血液透析患者认知功能变化的特征及风险因素分析
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摘要
目的探讨血液透析患者认知功能变化的特征以及认知功能变化的风险因素。方法采集血液透析患者基线资料以及2次蒙特利尔认知评估量表(MoCA)测试结果,分析患者2年期间认知功能变化的特征并采用多元线性回归分析认知功能变化的风险因素。结果 103例患者纳入研究,其中认知功能障碍69例(67.0%),认知功能障碍组的年龄、透析龄、卒中以及心脏病患病比例均高于认知功能正常组,血红蛋白、受教育程度以及MoCA评分均低于正常组(P<0.05)。2年后患者MoCA、视空间与执行功能以及延迟回忆得分均低于2年前(P<0.05)。多元线性回归结果显示,MoCA变化量受年龄、受教育程度、心脏病史以及透析龄影响;视空间与执行功能变化量受年龄、受教育程度以及心脏病史影响;延迟回忆变化量受年龄、受教育程度以及透析龄影响(均P<0.05)。结论血液透析患者认知功能随着时间延长呈现显著下降趋势,主要是视空间与执行功能和延迟回忆功能下降。高龄、受教育程度低、心脏病史以及透析龄长是此类患者认知功能下降的风险因素。
Objective To analyze the characteristics of cognitive function changes and its associated risk factors in hemodialysis patients.MethodsBaseline data of hemodialysis patients and the results of two Montreal Cognitive Assessment Scale(MoCA) tests were collected. The characteristics of cognitive function changes in patients in two years were analyzed,and the associated risk factors of cognitive function changes were analyzed by multiple linear regression method.ResultsA total of 103 patients were included in the study(67.0%). It was found that age,dialysis age and the prevalence rates of stroke and heart disease were higher in cognitive impairment group than those in normal group. And hemoglobin level,education and the scores of MoCA were significantly lower in cognitive impairment group than those in normal group(P<0.05). After two years,the scores of MoCA,visual space,executive function and delayed recall were significantly lowerthan those of baseline(P<0.05). Multivariate linear regression analysis showed that changes of MoCA were affected by age,education level,history of heart disease and dialysis age; changes of visual space and executive function were affected byage,education level and history of heart disease; and changes of delayed recall were affected by age,education level anddialysis age(all P<0.05).ConclusionCognitive function shows a significant downward trend during a two-year period inhemodialysis patients,which are mainly in the area of visual space,executive function and delayed recall. Older age,lowereducation,history of heart disease and longer dialysis age are risk factors for cognitive decline in these patients.
Objective To analyze the characteristics of cognitive function changes and its associated risk factors in hemodialysis patients.MethodsBaseline data of hemodialysis patients and the results of two Montreal Cognitive Assessment Scale(MoCA) tests were collected. The characteristics of cognitive function changes in patients in two years were analyzed,and the associated risk factors of cognitive function changes were analyzed by multiple linear regression method.ResultsA total of 103 patients were included in the study(67.0%). It was found that age,dialysis age and the prevalence rates of stroke and heart disease were higher in cognitive impairment group than those in normal group. And hemoglobin level,education and the scores of MoCA were significantly lower in cognitive impairment group than those in normal group(P<0.05). After two years,the scores of MoCA,visual space,executive function and delayed recall were significantly lowerthan those of baseline(P<0.05). Multivariate linear regression analysis showed that changes of MoCA were affected by age,education level,history of heart disease and dialysis age; changes of visual space and executive function were affected byage,education level and history of heart disease; and changes of delayed recall were affected by age,education level anddialysis age(all P<0.05).ConclusionCognitive function shows a significant downward trend during a two-year period inhemodialysis patients,which are mainly in the area of visual space,executive function and delayed recall. Older age,lowereducation,history of heart disease and longer dialysis age are risk factors for cognitive decline in these patients.
