摘要
目的比较维持性血液透析(血透)与腹膜透析(腹透)患者认知功能的差异,评价透析模式对认知功能的影响。方法本研究为横断面研究,纳入2013年7月至2014年7月本院规律透析患者,采用多种认知量表评估认知功能及核磁共振检查评价脑小血管病变。结果共入选189例患者,包括血透122例及腹透67例。两组患者年龄差异无统计学意义[(56.4±13.2)岁比(56.4±16.1)岁,t=0.004,P=0.997],血透患者的透析龄、血白蛋白水平高于腹透患者[58.0(16.8,107.5)个月比31.0(7.0,67.0)个月,Z=-3.490,P<0.001;(39.6±3.9)g/L比(35.3±3.8)g/L,t=7.328,P<0.001]。两组患者的脑小血管病患病率差异无统计学意义(均P>0.05)。二分类Logistic回归分析结果显示,腹透患者的即时记忆损害、长期延迟记忆障碍风险分别是血透患者的11.90倍及6.18倍(95%CI 1.40~101.08,P=0.023;95%CI 2.12~18.05,P=0.001),校正年龄、教育水平、透析龄、血肌酐及脑小血管病后上述趋势仍然存在。腹透患者的执行功能障碍风险是血透患者的43%(OR=0.43,95%CI 0.17~1.04,P=0.061)。结论本研究中腹透患者的记忆功能差于血透患者,而腹透患者执行功能可能优于血透患者,两组的语言功能没有显著差异,认知功能间的差别尚未发现受脑小血管病影响。
Objective To evaluate whether dialysis modality will affect cognitive function in dialysis population.Methods This was a cross-sectional study.Chronic dialysis patients in our center was screened from July 2013 to July 2014.All of the subjects received brain magnetic resonance imaging(MRI)examination and comprehensive cognitive function evaluation.Results A total of 189 chronic dialysis patients were enrolled in this study,122 cases on hemodialysis(HD)and 67 cases on peritoneal dialysis(PD).There was no significant difference in age between HD and PD groups[(56.4±13.2)years vs(56.4±16.1)years,t=0.004,P=0.997].The dialysis vintage and serum albumin of HD patients was higher than those of PD patients[58.0(16.8,107.5)months vs 31.0(7.0,67.0)months,Z=-3.490,P<0.001;(39.6±3.9)g/L vs(35.3±3.8)g/L,t=7.328,P<0.001,respectively].The prevalence of cerebral small vessel diseases(CSVDs)was comparable between HD and PD groups(all P>0.05).Compared with HD patients,PD patients presented a 11.90-fold risk of immediate memory impairment(95%CI 1.40-101.08,P=0.023)and a 6.18-fold risk of long-delayed memory impairment(95%CI 2.12-18.05,P=0.001).After adjusting for age,educational lever,dialysis vintage,serum creatinine,and CSVDs,the influence of dialysis modality on memory still worked.PD patients presented a 43%risk of executive function impairment of HD patients(OR=0.43,95%CI 0.17-1.04,P=0.061).Conclusions HD patients manifested better memory than PD patients,while PD probably performed better in executive function than HD patients.There was no significant difference in language function between the two groups.The difference in cognitive function may not be related to CSVDs.
作者
钱玉珺
杨建萍
侯波
有慧
韩菲
袁晶
朱以诚
冯逢
郑可
陈丽萌
李雪梅
Qian Yujun;Yang Jianping;Hou Bo;You Hui;Han Fei;Yuan Jing;Zhu Yicheng;Feng Feng;Zheng Ke;Chen Limeng;Li Xuemei(Department of Nephrology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Nephrology,Clinical Center at Beijing Road,Xinjiang Military Region General Hospital,Urumqi 830011,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2020年第9期657-665,共9页
Chinese Journal of Nephrology
基金
中国肾脏病学青年医师研究基金。
关键词
腹膜透析
肾透析
认知功能障碍
脑小血管病
Peritoneal dialysis
Renal dialysis
Cognitive dysfunction
Cerebral small vessel disease
