构建维持性血液透析患者继发轻度认知功能障碍预测模型及应用性分析
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摘要
目的:用相关临床指标,构建维持性血液透析(MHD)患者继发轻度认知功能障碍(MCI)预测模型,并分析该模型的应用价值。方法:收集2016-02—2017-01,在本院接受MHD终末期肾脏疾病(ESRD)患者的临床资料,并行为期18个月随访。依其预后筛选MCI风险指标和临界值,分析其对继发MCI时间窗的评判效能。结果:454例接受MHD的ESRD患者中7例失访,受访447例患者,其中305例认知功能正常,142例继发MCI。Cox回归分析显示,MHD继发MCI风险模型由年龄、心理抑郁程度、社会支持程度、转铁蛋白饱和度(TSAT)组成,其中年龄及心理抑郁程度为危险因素、社会支持程度及TSAT为保护性因素。年龄≥68.317岁、社会支持量表(SSQ)分值<18.724分、TSAT<38.162%MHD患者,继发MCI的时间窗更短,具有显著评判效能。结论:年龄、心理抑郁程度、社会支持程度、TSAT含量是MHD患者继发MCI的独立影响因素,且年龄≥68.317岁、SSQ量表<18.724分、TSAT含量<38.162%为继发MCI的评判临界点。
Objective: To collect the relevant clinical indicators of patients receiving maintenance hemodialysis(MHD). The predictive model was constructed to evaluate the predictive value of mild cognitive impairment(MCI), and the applicability of the model was verified based on the time window of secondary prognosis. Method: Continued inclusion of end-stage renal disease(ESRD) patients during the period from February 2016 to January 2017 was the observation cohort, to collect relevant clinical data, for an 18-month follow-up to confirm prognosis. According to the follow-up results to predict the impact of secondary MCI risk indicators, and verify the relevant indicators of the critical value of the secondary MCI time window evaluation effectiveness. Results: The study concluded that 454 patients with MHD received ESRD, of which 7 patients were lost, the final 142 patients with secondary MCI, 305 patients in the follow-up period of cognitive function is normal. Cox regression analysis showed that the risk model of secondary MCI in MHD patients was composed of age, degree of psychological depression, degree of social support and TSAT content, among which age and degree of psychological depression were risk factors, degree of social support and TSAT were protective factors. The age≥68.317 years old, SSQ scale <18.724 points, TSAT content <38.162% of the subjects, secondary MCI time window shorter, were the independent factors of the critical value of a significant evaluation of the effectiveness. Conclusion: Age, degree of psychological depression, degree of social support and TSAT content is the independent influencing factor of secondary MCI in patients receiving MHD therapy,and age≥68.317 years old,SSQ scale<18.724 points,TSAT content<38.162%for the secondary MCI critical point.
Objective: To collect the relevant clinical indicators of patients receiving maintenance hemodialysis(MHD). The predictive model was constructed to evaluate the predictive value of mild cognitive impairment(MCI), and the applicability of the model was verified based on the time window of secondary prognosis. Method: Continued inclusion of end-stage renal disease(ESRD) patients during the period from February 2016 to January 2017 was the observation cohort, to collect relevant clinical data, for an 18-month follow-up to confirm prognosis. According to the follow-up results to predict the impact of secondary MCI risk indicators, and verify the relevant indicators of the critical value of the secondary MCI time window evaluation effectiveness. Results: The study concluded that 454 patients with MHD received ESRD, of which 7 patients were lost, the final 142 patients with secondary MCI, 305 patients in the follow-up period of cognitive function is normal. Cox regression analysis showed that the risk model of secondary MCI in MHD patients was composed of age, degree of psychological depression, degree of social support and TSAT content, among which age and degree of psychological depression were risk factors, degree of social support and TSAT were protective factors. The age≥68.317 years old, SSQ scale <18.724 points, TSAT content <38.162% of the subjects, secondary MCI time window shorter, were the independent factors of the critical value of a significant evaluation of the effectiveness. Conclusion: Age, degree of psychological depression, degree of social support and TSAT content is the independent influencing factor of secondary MCI in patients receiving MHD therapy,and age≥68.317 years old,SSQ scale<18.724 points,TSAT content<38.162%for the secondary MCI critical point.
引文
1 马惠娟, 唐骅, 吕凛生,等. 维持性血液透析患者心脑血管预后的影响因素[J].中华肾脏病杂志,2015, 31(9): 652—657.