引文
[1]O’Lone E,Connors M,Masson P,et al.Cognition in people with end-stage kidney disease treated with hemodialysis:a systematic review and meta-analysis[J].Am J Kidney Dis,2016,67(6):925-935.doi:10.1053/j.ajkd.2015.12.028.
[2]Vanderlinden JA,Ross-White A,Holden R,et al.Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease:a systematic review and meta-analysis[J].Nephrology,2019,24(1):5-16.doi:10.1111/nep.13448.
[3]Goto NA,van Loon IN,Morpey MI,et al.Geriatric assessment in elderly patients with end-stage kidney disease[J].Nephron,2019,141(1):41-48.doi:10.1159/000494222.
[4]Madero M,Gul A,Sarnak MJ.Cognitive function in chronic kidney disease[J].Semin Dial,2008,21(1):29-37.doi:10.1111/j.1525-139x.2007.00384.x.
[5]Chen KL,Xu Y,Chu AQ,et al.Validation of the Chinese version of montreal cognitive assessment basic for screening mild cognitive impairment[J].J Am Geriatr Soc,2016,64:e285-e290.doi:10.1111/jgs.14530.
[6]Murray AM,Tupper DE,Knopman DS,et al.Cognitive impairment in hemodialysis patients is common[J].Neurology,2006,67(2):216-223.doi:10.1212/01.wnl.0000277706.91529.2b.
[7]Sarnak MJ,Tighiouart H,Scott TM,et al.Frequency of and risk factors for poor cognitive performance in hemodialysis patients[J].Neurology,2013,80(5):471-480.doi:10.1212/WNL.0b013e31827f0f7f.
[8]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.Guo JY,Li T,He YC.Analysis of cognitive impairment and relevant risk factors in maintained hemodialysis patients[J].Chinese Journal of Practical Nervous Diseases,2016,19(11):93-94.
[9]Jacqmin-Gadda H,Fabrigoule C,Commenges D,et al.A 5-year longitudinal study of the mini-mental state examination in normal aging[J].Am J Epidemiol,1997,145(6):498-506.doi:10.1016/s0197-4580(96)80223-5.
[10]Zhang YH,Yang ZK,Wang JW,et al.Cognitive changes in peritoneal dialysis patients:a multicenter prospective cohort study[J].Am J Kidney Dis,2018,72(5):691-700.doi:10.1053/j.ajkd.2018.04.020.
[11]Drew DA,Weiner DE,Tighiouart H,et al.Cognitive decline and its risk factors in prevalent hemodialysis patients[J].Am J Kidney Dis,2017,69(6):780-787.doi:10.1053/j.ajkd.2016.11.015.
[12]Drew DA,Bhadelia R,Tighiouart H,et al.Anatomic brain disease in hemodialysis patients:a cross-sectional study[J].Am J Kidney Dis,2013,61(2):271-278.doi:10.1053/j.ajkd.2012.08.035.
[13]Cheung AK,Sarnak MJ,Yan G,et al.Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients[J].Kidney Int,2000,58(1):353-362.doi:10.1046/j.1523-1755.2000.00173.x.
[14]Seliger SL,Gillen DL,Longstreth WTJ,et al.Elevated risk of stroke among patients with end-stage renal disease[J].Kidney Int,2003,64(2):603-609.doi:10.1046/j.1523-1755.2003.00101.x.
[15]Buckner RL.Memory and executive function in aging and AD:multiple factors that cause decline and reserve factors that compensate[J].Neuron,2004,44(1):195-208.doi:10.1016/j.neuron.2004.09.006.
[16]McAdams-DeMarco MA,Tan J,Salter ML,et al.Frailty and cognitive function in incident hemodialysis patients[J].Clin J Am Soc Nephrol,2015,10(12):2181-2189.doi:10.2215/cjn.01960215.
