老年血液透析患者昼夜血压变异度与认知功能相关性的临床研究

摘要

目的 探讨老年血液透析患者(HD )认知功能与昼夜血压变异度的关系. 方法 通过蒙特利尔认知量表( MoCA)筛查患者认知功能,同时监测患者24 h动态血压变化并计算昼夜间血压变异度,比较认知功能的相关指标并通过多因素 Logistic回归方法分析认知功能损伤与昼夜血压变异度的关系. 结果 106例老年 HD患者,平均年龄(73. 1 ± 12. 9 )岁,认知功能损伤者69例,认知功能损害患病率为63. 4%.认知功能损伤患者与认知功能正常患者24 h平均收缩压为(151.3 ± 20.1)mmHg和(131.1 ± 11.7 )mmHg(1 mmHg＝0.133 kPa)(t＝5.36 ,P＜0.05) ;昼间平均收缩压为(167.6 ± 28.2)mmHg和(139.1 ± 14.2)mmHg(t＝4.98 ,P＜0.05) ;夜间平均收缩压为(139.9 ± 18.5)mmHg和(100.2 ± 11.3)mmHg(t＝6.21 ,P＜0.05) ,昼夜间收缩压变异度为(8.2 ± 1.6)% 和(19.9 ± 2.9)%(χ2＝44.67 ,P＜0.05).多因素Logistic回归显示,年龄、教育程度、贫血、糖尿病均与认知功能损伤相关,其比值比(OR)及95% 可信区间(CI)分别为:1.5(1.1～2.2)、1.8(1.4～2.5)、1.7(1.1～2.6)、2.1(1.7～3.1)(P＜0.05) ;昼夜间收缩压变异度也与认知功能损伤相关,其 OR(95% CI)为1.4(1.1～1.9)(P＜0.05). 结论 老年血液透析患者认知功能损伤与年龄、教育程度、高血压、糖尿病相关,昼夜间收缩压变异度也是认知功能损伤发生的独立风险因素.%Objective To investigate the relationship between cognitive impairments in elderly patients receiving hemodialysis and blood pressure variability during the dayight cycle. Methods A cross-sectional study was performed in 106 hemodialysis patients to evaluate cognitive function with Montreal Cognitive Assessment (MoCA) and blood pressure variability with a 24 h ambulatory blood pressure monitor. A multi-Logistic regression was conducted to analyze potential risk factors associated with cognitive impairments. Results A hundred and six patients had an average age of (73.1 ± 12.9)years.Sixty-nine out of 106 (63.4%) suffered cognitive impairments with MoCA scores lower than 26. Measurements for patients with cognitive impairments versus patients without cognitive impairments included twenty-four-hour ambulatory blood systolic pressure[(151.3 ± 20.1)mmHg vs. (131.1±11.7)mmHg ,P＜ 0.05],day-time average systolic blood pressure[(167.6±28.2)mmHg vs.(139.1 ± 14.2)mmHg ,P ＜ 0.05] ,night-time average systolic blood pressure [(139.9 ± 18.5) mmHg vs.(100.2± 11.3)mmHg ,P＜ 0.05] ,difference in systolic blood pressure between day and night[(167.6 ± 28.2)mmHg vs. (139.1 ± 14.2)mmHg ,P＜ 0.05] ,and coefficient of variation of systolic blood pressure [(8.2 ± 1.6)% vs. (19.9 ± 2.9)%,χ2＝ 44.67 ,P ＜ 0.05].Multi-logistic regression analysis showed that age (OR :1.5 ,95% CI :1.1-2.2 ,P＜0.05) ,education level (OR :1.8 , 95% CI :1.4-2.5 ,P＜0.05) ,anemia (OR :1.7 ,95% CI :1.1-2.6 ,P＜0.05) ,and diabetes (OR :2.1 , 95% CI :1.7-3.1 ,P＜0.05) were associated with cognitive impairments.Moreover ,the coefficient of variation of systolic blood pressure was also independently correlated with cognitive impairments (OR :1.4 ,95% CI :1.1-1.9 ,P＜0.05). Conclusions Cognitive impairment has a high prevalence among elderly hemodialysis patients and is associated with anemia ,age ,education level ,hypertension and diabetes.Besides ,the coefficient of variation of low systolic blood pressure may be an independent risk factor for cognitive impairment.