血液透析患者脑血流动力学变化与认知功能损伤相关性临床研究

目的探讨维持性血液透析(MHD)患者脑血流动力学变化与认知功能损伤的关系。方法对2017年5月至6月在北京世纪坛医院94例MHD患者,根据蒙特利尔认知评估量表(MoCA)评估分为认知功能损伤(CI)组与认知功能正常(NC)组。采用经颅多普勒超声(TCD)进行脑血流动力学检查。比较两组患者之间相关指标,采用二分类Logistic回归方法分析CI与TCD指标的关系。结果 94例患者中,CI组59例,NC组35例,CI患病率为62.8%。CI组年龄、女性患者比例、透析龄及心脏病患病比例均高于NC组,受教育程度低于NC组(P<0.05)。CI组大脑中动脉(MCA)及大脑前动脉(ACA)的平均血流速(Vm)均低于NC组,MCA及ACA的搏动指数(PI)均高于NC组(P<0.05)。Logistic回归结果显示,年龄、心脏病史、MCA-Vm及MCA-PI是MHD患者CI发生的相关危险因素(P<0.05)。结论MHD患者颅内动脉平均血流速度降低,其中MCA-Vm越低,MCA-PI越高,患者发生认知功能损伤的风险越大。

Correlation between cerebral hemodynamic changes and cognitive impairment in hemodialysis patients

Objective To investigate the association between cerebral hemodynamic changes and cognitive impairments in maintenance hemodialysis(MHD)patients. Methods According to the Montreal Cognitive Assessment Scale(MoCA),94 MHD patients in Beijing Shijitan Hospital from May 2017 to June 2017 were divided into cognitive impairment(CI)group and normal cognitive function(NC)group. The cerebral hemodynamics was examined by transcranial Doppler(TCD).Relevant indicators between the two groups were compared,and the relationship between cognitive impairment and TCD indicators was analyzed by binary logistic regression. Results Among 94 MHD patients, 59 in CI group and 35 in NC groug, the incidence of CI was 62.8%. Age,proportion of female patients,dialysis age and heart disease rate in CI group were higher than those in NC group,and the education level was lower than that in NC group(P<0.05). The mean blood flow velocity(Vm)of middle cerebral artery(MCA)and anterior cerebral artery(ACA)in CI group was lower than that in NC group. The pulsation index(PI)of MCA and ACA was higher than that in NC group(P<0.05). Logistic regression showed that age,history of heart disease,MCA-Vm and MCA-PI were risk factors for cognitive impairment in MHD patients(P<0.05). Conclusion The mean blood flow velocity of intracranial artery is decreased in MHD patients, and the lower the MCA-Vm and the higher the MCA-PI,the greater the risk of cognitive impairment in those patients.