维持性血液透析患者认知功能损害及危险因素的临床调查
发布时间：2018-10-30 18:28
【摘要】：背景与目的：维持性血液透析患者更易发生认知功能损害,严重的认知功能损害与血液透析患者的高死亡率、终止透析,住院率,致残等不良预后密切相关。同时,我可们可以通过认知功能水平评估患者的脑功能状态,及时发现问题。认知功能损害增加了患者的死亡风险。国内目前对于维持性血液透析患者认知功能状态的研究开展较少。本研究旨在初步调查维持性血液透析人群的认知功能状态并探讨其相关危险因素。 对象与方法：本研究为横断面调查研究。于2012年1月-2012年3月间对在河北医科大学第三医院行维持性血液透析治疗患者71例,其中原发病疾病为慢性肾小球肾炎28例(39.4%),糖尿病肾病11例(15.5%),高血压肾损害9例(12.7%)；年龄在22～83岁之间,平均53.1±15.8岁；其中男性37例(52.1%),女性34例(47.9%)；透析时间在4～140月之间,平均透析时间在4～140月之间,平均39.7±29.6月月。 记录71例参与者性别、年龄、透析龄、原发病、既往病史等个人信息,并连续记录10次透析前血压、透析过程中血压变化。神经心理学测试部分采用蒙特利尔量表中文版评估其认知功能(受教育年限小于12年者加1分,总分26分认为存在认知功能损害),由同一调查员依据标准指导语,对受试对象进行神经心理学量表测试,准确记录结果。所有量表完成时间均为患者接受透析治疗前。实验室检查部分血样采集时间均为患者行血液透析治疗前。影像学检查部分患者行侧位腹平片检查,观察腹主动脉钙化情况,由影像科医师按照国外评分标准进行血管钙化评分。 结果：71例患者全部完成了量表,平均得分为22.9±4.3,其中45例量表得分小于26分,26例得分大于(含)26分,故本研究认知功能损害发生情况为63.4%。将患者分为认知功能损害组与无认知功能损害组,首先进行单因素分析,两组间,参与者年龄构成、受教育时间、透析过程中最低舒张压、原发病中糖尿病肾病比例存在明显差异,P均小于0.05,有统计学意义；性别构成、血清白蛋白水平存在差异,但0.05P0.10,结果趋于有统计学意义。而两组间透析龄、腹主动脉钙化水平、血红蛋白水平、透析前血压水平、透析过程中血压变化幅度、脑血管意外病史、体重指数等因素的差异,P0.10,无统计学意义。然后将有或趋于有统计学意义的影响因素进行多重逐步回归分析,最终女性(OR=3.542,P0.05)和低文化水平(OR=-O.803,P0.05)被确定为认知损害的独立危险因素。 结论：在维持性血液透析患者中,认知功能损害普遍存在,女性较男性更易发生认知功能损害,且受教育时间越短,发生认知功能损害的可能越大。
[Abstract]:Background & objective: maintenance hemodialysis patients are more prone to cognitive impairment. The severe cognitive impairment is closely related to the high mortality rate, termination of dialysis, hospitalization rate, disability and other adverse prognosis of hemodialysis patients. At the same time, we can assess the cognitive function of patients with brain function state, timely detection of problems. Cognitive impairment increases the risk of death. There are few studies on cognitive function of maintenance hemodialysis patients in China. The aim of this study was to investigate the cognitive status and risk factors of maintenance hemodialysis population. Objects and methods: this study is a cross-sectional investigation. From January 2012 to March 2012, 71 patients were treated with maintenance hemodialysis in the third Hospital of Hebei Medical University. The primary diseases were chronic glomerulonephritis in 28 cases (39.4%) and diabetic nephropathy in 11 cases (15.5%). Renal damage was found in 9 cases (12.7%). The average age was 53.1 卤15.8 years old, 37 cases were male (52.1%), 34 cases were female (47.9%). The dialysis time was 4 ~ 140 months and the average dialysis time was 4 ~ 140 months, with an average of 39.7 卤29.6 months. Sex, age, age of dialysis, primary disease, medical history and other personal information were recorded in 71 participants, and blood pressure was recorded before dialysis for 10 times, and the blood pressure was changed during dialysis. The Chinese version of the Montreal scale was used to assess the cognitive function of the neuropsychological test (those with less than 12 years of education plus 1 score, with a total score of 26 points) were assessed by the same investigator according to the standard guidance language. The subjects were tested with neuropsychological scale and the results were recorded accurately. The completion time of all scales was before dialysis treatment. Some blood samples were collected before hemodialysis treatment. Part of the patients underwent lateral plain radiography to observe the calcification of the abdominal aorta, and the vascular calcification score was evaluated by the radiologist according to the foreign scoring standard. Results: all 71 patients completed the scale, with an average score of 22.9 卤4.3, in which 45 patients had a score of less than 26 and 26 patients had a score greater than 26. Therefore, the incidence of cognitive impairment in this study was 63.4%. The patients were divided into two groups: cognitive impairment group and non-cognitive impairment group. There was significant difference in the proportion of primary diabetic nephropathy (P < 0.05). Gender composition, serum albumin level was different, but 0.05 P 0.10, the result tended to have statistical significance. However, there were no significant differences in dialysis age, abdominal aortic calcification level, hemoglobin level, blood pressure level before dialysis, changes in blood pressure during dialysis, cerebrovascular accident history and body mass index between the two groups (P0.10). Then multiple stepwise regression analysis was carried out on the influential factors which had or tended to be statistically significant. Finally, women (OR=3.542,P0.05) and low educational level (OR=-O.803,P0.05) were identified as independent risk factors for cognitive impairment. Conclusion: cognitive impairment is common in maintenance hemodialysis patients. Women are more likely to suffer from cognitive impairment than men, and the shorter the time of education, the greater the likelihood of cognitive impairment.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