[17]Weiner DE,Scott TM,Giang LM,et al.Cardiovascular disease and cognitive function in maintenance hemodialysis patients[J].Am JKidney Dis,2011,58(5):773-781.doi:10.1053/j.ajkd.2011.03.034.2019-01-232019-04-19
[2]Vanderlinden JA,Ross-White A,Holden R,et al.Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease:a systematic review and meta-analysis[J].Nephrology,2019,24(1):5-16.doi:10.1111/nep.13448.
[3]Goto NA,van Loon IN,Morpey MI,et al.Geriatric assessment in elderly patients with end-stage kidney disease[J].Nephron,2019,141(1):41-48.doi:10.1159/000494222.
[4]Madero M,Gul A,Sarnak MJ.Cognitive function in chronic kidney disease[J].Semin Dial,2008,21(1):29-37.doi:10.1111/j.1525-139x.2007.00384.x.
[5]Chen KL,Xu Y,Chu AQ,et al.Validation of the Chinese version of montreal cognitive assessment basic for screening mild cognitive impairment[J].J Am Geriatr Soc,2016,64:e285-e290.doi:10.1111/jgs.14530.
[6]Murray AM,Tupper DE,Knopman DS,et al.Cognitive impairment in hemodialysis patients is common[J].Neurology,2006,67(2):216-223.doi:10.1212/01.wnl.0000277706.91529.2b.
[7]Sarnak MJ,Tighiouart H,Scott TM,et al.Frequency of and risk factors for poor cognitive performance in hemodialysis patients[J].Neurology,2013,80(5):471-480.doi:10.1212/WNL.0b013e31827f0f7f.
[8]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.Guo JY,Li T,He YC.Analysis of cognitive impairment and relevant risk factors in maintained hemodialysis patients[J].Chinese Journal of Practical Nervous Diseases,2016,19(11):93-94.
[9]Jacqmin-Gadda H,Fabrigoule C,Commenges D,et al.A 5-year longitudinal study of the mini-mental state examination in normal aging[J].Am J Epidemiol,1997,145(6):498-506.doi:10.1016/s0197-4580(96)80223-5.
[10]Zhang YH,Yang ZK,Wang JW,et al.Cognitive changes in peritoneal dialysis patients:a multicenter prospective cohort study[J].Am J Kidney Dis,2018,72(5):691-700.doi:10.1053/j.ajkd.2018.04.020.
[11]Drew DA,Weiner DE,Tighiouart H,et al.Cognitive decline and its risk factors in prevalent hemodialysis patients[J].Am J Kidney Dis,2017,69(6):780-787.doi:10.1053/j.ajkd.2016.11.015.
[12]Drew DA,Bhadelia R,Tighiouart H,et al.Anatomic brain disease in hemodialysis patients:a cross-sectional study[J].Am J Kidney Dis,2013,61(2):271-278.doi:10.1053/j.ajkd.2012.08.035.
[13]Cheung AK,Sarnak MJ,Yan G,et al.Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients[J].Kidney Int,2000,58(1):353-362.doi:10.1046/j.1523-1755.2000.00173.x.
[14]Seliger SL,Gillen DL,Longstreth WTJ,et al.Elevated risk of stroke among patients with end-stage renal disease[J].Kidney Int,2003,64(2):603-609.doi:10.1046/j.1523-1755.2003.00101.x.
[15]Buckner RL.Memory and executive function in aging and AD:multiple factors that cause decline and reserve factors that compensate[J].Neuron,2004,44(1):195-208.doi:10.1016/j.neuron.2004.09.006.
[16]McAdams-DeMarco MA,Tan J,Salter ML,et al.Frailty and cognitive function in incident hemodialysis patients[J].Clin J Am Soc Nephrol,2015,10(12):2181-2189.doi:10.2215/cjn.01960215.
[17]Weiner DE,Scott TM,Giang LM,et al.Cardiovascular disease and cognitive function in maintenance hemodialysis patients[J].Am JKidney Dis,2011,58(5):773-781.doi:10.1053/j.ajkd.2011.03.034.2019-01-232019-04-19