慢性肾脏病患者认知功能状况及危险因素

doi:10.3969/j.issn.1006-7795.2023.05.013

摘要/Abstract

摘要： 目的探讨慢性肾脏病（chronic kidney disease, CKD）患者认知功能水平及其危险因素。方法收集首都医科大学附属北京天坛医院肾内科就诊的患者132例，根据CKD临床实践指南，计算得出估算肾小球滤过率（estimated glomerular filtration rate, eGFR），据此分为健康组［eGFR≥90 mL·min^－1·(1.73 m2)^-1，25例］，轻度CKD组［eGFR≥60 mL·min^－1·(1.73 m2)^-1，51例］，中/重度CKD组［eGFR<60 mL·min^－1·(1.73 m2)^-1，34例］和CKD血液透析组（22例）。患者平均年龄为（55.3 ± 14.0）岁，中位eGFR为94.0 mL·min^-1·(1.73 m2)^-1。比较4组患者的临床特征，应用蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）进行认知功能评价。此外，对入组患者行睡眠呼吸监测，包含睡眠暂停低通气指数（apnea hypopnea index, AHI）和氧减指数（oxygen reduction index, ODI），使用Morpheus Ox软件进行统计。采用方差分析及卡方检验进行组间比较，多因素分析采用Logistic回归模型，分析认知障碍相关的危险因素。结果与肾功能正常人群相比，随着肾脏受损及肾功能恶化，MoCA评分降低，且其中执行功能评分下降更为明显，差异均有统计学意义（P<0.01）。多因素Logistic回归分析提示，低血红蛋白（OR=0.97,95%CI：0.95~0.99）和高龄（OR=1.10,95%CI：1.05~1.15）可能是引起认知障碍的危险因素。结论随着eGFR水平的下降，CKD患者出现认知功能障碍，其临床表现较为严重，低血红蛋白和高龄可能是认知障碍发生的危险因素。

关键词: 认知功能, 慢性肾脏病, 估算肾小球滤过率, 蒙特利尔认知评估量表

Abstract: Objective To evaluate cognitive function and potential risk factors in patients with chronic kidney disease (CKD). Methods Totally 132 patients from Beijing Tiantan Hospital, Capital Medical University were included in this study, and they were divided into four groups according to CKD criteria and estimated glomerular filtration rate (eGFR) levels: healthy participants (n=25), mild CKD ［(eGFR ≥ 60 mL·min^-1·(1.73 m2)^-1］ group (n=51), moderate to severe CKD ［eGFR<60 mL·min-1·(1.73 m2)^-1］ group (n=34), and CKD hemodialysis group (n=22). The participants had a median eGFR of 94.0 mL·min^-1·(1.73 m2)^-1, with an average age of (55.3 ± 14.0) years. Clinical characteristics of the patients were compared between 4 groups. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA). Furthermore, sleep breathing monitoring was performed on the included participants, including sleep apnea Hypopnea index (AHI) and oxygen reduction index (ODI), The statistical analysis was done with morpheus ox software. Analysis of variance and Chi-squared test were used to compare differences between groups. The correlation and cognitive-related risk factors were determined by logistic regression analysis. Results Compared with healthy control group, MoCA scores decreased with renal function deterioration, and the impairment of executive function was more severe (P<0.01). The multivariate logistic regression analysis results suggested that low hemoglobin (OR＝0.97, 95% CI： 0.95-0.99) and age (OR＝1.10, 95% CI： 1.05-1.15) might be risk factors for cognitive impairment in CKD patients. Conclusions CKD patients might show cognitive impairment with a decrease of eGFR levels, and clinical symptoms could be more severe in these patients. Low hemoglobin and age may be risk factors accounting for cognitive impairment in CKD patients.

Key words: cognitive function, chronic kidney disease, estimated glomerular filtration rate, Montreal Cognitive Assessment

中图分类号:

R692

封怡多, 黄琪, 周亦伦 . 慢性肾脏病患者认知功能状况及危险因素[J]. 首都医科大学学报, 2023, 44(5): 788-794.

Feng Yiduo, Huang Qi, Zhou Yilun. Cognitive function and risk factors in patients with chronic kidney disease[J]. Journal of Capital Medical University, 2023, 44(5): 788-794.

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