Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Cells. 2020 Oct 15;9(10):2303. doi: 10.3390/cells9102303.
Cognitive impairment (CI) is not uncommon in dialysis patients. Various factors have been implicated. This study aims to examine mutual interaction of various clinical factors for CI in patients receiving hemodialysis. A total of 48 hemodialysis patients in outpatient clinic were recruited from 2015 to 2017. Demographics, circulating uremic toxin concentrations, miRNA concentrations, and nerve injury protein concentrations were collected. Clinical dementia rating (CDR) scores were used to stratify the functional scores of the patients. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic test performance for predicting dichotomous results, and cumulative ROC analysis was used to examine the combined contribution of clinical factors. CDR scale 0 included 15 patients (mean age, 59.1 years); CDR > 0.5 included 33 patients (mean age, 64.0 years). On cumulative ROC analysis, the major predictors of mild CI were hemoglobin, age, sex, homocysteine, neuron-specific enolase (NSE), and miR-486. The cumulative area under the curve (AUC) on combining hemoglobin, age, and miR-486 was the highest (0.897, 95% confidence interval 0.806-0.988). Two dichotomized variables reached 81.82% sensitivity and 86.67% specificity, with the likelihood ratio for positive and negative results being 6.14 and 0.21, respectively. In conclusion, hemoglobin, age, and miR-486 display high-degree combined effects on mild CI in patients receiving hemodialysis.
认知障碍（CI）在透析患者中并不少见。多种因素与之相关。本研究旨在探讨接受血液透析患者的各种临床因素对 CI 的相互作用。2015 年至 2017 年期间，我们从门诊招募了 48 名血液透析患者。收集了人口统计学资料、循环尿毒症毒素浓度、miRNA 浓度和神经损伤蛋白浓度。采用临床痴呆评定量表（CDR）评分对患者的功能评分进行分层。使用受试者工作特征（ROC）分析评估诊断测试对二分类结果的预测性能，使用累积 ROC 分析评估临床因素的综合贡献。CDR 量表 0 包括 15 名患者（平均年龄 59.1 岁）；CDR＞0.5 包括 33 名患者（平均年龄 64.0 岁）。在累积 ROC 分析中，血红蛋白、年龄、性别、同型半胱氨酸、神经元特异性烯醇化酶（NSE）和 miR-486 是轻度 CI 的主要预测因子。结合血红蛋白、年龄和 miR-486 的累积曲线下面积（AUC）最高（0.897，95%置信区间 0.806-0.988）。两个二分类变量的敏感性为 81.82%，特异性为 86.67%，阳性和阴性结果的似然比分别为 6.14 和 0.21。综上所述，血红蛋白、年龄和 miR-486 对接受血液透析的患者的轻度 CI 具有高度的综合影响。
