907, 1.027 and 0.696 respectively; 95% CI：1.042～1.507, 0.830～0.992, 1.001～1.054 and 0.491～0.989 respectively; P= 0.016, 0.032, 0.044 and 0.043 respectively). Receiver operating characteristic curve analysis showed that age, PLR and the model of the combined two had better predictive values for CI in MHD and PD patients, and the combined model had the highest predictive value (for MHD patients: AUC=0.714, 0.723 and 0.798 respectively; 95% CI：0.611～0.817, 0.620～0.826 and 0.711～0.886 respectively; P＜0.001; for PD patients: AUC=0.684, 0.810 and 0.849 respectively; 95% CI：0.533～0.836, 0.679～0.941 and 0.736～0.962 respectively; P=0.027, ＜0.001 and ＜0.001 respectively).  Conclusion  Age, PLR, cystatin C and Hcy are the independent risk factors for CI in MHD patients; age, PLR, hemoglobin and 25-hydroxy-vitamin-D are the independent risk factors for CI in PD patients. Therefore, these factors should be closely monitored during treatment of MHD and PD patients. Early intervention of these factors may delay or avoid the occurrence of CI in dialysis patients.

Key words: End-stage renal disease, Cognitive impairment, Maintenance hemodialysis, Peritoneal dialysis

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