维持性血液透析患者认知功能障碍及其危险因素分析(1)
摘要：目的 探讨维持性血液透析(MHD)患者认知功能障碍发生情况及其危险因素。方法 选择2019年5～7月我院101例血液透析患者作为研究对象，根据蒙特利尔认知量表(MoCA)评分将其分为认知功能损伤组及认知功能正常组，通过二元Logistic回归分析患者认知功能障碍的危险因素，绘制ROC曲线评价实验室指标对MHD患者认知功能损伤的预测效能。结果 101例患者中认知功能损伤组62例，认知功能正常组39例，认知功能损伤患病率为61.38%;两组年龄、受教育年限、有无糖尿病、透析龄、血红蛋白(HB)、血清白蛋白、25羟维生素D及MoCA评分比较，差异有统计学意义(P<0.05)。Logistic回归分析显示年龄、受教育年限、糖尿病、透析龄、HB及25羟维生素D均与认知功能障礙有关。ROC曲线分析显示，HB为99.5 g/L时，其诊断MHD患者认知损伤的敏感度和特异度分别为84.58%、69.43%，曲线下面积为0.835(95%CI：0.759～0.913);当25羟维生素D为17.95 ng/ml 时，其诊断MHD患者认知损伤的敏感度和特异度分别为79.53%、51.59%，曲线下面积为0.653(95%CI：0.542～0.765)。结论 认知功能损伤在MHD患者中所占比率较高，年龄、透析龄、糖尿病、受教育程度与患者发生认知功能障碍相关，贫血、25羟维生素D缺乏是认知功能损伤的独立危险因素。
关键词：血液透析;认知功能障碍;贫血;25羟维生素D
中图分类号：R459.5 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.09.028
文章编号：1006-1959(2020)09-0096-03
Analysis of Cognitive Dysfunction and Risk Factors in Maintenance Hemodialysis Patients
YANG Jie，LIU Yong-mei
(Department of Nephrology，Chaohu Hospital，Anhui Medical University，Chaohu 238000，Anhui，China)
Abstract：Objective To explore the occurrence and risk factors of cognitive dysfunction in patients with maintenance hemodialysis (MHD).Methods 101 cases of hemodialysis patients in our hospital from May to July 2019 were selected as the research object， and they were divided into cognitive impairment group and normal cognitive function group according to the Montreal Cognitive Scale (MoCA) score， through binary Logistic regression analyze the risk factors of patients' cognitive dysfunction and draw ROC curve to evaluate the predictive effect of laboratory indicators on cognitive impairment of MHD patients.Results Among the 101 patients， 62 were in the cognitive impairment group and 39 in the normal cognitive function group. The prevalence of cognitive impairment was 61.38%; the age， years of education， diabetes， dialysis age， and hemoglobin (HB) ， Serum albumin， 25-hydroxyvitamin D and MoCA scores were compared， the difference was statistically significant(P<0.05). Logistic regression analysis showed that age， years of education， diabetes， dialysis age， HB and 25-hydroxyvitamin D were all related to cognitive impairment. ROC curve analysis showed that when HB was 99.5 g/L， the sensitivity and specificity for the diagnosis of cognitive impairment in MHD patients were 84.58% and 69.43%， respectively， and the area under the curve was 0.835(95%CI：0.759～0.913); When the 25-hydroxyvitamin D was 17.95 ng/ml， the sensitivity and specificity of the diagnosis of cognitive impairment in MHD patients were 79.53% and 51.59%， respectively， and the area under the curve was 0.653 (95%CI：0.542～0.765).Conclusion Cognitive impairment is higher in patients with MHD. Age， dialysis age， diabetes， and education level are associated with cognitive dysfunction.Anemia and 25-hydroxyvitamin D deficiency are independent risk factors for cognitive impairment., 百拇医药(杨杰 刘永梅)
关键词：血液透析;认知功能障碍;贫血;25羟维生素D
中图分类号：R459.5 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.09.028
文章编号：1006-1959(2020)09-0096-03
Analysis of Cognitive Dysfunction and Risk Factors in Maintenance Hemodialysis Patients
YANG Jie，LIU Yong-mei
(Department of Nephrology，Chaohu Hospital，Anhui Medical University，Chaohu 238000，Anhui，China)
Abstract：Objective To explore the occurrence and risk factors of cognitive dysfunction in patients with maintenance hemodialysis (MHD).Methods 101 cases of hemodialysis patients in our hospital from May to July 2019 were selected as the research object， and they were divided into cognitive impairment group and normal cognitive function group according to the Montreal Cognitive Scale (MoCA) score， through binary Logistic regression analyze the risk factors of patients' cognitive dysfunction and draw ROC curve to evaluate the predictive effect of laboratory indicators on cognitive impairment of MHD patients.Results Among the 101 patients， 62 were in the cognitive impairment group and 39 in the normal cognitive function group. The prevalence of cognitive impairment was 61.38%; the age， years of education， diabetes， dialysis age， and hemoglobin (HB) ， Serum albumin， 25-hydroxyvitamin D and MoCA scores were compared， the difference was statistically significant(P<0.05). Logistic regression analysis showed that age， years of education， diabetes， dialysis age， HB and 25-hydroxyvitamin D were all related to cognitive impairment. ROC curve analysis showed that when HB was 99.5 g/L， the sensitivity and specificity for the diagnosis of cognitive impairment in MHD patients were 84.58% and 69.43%， respectively， and the area under the curve was 0.835(95%CI：0.759～0.913); When the 25-hydroxyvitamin D was 17.95 ng/ml， the sensitivity and specificity of the diagnosis of cognitive impairment in MHD patients were 79.53% and 51.59%， respectively， and the area under the curve was 0.653 (95%CI：0.542～0.765).Conclusion Cognitive impairment is higher in patients with MHD. Age， dialysis age， diabetes， and education level are associated with cognitive dysfunction.Anemia and 25-hydroxyvitamin D deficiency are independent risk factors for cognitive impairment., 百拇医药(杨杰 刘永梅)