慢性肾脏病不同分期患者认知功能障碍的相关性研究(1)
【摘要】 目的 研究慢性腎脏病(CKD)与患者认知功能障碍(CI)的相关性，探讨早期预防CI发生，延缓其向痴呆进展的方法。 方法 选取右江民族医学院附属医院门诊体检健康者36例，为健康对照组(A组)，另选取在右江民族医学院附属医院肾内科住院符合诊断标准的124例CKD患者，根据肾小球滤过率(GFR)分为三组：CKD1～2期组(B组，n=36)、CKD3～4期组(C组，n=59)、CKD5期非透析组(D组，n=29)，记录所有入选者的Scr、GFR、Hcy、UA、β2-MG、Ca、P、Hb、Alb、TG、TC、HDL、LDL、VLDL等检验指标。运用蒙特利尔(MoCA)认知评估量表对所有入选者的认知功能进行评分并记录。分析正常人与CKD患者发生CI的情况以及不同分期CKD患者发生CI的情况，寻找CKD患者发生CI的危险因素及保护因素，提出预防及延缓CKD患者发生CI的方法。结果 (1)使用秩和检验对四组的GFR及MoCA评分进行分析，随着肾功能下降，MoCA评分下降，四组的MoCA评分比较差异有统计学意义(P<0.01)，组间两两比较，B组与A组，C组与D组比较差异无统计学意义(P>0.05)。使用χ2检验对四组的CI进行分析，四组的CI发生率比较差异有统计学意义(P<0.01)，CKD患者普遍存在CI，随着肾功能下降，CKD患者CI发生率逐渐增加，但C组与D组CI发生率比较差异无统计学意义(P>0.05)。(2)使用方差分析对四组的各检验指标进行分析，结果显示：Scr、Hcy、UA、β2-MG、Ca、P、Hb、Alb、TG、TC、HDL、VLDL比较差异均有统计学意义(P<0.01)，LDL比较差异无统计学意义(P>0.05)。随着肾功能下降，CKD患者体内Scr、Hcy、UA、β2-MG、P、TG、TC、VLDL水平有上升趋势，Hb、Alb、Ca水平则有下降趋势。(3)使用单因素分析对一般资料及各检验指标进行分析，将有统计学意义的Scr、GFR、β2-MG、UA、Ca、Alb、TC、Hb、P、Hcy、TG纳入二元Logistic回归分析，结果显示Hb、P、Hcy、TG差异有统计学意义(P<0.05或0.01)，Scr、GFR、β2-MG、UA、Ca、Alb、TC差异无统计学意义(P>0.05)；P、Hcy、TG是CKD患者发生CI的危险因素，Hb是CKD患者发生CI的保护因素。结论 与普通人群相比，CKD患者更容易发生CI，且随着肾功能下降CI发生率升高；高TG、高Hcy、高P、低Hb是CKD患者发生CI的危险因素。
【关键词】 慢性肾脏病；认知功能障碍；相关性
中图分类号：R692 文献标识码：A DOI：10.3969/j.issn.1003-1383.2018.03.006
【Abstract】 Objective To study correlation between chronic kidney disease (CKD) and cognitive impairment (CI)，so as to explore the methods of early prevention of cognitive dysfunction and to delay its progression to dementia.Methods 36 persons who underwent healthy physical examination from outpatient clinics of the Affiliated Hospital of Youjiang Medical University for Nationalities were selected as health control group(group A).124 CKD patients who were hospitalized in the Renal Department of the Affiliated Hospital of Youjiang Medical University for Nationalities were divided into the following three groups according to glomerular filtration rate (GFR)：CKD 1 to 2 stage group (group B，n=36)，CKD 3 to 4 stage group (group C，n=59)，CKD 5 stage with non-dialysis group (group D，n=29).And then，test indexes including Scr，GFR，Hcy，UA，β2-MG，Ca，P，Hb，Alb，TG，TC，HDL，LDL and VLDL of all participants were recorded.And montreal cognitive assessment(MoCA)scale was used to evaluate and record the cognitive function of all the participants.In addition，the occurrence of CI in normal persons and patients with CKD at different stages was analyzed，and the risk factors and protective factors of CI in patients with CKD were found out to propose methods to prevent and delay the occurrence of CI in patients with CKD.Results (1) The GFR and MoCA scores of the four groups were analyzed by rank sum test.The MoCA score decreased with the decline of renal function，difference in MoCA scores among the four groups was statistically significant(P<0.01).Pairwise comparison showed that difference between the group B and the group A as well as that between the group C and the group D was not statistically significant(P>0.05).The CI incidence of the four groups was analyzed by χ2 test，and there was statistically significant difference in CI incidence among the four groups (P<0.01).CI was prevalent in CKD patients，the incidence gradually increased with the decrease of renal function，but there was no statistically significant difference in CI incidence between the group C and the group D(P>0.05).(2) The analysis of the test indexes of the four groups by variance analysis showed that the difference of Scr，Hcy，UA， β2-MG，Ca，P，Hb，Alb，TG，TC，HDL and VLDL was statistically significant(P<0.01)，but the difference of LDL was not statistically significant(P>0.05).With the decrease of renal function in patients with CKD，the levels of Scr，Hcy，UA，β2-MG，P，TG，TC and VLDL increased and the levels of HB，Alb and Ca decreased.(3) General data and test indexes were analyzed by univariate analysis.Scr，GFR，β2-MG，UA，Ca，Alb，TC，Hb，P，Hcy and TG with statistical significance were included in binary Logistic regression analysis，which showed that the difference of Hb，P，Hcy and TG was statistically significant(P<0.05 or 0.001)，and the difference of Scr，GFR，β2-MG，UA，Ca，Alb and TC was not statistically significant(P>0.05).In addition，P，Hcy and TG were risk factors of CI for CKD patients，and Hb was the protective factor of CI in patients with CKD.Conclusion Compared with general people，CI was more likely to occur in patients with CKD，and the incidence of CI increases with the decline of renal function，and high TG，high Hcy，high P and low Hb are the risk factors of CI in CKD patients., http://www.100md.com(甘文倩 王洁 李雪斌 黄美莺 马瑞英 杨彩梅)
