CAJ | 학술논문

目的了解规律性血液透析(血透)患者脑部损害情况,包括脑血管病变及种类与认知功能的改变,分析其潜在的影响因素.方法病例来自北京协和医院的血透患者230例,最终入组117例.采用横断面调查方法.调查和分析患者人口学、透析充分性、头颅磁共振图像(MRI)、磁共振血管成像(MRA)等资料.应用简易精神状态检查量表(C-MMSE)及蒙特利尔认知评估量表(C-MoCA量表)评估患者的认知状况.Spearman分析、logistic回归或多元线性回归法分析患者脑部损害的影响因素.结果患者平均年龄(56.0±12.5)岁,透析龄(73.5±60.8)个月.既往有脑梗死及脑出血病史者均为5.1％;透析中出现需要处理的低血压者占16.2％;单池尿素清除率(spKt/V)为(1.45±0.25).头部核磁检查结果:脑动脉狭窄者占12.0％,皮层梗死者5.1％,慢性期血肿7.7％,腔梗者占39.3％,微出血占47.0％,脑白质异常信号者52.1％.C-MMSE评分异常者占20.9％,C-MOCA评分异常者占65.2％.多元线性回归分析显示,年龄(b=0.059,P＜0.01)及透析龄(b=0.005,P＜0.05)是脑白质病变(WMLs)的影响因素.透析中低血压是血透患者腔梗(b=2.123,P＜ 0.01)、微出血(b=3.531,P＜ 0.01)的独立危险因素.血清白蛋白水平低是透析患者认知评分下降的独立危险因素(b=0.314,P＜0.05).logistic回归分析显示,透析前收缩压(SBP)是皮层梗死的独立危险因素[OR=1.088,95％CI(1.018～1.152),P＜0.05].性别、透析年限、透析前血清总二氧化碳(TCO2)与慢性期血肿密切相关.结论血透患者脑白质病变重、脑微出血及腔隙性梗塞等患病率高,认知能力下降.WMLs与透析龄相关;腔梗及微出血病灶与透析中低血压相关;腔隙性梗塞、WMLs及营养状况与患者认知能力下降有关.
목적 료해규률성혈액투석(혈투)환자뇌부손해정황,포괄뇌혈관병변급충류여인지공능적개변,분석기잠재적영향인소.방법 병례래자북경협화의원적혈투환자230례,최종입조117례.채용횡단면조사방법.조사화분석환자인구학、투석충분성、두로자공진도상(MRI)、자공진혈관성상(MRA)등자료.응용간역정신상태검사량표(C-MMSE)급몽특리이인지평고량표(C-MoCA량표)평고환자적인지상황.Spearman분석、logistic회귀혹다원선성회귀법분석환자뇌부손해적영향인소.결과 환자평균년령(56.0±12.5)세,투석령(73.5±60.8)개월.기왕유뇌경사급뇌출혈병사자균위5.1％;투석중출현수요처리적저혈압자점16.2％;단지뇨소청제솔(spKt/V)위(1.45±0.25).두부핵자검사결과:뇌동맥협착자점12.0％,피층경사자5.1％,만성기혈종7.7％,강경자점39.3％,미출혈점47.0％,뇌백질이상신호자52.1％.C-MMSE평분이상자점20.9％,C-MOCA평분이상자점65.2％.다원선성회귀분석현시,년령(b=0.059,P＜0.01)급투석령(b=0.005,P＜0.05)시뇌백질병변(WMLs)적영향인소.투석중저혈압시혈투환자강경(b=2.123,P＜ 0.01)、미출혈(b=3.531,P＜ 0.01)적독립위험인소.혈청백단백수평저시투석환자인지평분하강적독립위험인소(b=0.314,P＜0.05).logistic회귀분석현시,투석전수축압(SBP)시피층경사적독립위험인소[OR=1.088,95％CI(1.018～1.152),P＜0.05].성별、투석년한、투석전혈청총이양화탄(TCO2)여만성기혈종밀절상관.결론 혈투환자뇌백질병변중、뇌미출혈급강극성경새등환병솔고,인지능력하강.WMLs여투석령상관;강경급미출혈병조여투석중저혈압상관;강극성경새、WMLs급영양상황여환자인지능력하강유관.
Objective To investigate cerebrovascular lesions on maintenance hemodialysis (MHD) patients,including types of cerebrovascular disease,and cognitive function changes.Methods A cross-sectional study was applied.A total of 270 MHD patients at hemodialysis center of Peking Union Medical College Hospital were screened,and finally 117 cases were enrolled.Demographic information,aboratory data,MRI and MRA data were collected and assessed.Cognitive function was evaluated with C-MMSE (Chinese mini mental test examination) and C-MoCA (Chinese montreal cognitive assessment).The related factors were selected by Spearman correlation analysis,multiple linear regression and logistic regression analysis.Results The patients' average age was (56.0± 12.5) years,average hemodialysis age was (73.5±60.8) months.Only 5.1％ patients had clinical history of cerebral infarction or hemorrhage.Pre-hemodialysis blood pressure was (142.7/80.3 ± 18.2/12.9) mmHg,Post-hemodialysis blood pressure was (130.2/79.1±23.4/14.9) mmHg.A total of 18.8％ patients had intra-hemodialysis hypotension,spKt/V was (1.45±0.25).MR results showed that 12.0％ patients had cerebral artery stenosis,5.1％ patients had cortical infarcts,39.3％ patients had lacunar infarcts,47.0％ patients had microbleeds,7.7％ patients had chronic hematoma,52.1％ patients had abnormal brain whiter matter lesions (WMLs).In cognitive function evaluation,20.9％ patients had abnormal C-MMSE scores,but 65.2％ patients had abnormal C-MoCA results.Multiple linear regression showed age (b=0.059,P ＜ 0.01),dialysis age (b=0.005,P ＜ 0.05) were associated with WMLs in MHD patients.Intra-hemodialysis hypotension was an independent risk factor of lacunar infarcts (b=2.123,P ＜ 0.01)and microbleeds (b=3.531,P ＜ 0.01).Low serum albumin level was an independent risk factor of cognitive decline (b=0.314,P＜0.05).Logistic regression analysis showed pre-hemodialysis systolic blood pressure was an independent risk factor of cortical infarcts [OR=1.088,95％CI (1.018-1.152),P ＜ 0.05].Gender,dialysis age and pre-dialysis serum TCO2 level were related with chronic hematoma.Conclusions WMLs is related with dialysis voltage.Lacunar infarcts and mirobleeds are related with intra-hemodialysis hypotension.Lacunar infarcts,WMLs and nutritional status are contributed to decline of cognition in MHD patients.