[Abstract]:Background & objective: maintenance hemodialysis patients are more prone to cognitive impairment. The severe cognitive impairment is closely related to the high mortality rate, termination of dialysis, hospitalization rate, disability and other adverse prognosis of hemodialysis patients. At the same time, we can assess the cognitive function of patients with brain function state, timely detection of problems. Cognitive impairment increases the risk of death. There are few studies on cognitive function of maintenance hemodialysis patients in China. The aim of this study was to investigate the cognitive status and risk factors of maintenance hemodialysis population. Objects and methods: this study is a cross-sectional investigation. From January 2012 to March 2012, 71 patients were treated with maintenance hemodialysis in the third Hospital of Hebei Medical University. The primary diseases were chronic glomerulonephritis in 28 cases (39.4%) and diabetic nephropathy in 11 cases (15.5%). Renal damage was found in 9 cases (12.7%). The average age was 53.1 卤15.8 years old, 37 cases were male (52.1%), 34 cases were female (47.9%). The dialysis time was 4 ~ 140 months and the average dialysis time was 4 ~ 140 months, with an average of 39.7 卤29.6 months. Sex, age, age of dialysis, primary disease, medical history and other personal information were recorded in 71 participants, and blood pressure was recorded before dialysis for 10 times, and the blood pressure was changed during dialysis. The Chinese version of the Montreal scale was used to assess the cognitive function of the neuropsychological test (those with less than 12 years of education plus 1 score, with a total score of 26 points) were assessed by the same investigator according to the standard guidance language. The subjects were tested with neuropsychological scale and the results were recorded accurately. The completion time of all scales was before dialysis treatment. Some blood samples were collected before hemodialysis treatment. Part of the patients underwent lateral plain radiography to observe the calcification of the abdominal aorta, and the vascular calcification score was evaluated by the radiologist according to the foreign scoring standard. Results: all 71 patients completed the scale, with an average score of 22.9 卤4.3, in which 45 patients had a score of less than 26 and 26 patients had a score greater than 26. Therefore, the incidence of cognitive impairment in this study was 63.4%. The patients were divided into two groups: cognitive impairment group and non-cognitive impairment group. There was significant difference in the proportion of primary diabetic nephropathy (P < 0.05). Gender composition, serum albumin level was different, but 0.05 P 0.10, the result tended to have statistical significance. However, there were no significant differences in dialysis age, abdominal aortic calcification level, hemoglobin level, blood pressure level before dialysis, changes in blood pressure during dialysis, cerebrovascular accident history and body mass index between the two groups (P0.10). Then multiple stepwise regression analysis was carried out on the influential factors which had or tended to be statistically significant. Finally, women (OR=3.542,P0.05) and low educational level (OR=-O.803,P0.05) were identified as independent risk factors for cognitive impairment. Conclusion: cognitive impairment is common in maintenance hemodialysis patients. Women are more likely to suffer from cognitive impairment than men, and the shorter the time of education, the greater the likelihood of cognitive impairment.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1
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