无认知损害维持性血液透析患者的脑部病变———来自MRI的证据

Cerebral lesions in maintenance hemodialysis patients without cognitive impairment：A magnetic resonance imaging study

摘要:

目的：了解无认知损害维持性血液透析患者（maintenance hemodialysis，MHD）患者脑部病变的现状，分析潜在的影响因素，初步探讨其脑部病变与认知功能及抑郁的关系。方法：选取无认知损害MHD患者和健康对照组各30例，采用横断面调查法，比较2组被试大脑核磁共振成像（magnetic resonance imaging，MRI）的差异。收集MHD组人口学数据、实验室数据，使用蒙特利尔认知评估量表（Montreal cognitive assessent，MoCA）、贝克抑郁量表（Beck depression inventory，BDI）评估其认知功能和抑郁现状。使用logistic回归分析其脑部病变的影响因素，Mann-Whitney检验比较有无脑部病变MHD患者认知功能和抑郁状况的差异。结果：30位无认知损害MHD患者检出脑部病变的有16例，检出率为53.33%。其中，腔隙性脑梗死11例（36.67%），脑白质脱髓鞘改变6例（20.00%），多发性缺血灶7例（23.33%），明显高于健康对照组的2例（χ2=15.556，P=0.000）。血磷（OR=12.297，95%CI=1.106～136.737，P<0.05）是无认知损害MHD患者腔隙性脑梗死的独立危险因素；血磷（OR=77.492，95%CI=1.571～3 822.433，P<0.05）是其多发性缺血灶的独立危险因素。有脑小血管病变（腔隙性脑梗死和多发性缺血灶，Z=-2.10，P=0.036）、脑白质脱髓鞘改变患者（Z=-2.13，P=0.038）MoCA评分较无病变组均明显降低，BDI评分则无统计学差异。结论：无认知损害的MHD患者广泛存在着脑部病变，以腔隙性脑梗死、脑白质脱髓鞘改变和多发性缺血灶为代表。血磷是其脑小血管病变的独立危险因素。脑小血管病变和脑白质脱髓鞘改变与患者的认知功能下降有关。

Abstract:

Objective：To identify the prevalence of cerebral lesions in maintenance hemodialysis（MHD） patients without cognitive im－pairment，analyze the potential risk factors，and preliminarily investigate the relationship between the cerebral lesions and their cognitive function/depression. Methods：A cross-sectional study was conducted on 30 MHD patients without cognitive impairment and 30 healthy controls，and the brain magnetic resonance imaging findings were compared between the two groups of patients. Demographic information and laboratory data were collected. The Montreal cognitive assessment（MoCA） and Beck depression inventory（BDI） were used to evaluate their cognitive function and depression. A logistic regression analysis was performed to identify the risk factors for cerebral lesions. The Mann-Whitney U test was used to evaluate the differences in cognitive function and depression between the MHD patients with and without cerebral lesions. Results：Among the 30 MHD patients without cognitive impairment，16（53.33%） had cerebral lesions，including lacunar infarctions in 11（36.67%） cases，leukoencephalopathy in 6（20.00%） cases，and multiple ischemic lesions in 7（23.33%） cases，versus 2 cases of cerebral lesions in the control group（ χ2=15.556，P=0.000）. The logistic regres－sion analysis showed that serum phosphate was an independent risk factor for lacunar infarctions（OR=12.297，95%CI=1.106 to 136.737，P<0.05） and multiple ischemic lesions（OR=77.492，95%CI=1.571 to 3 822.433，P<0.05） in MHD patients without cognitive impairment. The MoCA score was significantly higher in MHD patients without cerebral lesions than in those with cerebral small vessel diseases（lacunar infarctions and multiple ischemic lesions，Z=-2.10，P=0.036） and those with leukoencephalopathy（Z=-2.13，P=0.038），while the BDI score was not significant between them. Conclusions：More than half of the MHD patients without cognitive impairment have cerebral lesions，such as lacunar infarc－tions，multiple ischemic lesions，and leukoencephalopathy. Serum phosphate is an independent risk factor for cerebral small vessel diseases. Cerebral small vessel diseases and leukoencephalopathy are associated with cognitive function decline in MHD patients.