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4 易建,万幼云,徐晓满.两种透析方法治疗终末期糖尿病肾病前后患者血管内皮生长因子和基质金属蛋白酶-9水平变化[J].微循环学杂志,2016,26(2):49—52.
5 Stevens PE, Levin A. Kidney disease: improving global outcomes chronic kidney disease guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline [J]. Ann Intern Med, 2013, 158(11):825-830.
6 Chen YP. Definition and classification of chronic kidney diseases from K/DOQI to KDIGO: contribution and questions[J]. J Clin Nephrol, 2012, 11(1): 4—6.
7 中国防治认知功能障碍专家共识专家组.中国防治认知功能障碍专家共识[J].中华内科杂志, 2006,45(2): 171—173.
8 Angermann S, Baumann M, Wassertheurer S, et al. Pulse-wave velocity is associated with cognitive impairment in haemodialysis patients[J]. Clinical Science, 2017, 131(13):1 495-1 498.
9 Wang Q, Yang ZK, Sun XM, et al. Association of social support and family environment with cognitive function in peritoneal dialysis patients[J]. Peritoneal Dialysis International Journal of the International Society for Peritoneal Dialysis, 2017, 37(1): 14-20.
10 任建伟, 韩布新, 刘世华,等. 维持性血液透析患者生化指标与心理功能的相关性及影响因素[J].中华肾脏病杂志, 2012,28(6):493—494.
11 Kelly DM. Phenotyping cognitive impairment in dialysis patients: insights from experimental mouse models[J]. Acta Neuropathologica, 2018, 135(1):1—2.
12 任建伟, 韩带新, 刘世华. 维持性MHD患者记忆执行功能研究[J].中华肾脏病杂志,2010,26(4):275—278.微循环学杂志,2019,29(1):73-76○C 2019 CHINESE JOURNAL OF MICROCIRCULATION doi:10.3969/j.issn.1005-1740.2019.01.016微循环学杂志2019年第29卷第1期肾脏病与血液净化 ?
2 Tavakoli M, Mitu-Pretorian M, Petropoulos IN, et a1. Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation[J]. Diabetes, 2013,62(1):254—260.
3 马永兴, 俞卓伟. 现代痴呆学[M]. 北京: 科学技术文献出版社, 2008:225—229.
4 易建,万幼云,徐晓满.两种透析方法治疗终末期糖尿病肾病前后患者血管内皮生长因子和基质金属蛋白酶-9水平变化[J].微循环学杂志,2016,26(2):49—52.
5 Stevens PE, Levin A. Kidney disease: improving global outcomes chronic kidney disease guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline [J]. Ann Intern Med, 2013, 158(11):825-830.
6 Chen YP. Definition and classification of chronic kidney diseases from K/DOQI to KDIGO: contribution and questions[J]. J Clin Nephrol, 2012, 11(1): 4—6.
7 中国防治认知功能障碍专家共识专家组.中国防治认知功能障碍专家共识[J].中华内科杂志, 2006,45(2): 171—173.
8 Angermann S, Baumann M, Wassertheurer S, et al. Pulse-wave velocity is associated with cognitive impairment in haemodialysis patients[J]. Clinical Science, 2017, 131(13):1 495-1 498.
9 Wang Q, Yang ZK, Sun XM, et al. Association of social support and family environment with cognitive function in peritoneal dialysis patients[J]. Peritoneal Dialysis International Journal of the International Society for Peritoneal Dialysis, 2017, 37(1): 14-20.
10 任建伟, 韩布新, 刘世华,等. 维持性血液透析患者生化指标与心理功能的相关性及影响因素[J].中华肾脏病杂志, 2012,28(6):493—494.
11 Kelly DM. Phenotyping cognitive impairment in dialysis patients: insights from experimental mouse models[J]. Acta Neuropathologica, 2018, 135(1):1—2.
12 任建伟, 韩带新, 刘世华. 维持性MHD患者记忆执行功能研究[J].中华肾脏病杂志,2010,26(4):275—278.微循环学杂志,2019,29(1):73-76○C 2019 CHINESE JOURNAL OF MICROCIRCULATION doi:10.3969/j.issn.1005-1740.2019.01.016微循环学杂志2019年第29卷第1期肾脏病与血液净化 ?