Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients-猫眼课题宝

DOI：

10.1159/000487092

发表时间：

2018-01-01

期刊：

NEPHRON

影响因子：

2.5

通讯作者：

中科院分区：

医学4区

文献类型：

作者：

Kovarova, Lucie;Valerianova, Anna;Malik, Jan

背景/目的：在接受慢性血液透析（HD）的患者中，认知功能障碍（CI）的发生率较高，这是一个令人担忧的问题。其病理生理机制尚不清楚，有迹象表明脑缺血可能是其关键原因之一。通过近红外光谱测量的脑组织氧合已知在HD患者中降低。然而，尚不清楚CI是否与这些患者的脑氧合降低相关。我们研究的主要目的是探索这种可能的关联。我们的次要目的是评估可能与脑缺血和CI相关的其他因素。方法：39例接受慢性HD治疗的患者纳入本横断面研究。所有测量均在HD会话开始前进行。蒙特利尔认知评估（莫卡）是根据已发表的建议进行的。使用INVOS 5100 C设备测量左额叶的局部血氧饱和度（rSO 2）。记录基本病史、实验室检查资料，分析握力。我们使用非配对t检验比较认知正常患者（MoCA评分>= 26）和CI患者（莫卡评分< 26）的rSO 2和其他变量。多元线性回归分析用于校正主要混杂因素。结果：与认知正常患者相比，认知受损患者的脑rSO 2值较低（48 +/- 9 vs. 57 +/-10%，p = 0.01）。在其他变量中，较高的红细胞分布宽度（15.8 +/- 1.9 vs. 13.8 +/-1.6%，p = 0.01）和较低的握力（49.2 +/- 23.3 vs. 99.3 +/- 31.4 lbs，p < 0.001）也显示出与CI显著相关。校正年龄和性别后，rSO 2和莫卡评分之间的关系显著（p = 0.007）。结论：脑氧合降低与接受慢性HD的患者的认知能力较弱相关。进一步了解血液透析患者脑缺血的原因可能会导致预防这一人群的认知能力下降。(C)2018 S. Karger AG，巴塞尔

Background/Aims: High rates of cognitive impairment (CI) are an alarming problem in patients undergoing chronic hemodialysis (HD). Its pathophysiology remains unclear and there are indications that brain ischemia might be one of the key causes. Cerebral tissue oxygenation, as measured by near-infrared spectroscopy, is known to be decreased in HD patients. However, it is unknown whether CI is associated or not associated with lower cerebral oxygenation in these patients. The primary aim of our study was to probe this possible association. Our secondary aim was to assess other factors possibly related to cerebral ischemia and CI. Methods: Thirty-nine patients treated by chronic HD were included in this cross-sectional study. All measurements were performed before the initiation of an HD session. The Montreal Cognitive Assessment (MoCA) was administered according to published recommendations. Regional saturation of oxygen (rSO2) of the left frontal lobe was measured using the INVOS 5100C device. Basic medical history and laboratory data were recorded, and handgrip strength was analyzed. We used the unpaired t test to compare the rSO2 and other variables between cognitively normal patients (MoCA score >= 26) and those who displayed CI (MoCA score < 26). Multiple linear regression analysis was used to adjust for principal confounders. Results: Cognitively impaired patients had lower brain rSO2 values compared to cognitively normal patients (48 +/- 9 vs. 57 +/- 10%, p = 0.01). Among other variables, higher red cell distribution width (15.8 +/- 1.9 vs. 13.8 +/- 1.6%, p = 0.01) and lower hand grip strength (49.2 +/- 23.3 vs. 99.3 +/- 31.4 lbs, p < 0.001) also displayed a significant association with CI. The relation between rSO2 and MoCA score was significant after adjustment for age and gender (p = 0.007). Conclusion: Decreased brain oxygenation is associated with weaker cognitive performance in patients undergoing chronic HD. Further understanding the causes of cerebral ischemia in HD patients could lead to the prevention of cognitive decline in this population. (C) 2018 S. Karger AG, Basel

Low Cerebral Oxygenation Is Associated with Cognitive Impairment in Chronic Hemodialysis Patients

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