【关键词】 慢性肾脏病；认知功能障碍；相关性
中图分类号：R692 文献标识码：A DOI：10.3969/j.issn.1003-1383.2018.03.006
【Abstract】 Objective To study correlation between chronic kidney disease (CKD) and cognitive impairment (CI)，so as to explore the methods of early prevention of cognitive dysfunction and to delay its progression to dementia.Methods 36 persons who underwent healthy physical examination from outpatient clinics of the Affiliated Hospital of Youjiang Medical University for Nationalities were selected as health control group(group A).124 CKD patients who were hospitalized in the Renal Department of the Affiliated Hospital of Youjiang Medical University for Nationalities were divided into the following three groups according to glomerular filtration rate (GFR)：CKD 1 to 2 stage group (group B，n=36)，CKD 3 to 4 stage group (group C，n=59)，CKD 5 stage with non-dialysis group (group D，n=29).And then，test indexes including Scr，GFR，Hcy，UA，β2-MG，Ca，P，Hb，Alb，TG，TC，HDL，LDL and VLDL of all participants were recorded.And montreal cognitive assessment(MoCA)scale was used to evaluate and record the cognitive function of all the participants.In addition，the occurrence of CI in normal persons and patients with CKD at different stages was analyzed，and the risk factors and protective factors of CI in patients with CKD were found out to propose methods to prevent and delay the occurrence of CI in patients with CKD.Results (1) The GFR and MoCA scores of the four groups were analyzed by rank sum test.The MoCA score decreased with the decline of renal function，difference in MoCA scores among the four groups was statistically significant(P<0.01).Pairwise comparison showed that difference between the group B and the group A as well as that between the group C and the group D was not statistically significant(P>0.05).The CI incidence of the four groups was analyzed by χ2 test，and there was statistically significant difference in CI incidence among the four groups (P<0.01).CI was prevalent in CKD patients，the incidence gradually increased with the decrease of renal function，but there was no statistically significant difference in CI incidence between the group C and the group D(P>0.05).(2) The analysis of the test indexes of the four groups by variance analysis showed that the difference of Scr，Hcy，UA， β2-MG，Ca，P，Hb，Alb，TG，TC，HDL and VLDL was statistically significant(P<0.01)，but the difference of LDL was not statistically significant(P>0.05).With the decrease of renal function in patients with CKD，the levels of Scr，Hcy，UA，β2-MG，P，TG，TC and VLDL increased and the levels of HB，Alb and Ca decreased.(3) General data and test indexes were analyzed by univariate analysis.Scr，GFR，β2-MG，UA，Ca，Alb，TC，Hb，P，Hcy and TG with statistical significance were included in binary Logistic regression analysis，which showed that the difference of Hb，P，Hcy and TG was statistically significant(P<0.05 or 0.001)，and the difference of Scr，GFR，β2-MG，UA，Ca，Alb and TC was not statistically significant(P>0.05).In addition，P，Hcy and TG were risk factors of CI for CKD patients，and Hb was the protective factor of CI in patients with CKD.Conclusion Compared with general people，CI was more likely to occur in patients with CKD，and the incidence of CI increases with the decline of renal function，and high TG，high Hcy，high P and low Hb are the risk factors of CI in CKD patients., http://www.100md.com(甘文倩 王洁 李雪斌 黄美莺 马瑞英 杨彩梅)