老年血液透析患者血清维生素D水平与认知功能损伤的横断面分析

摘要

目的 探讨老年血液透析(hemodialysis,HD)患者认知功能与血清25羟基维生素D(25-OH-D)水平的关系.方法 通过蒙特利尔认知量表筛查患者认知功能,同时检测患者血清25-OH-D水平,比较不同水平血清25-OH-D患者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血清25-OH-D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65.1％.血清25-OH-D水平缺乏组、不足组、正常组3组中认知功能损伤的患病率分别为75.5％、57.9％、52.6％,差异有统计学意义(P＜0.01).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(odd ratio,OR)及95％可信区间(confidence interval,CI)分别为1.67(1.13～2.42)、1.17(1.04～2.34)、1.37(1.10～2.71)、2.20(1.60～3.12)(P＜0.05);血清25-OH-D与认知功能损伤相关,其OR(95％CI)为1.12(1.01～1.23)(P＜0.05).结论 老年HD患者认知功能损伤不仅与年龄、教育程度、贫血、糖尿病显著相关,血清25-OH-D减低也是认知功能损伤发生的独立风险因素.%Objective To investigate the correlations between cognitive impairment of senior hemodialysis patients and serum 25-hydroxyviamin D (25-OH-D). Methods A cross-sectional study was performed in 106 hemodialysis patients. The cognitive function was evaluated by Montreal Cognitive Assessment (MoCA), and serum 25-OH-D level was assessed. A multi-logistic regression was performed to access the potential associated risk factor of cognitive impairments. Results The MoCA scores of 69 senior hemodialysis patients (65.1％), who aged from 60 to 86, were less than 26, which was defined as cognitive impairment. The prevalences of mild cognitive impairment in the 3 groups according to different 25-OH-D levels were 75.5％, 57.9％ and 52.6％, respectively; which were significantly increased in vitamin D deficiency groups. Multi-logistic regression analysis showed that age, educational status, anemia, and diabetics were associated with cognitive impairment, with the odd ratios (ORs) of 1.67 (1.13-2.42), 1.17 (1.04-2.34), 1.37 (1.10-2.71) and 2.20 (1.60-3.12), respectively (P＜0.05). Serum 25-OH-D level was independently associated with cognitive impairment (P＜0.05), with the OR (95％CI) of 1.12 (1.01-1.23). Conclusion Cognitive impairment is common in senior hemodialysis patients. It might be associated with anemia, senior age, educational status, hypertension and diabetics. There is also an association between cognitive impairment and serum 25-OH-D level, which might be a potential intervention measure in the future.