Peng Y Z, Shuai D, Zhou C M, Yuan J, Zha Y
Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550002, China.
Department of Nephrology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550002, China.
Zhonghua Yi Xue Za Zhi. 2023 Aug 29;103(32):2522-2528. doi: 10.3760/cma.j.cn112137-20230403-00531.
To explore the correlation between extracellular water/body cell mass (ECW/BCM) ratio and cognitive impairment (CI) in patients on maintenance hemodialysis (MHD). A multicenter, cross-sectional study was conducted in Guizhou Province. All adult MHD patients in hemodialysis centers of 18 hospitals in Guizhou Province between June and October 2020 were included. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. The ECW and BCM was derived from bioelectrical impedance, and the ECW/BCM ratio was calculated. The patients were divided into four groups based on the quartile of ECW/BCM ratio. Multivariate logistic regression analysis and subgroup analysis were conducted. A total of 3 160 patients were included in the final analysis, of which 761 (24.1%) developed CI. There were 1 868 males (59.1%) and 1 292 females (40.9%), and the mean age was (55±15) years. Multivariate logistic regression analysis showed that the risk of CI in ECW/BCM Q3 group was 1.55 times (95%: 1.03-2.34, =0.035) of that in group Q1, while the risk of CI in Q4 group was 1.62 times of that in group Q1 (95%: 1.05-2.51, =0.029). Subgroup analysis showed that there was an interaction between previous cerebrovascular event and ECW/BCM on CI ( for interaction=0.04). Patients with a previous history of cerebrovascular events had a higher risk of CI than those without. Among those with no previous cerebrovascular events, the risk of CI in group Q4 was 1.62 times of that in group Q1 (95%: 1.19-2.20), while the risk of CI in group Q4 was 7.17 times of that in group Q1 (95%: 1.59-32.35) in those with previous cerebrovascular events. Increased ECW/BCM ratio is associated with increased CI risk in patients with MHD, and the risk was more obvious in those with previous history of cerebrovascular events.
探讨维持性血液透析（MHD）患者细胞外液/体细胞质量（ECW/BCM）比值与认知障碍（CI）之间的相关性。在贵州省进行了一项多中心横断面研究。纳入了2020年6月至10月期间贵州省18家医院血液透析中心的所有成年MHD患者。采用简易精神状态检查表（MMSE）评分评估认知功能。通过生物电阻抗法得出ECW和BCM，并计算ECW/BCM比值。根据ECW/BCM比值的四分位数将患者分为四组。进行多因素逻辑回归分析和亚组分析。最终分析共纳入3160例患者，其中761例（24.1%）发生CI。男性1868例（59.1%），女性1292例（40.9%），平均年龄为（55±15）岁。多因素逻辑回归分析显示，ECW/BCM Q3组发生CI的风险是Q1组的1.55倍（95%：1.03 - 2.34，P = 0.035），而Q4组发生CI的风险是Q1组的1.62倍（95%：1.05 - 2.51，P = 0.029）。亚组分析显示，既往脑血管事件与ECW/BCM在CI方面存在交互作用（交互作用P = 0.04）。有既往脑血管事件病史的患者发生CI的风险高于无此病史者。在无既往脑血管事件病史的患者中，Q4组发生CI的风险是Q1组的1.62倍（95%：1.19 - 2.20），而在有既往脑血管事件病史的患者中，Q4组发生CI的风险是Q1组的7.17倍（95%：1.59 - 32.35）。MHD患者中ECW/BCM比值升高与CI风险增加相关，且在有既往脑血管事件病史的患者中这种风险更为明显。
