Department of Medicine, MinneapolisMedical Research Foundation, Minneapolis, MN, USA.
Diabetes Care. 2011 Aug;34(8):1827-32. doi: 10.2337/dc11-0186. Epub 2011 Jun 29.
Kidney disease is associated with cognitive impairment in studies of nondiabetic adults. We examined the cross-sectional relation between three measures of renal function and performance on four measures of cognitive function in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) study.
The relationships among estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (n = 2,968), albumin/creatinine ratio (ACR) ≥30 μg/mg (n = 2,957), and cystatin C level >1.0 mg/L (n = 532) with tertile of performance on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and Stroop Test of executive function were measured.
In adjusted logistic regression models, ACR ≥30 μg/mg was associated with performance in the lowest tertile, compared with the highest two tertiles, on the RAVLT (odds ratio 1.30, 95% CI 1.09-1.56, P = 0.006), equivalent to 3.6 years of aging, and on the DSST (1.47, 1.20-1.80, P = 0.001), equivalent to 3.7 years of aging. Cystatin C >1.0 mg/L was borderline associated with the lowest tertile on the DSST (1.81, 0.93-3.55, P = 0.08) and Stroop (1.78, 0.97-3.23, P = 0.06) in adjusted models. eGFR was not associated with any measure of cognitive performance.
In diabetic people with HbA(1c) >7.5% at high risk for cardiovascular disease, decreased cognitive function was associated with kidney disease as measured by ACR, a measure of microvascular endothelial pathology, and cystatin C, a marker of eGFR.
在非糖尿病成人的研究中，肾脏疾病与认知障碍有关。我们在心血管风险行动控制糖尿病记忆研究（ACCORD-MIND）中，检验了肾小球滤过率（eGFR）<60 mL/min/1.73 m²（n=2968）、白蛋白/肌酐比值（ACR）≥30 μg/mg（n=2957）和半胱氨酸蛋白酶抑制剂 C 水平>1.0 mg/L（n=532）这三种肾功能指标与四项认知功能测试（简易精神状态检查、 Rey 听觉言语学习测试、数字符号替代测试和 Stroop 执行功能测试）中得分最低三分位数的关系。
在调整后的逻辑回归模型中，与最高的两个三分位数相比，ACR ≥30 μg/mg 与 Rey 听觉言语学习测试的最低三分位数相关（比值比 1.30，95%置信区间 1.09-1.56，P=0.006），相当于衰老 3.6 年，与数字符号替代测试相关（1.47，1.20-1.80，P=0.001），相当于衰老 3.7 年。半胱氨酸蛋白酶抑制剂 C >1.0 mg/L 与调整后的模型中数字符号替代测试（1.81，0.93-3.55，P=0.08）和 Stroop 测试（1.78，0.97-3.23，P=0.06）的最低三分位数呈边缘相关。eGFR 与任何认知功能测试均无相关性。
在伴有高心血管疾病风险且糖化血红蛋白（HbA1c）>7.5%的糖尿病患者中，认知功能下降与肾脏疾病相关，肾脏疾病通过 ACR （一种微血管内皮病理学的测量指标）和半胱氨酸蛋白酶抑制剂 C（eGFR 的标志物）来衡量。
