瘦组织与脂肪组织比率作为维持性血液透析患者认知障碍的危险因素。

Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis.

作者信息

Tian Maolu, Yuan Jing, He Pinghong, Yu Fangfang, Long Changzhu, Zha Yan

机构信息

School of Medicine, Guizhou University, Guiyang, China; Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China.

Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China.

出版信息

J Psychosom Res. 2023 Nov;174:111464. doi: 10.1016/j.jpsychores.2023.111464. Epub 2023 Aug 16.

DOI:10.1016/j.jpsychores.2023.111464

PMID:37757523

Abstract

OBJECTIVE

The relationship between body mass index (BMI) and cognitive impairment (CI) remains controversial, and no research has been done to explore the effect of lean-to-fat (L/F) tissue ratio on the risk of CI in patients undergoing maintenance hemodialysis (MHD) so far. This study aimed to explore the effect of L/F tissue ratio on the risk of incident CI in patients undergoing MHD.

METHODS

In this observational cohort study, 3356 patients were recruited and followed up for a median of 2 years. Global cognitive function was measured using Mini-Mental State Examination score. Lean tissue mass (LTM) and fat tissue mass (FTM) were analyzed using body composition monitor based on bioimpedance spectroscopy (BCM-BIS), and L/F tissue ratio was calculated by LTM divided by FTM. Hazard ratios (HRs) for incident CI were determined by Cox regression.

RESULTS

The median age of the cohort was 55 years, and 68.7% patients were less educated. During the follow-up period, 1249 patients (37.2%) experienced incident CI. Patients with lower L/F tissue ratios had significantly higher risks of CI (HR 1.51, 95% confidence interval 1.24-1.84; p < 0.001) than those with higher L/F tissue ratios. The association between L/F tissue ratio and incident CI persisted in all subgroups stratified by sex, age, education status, especially in older and less educated participants. Both in all our patients and subgroups, BMI and CI occurrence were not independently relevant.

CONCLUSION

The L/F tissue ratio rather than BMI was an independent risk factor of incident cognitive impairment in patients undergoing MHD.

摘要

目的

体重指数（BMI）与认知障碍（CI）之间的关系仍存在争议，目前尚无研究探讨瘦体组织与脂肪组织比例（L/F）对维持性血液透析（MHD）患者发生CI风险的影响。本研究旨在探讨L/F组织比例对MHD患者发生CI风险的影响。

方法

在这项观察性队列研究中，招募了3356例患者并进行了中位时间为2年的随访。使用简易精神状态检查表评分来测量整体认知功能。基于生物电阻抗光谱法的人体成分监测仪（BCM-BIS）分析瘦体组织质量（LTM）和脂肪组织质量（FTM），并通过LTM除以FTM计算L/F组织比例。采用Cox回归确定发生CI的风险比（HR）。

结果

该队列的中位年龄为55岁，68.7%的患者受教育程度较低。在随访期间，1249例患者（37.2%）发生了CI。L/F组织比例较低的患者发生CI的风险（HR 1.51，95%置信区间1.24-1.84；p<0.001）显著高于L/F组织比例较高的患者。L/F组织比例与发生CI之间的关联在按性别、年龄、教育状况分层的所有亚组中均持续存在，尤其是在年龄较大和受教育程度较低的参与者中。在我们所有的患者及其亚组中，BMI与CI的发生均无独立相关性。