天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (3): 295-298.doi: 10.11958/20190038

• 临床研究 • 上一篇    下一篇

老年血液透析患者血清同型半胱氨酸与认知损伤相关性的临床研究

郭一丹，田茹，罗洋   

  1. 首都医科大学附属北京世纪坛医院肾内科（邮编100038）
  • 收稿日期:2019-01-07 修回日期:2019-02-21 出版日期:2019-03-15 发布日期:2019-04-24
  • 通讯作者: 罗洋 E-mail:luoyang96@163.com

Clinical investigation of the association between serum homocysteine and cognitive impairment in elderly patients with hemodialysis

GUO Yi-dan,TIAN Ru,LUO Yang   

  1. Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2019-01-07 Revised:2019-02-21 Published:2019-03-15 Online:2019-04-24
  • Contact: Yang Luo E-mail:luoyang96@163.com

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摘要： 目的 探讨老年血液透析（HD）患者血清同型半胱氨酸（Hcy）与认知功能损伤（cognitive impairment）的关系。方法 107例血液透析患者通过蒙特利尔认知量表（MoCA）筛查患者认知功能，将患者分为认知功能正常组及认知功能损伤组，同时收集患者临床资料及血清Hcy 等实验室检查资料，比较2组患者的相关指标并通过多因素Logistic回归分析认知功能损伤与血清Hcy关系。通过绘制受试者工作特征（ROC）曲线评价Hcy对HD患者认知功能损伤的预测效能。结果 107例HD患者中认知功能损伤者70例（65.4%）。2组MoCA评分、年龄、性别、受教育年限、卒中史、心脏病史、透析时间、血红蛋白及同型半胱氨酸水平差异均有统计学意义（P＜0.05）。多元Logistic回归显示：男性与血红蛋白水平升高是认知功能损伤的保护因素，其比值比（OR）及 95% 可信区间（CI）分别为：0.295（0.095～0.916）与0.952（0.910～0.997）；年龄增高、透析时间延长及血清Hcy水平升高是认知功能损伤的危险因素，OR及95%CI分别为：1.080（1.026～1.136）、1.022（1.008～1.036）、1.212（1.039～1.414）。以血清Hcy为变量对HD患者认知损伤诊断效能的ROC曲线下面积为0.711（0.611～0.811），判定其发生认知损伤血清Hcy临界值为20.65 μmol/L，此时敏感度为65.7%，特异度为56.8%。结论 血液透析患者认知功能损伤不仅与性别、年龄、透析时间、贫血相关，高血清Hcy水平也是认知功能损伤发生的独立危险因素，该指标可能成为预测认知功能损伤的有效指标。

关键词: 肾透析, 认知障碍, 高半胱氨酸, 老年人

Abstract: Objective To investigate the relationship between serum homocysteine (Hcy) and cognitive impairment(CI) in elderly patients with hemodialysis (HD). Methods A total of 107 HD patients were divided into normal cognition group and cognitive impairment group according to the evaluation of Montreal Cognitive Assessment (MoCA). Clinical data including serum Hcy level were collected in the two groups. Relevant indicators were compared between the two groups, and the relationship between cognitive impairment and serum level of Hcy was analyzed by multivariate Logistic regression.Receiver operating characteristics (ROC) curve was also plotted to evaluate the diagnostic value of Hcy for the cognitive impairment. Results Seventy(65.4%) of 107 HD patients suffered from cognitive impairment. There were significant differences in MoCA scores, age, gender, education level, stroke history, heart disease history, dialysis duration, hemoglobin and homocysteine levels between the two groups (P＜0.05). Multivariate Logistic regression showed that the increased levels of hemoglobin in male were protective factors for cognitive impairment. The odd ratio (OR) and 95% confidential interval (95%CI) were 0.295 (0.095-0.916) and 0.952 (0.910-0.997，P＜0.05). Age, prolonged dialysis and elevated serum Hcy level were risk factors for cognitive impairment. The OR values (95%CI) were 1.080 (1.026-1.136), 1.022 (1.008-1.036) and 1.212 (1.039-1.414), respectively（P＜0.05). The area under curve of ROC analysis was 0.711 (0.611-0.811), the cut-off point of serum Hcy under the maximum Youden index was 20.65 μmol/L, the sensitivity was 65.7% and the specificity was 56.8%. Conclusion Cognitive impairment is common in hemodialysis patients. It might be associated with gender, age,dialysis duration and anemia. High serum level of Hcy is also an independent risk factor for cognitive impairment, which may be an effective index for predicting cognitive impairment.

Key words: renal dialysis, cognition disorders, homocysteine, aged