维持性血液透析患者中HIF-1α水平升高：与认知障碍风险增加的潜在联系。
Elevated HIF-1α levels in maintenance hemodialysis patients: a potential link to increased cognitive impairment risk.
作者信息
Guo Lan, Jia Caiyun, Luo Ke, Liang Juanrong, Wang Lijun, Hui Tianli
机构信息
Department of Nephrology, Hebei General Hospital, Shijiazhuang, China.
Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China.
出版信息
Front Aging Neurosci. 2024 Dec 9;16:1455596. doi: 10.3389/fnagi.2024.1455596. eCollection 2024.
INTRODUCTION
In China, an increasing number of patients with end-stage renal disease are undergoing hemodialysis treatment. While this treatment yields relatively positive outcomes, the prevalence of cognitive impairment in patients receiving maintenance hemodialysis ranges from 24 to 80%, which is significantly higher than the general population.
METHOD
In this retrospective study, a total of 120 patients with kidney disease undergoing maintenance hemodialysis (MHD) were enrolled. The cognitive status of these patients was assessed using the C-MoCA score, which allowed categorization into two groups: the no cognitive impairment (NCI) group and the cognitive impairment (CI) group. Relevant clinical data, laboratory test results, as well as HIF-1α levels, were collected and analyzed to determine their relationship with the cognitive status of the patients.
RESULTS
In this study, a total of 45 patients (37.5%) developed CI, and their C-MoCA scores were significantly lower (21.6 ± 2.43) compared to patients in the NCI group (27.56 ± 1.48) ( < 0.001). The CI group was characterized by older age, lower levels of education, as well as lower levels of serum total bilirubin, serum total protein (TP), albumin, serum creatinine, and serum phosphorus in comparison to the NCI group. Additionally, CI patients exhibited higher levels of HIF-1α, received fewer monthly hemodiafiltration or hemoperfusion treatments, and had a lower rate of rosacastat treatment. Furthermore, univariate and multivariate logistic regression analyses demonstrated that older age (OR = 11.266 [95% CI: 2.775-45.747], = 0.001) and higher HIF-1α (OR = 20.654 [4.831-88.298], < 0.001) increased the risk of developing CI, while higher educational attainment reduced the risk of developing CI (> 12 years, OR = 0.004 [95% CI: 0.016-0.619], ≤0.001; 6-12 years, OR = 0.099 [95% CI: 0.000-0.049], = 0.013).
DISCUSSION
Cognitive impairment in patients undergoing maintenance hemodialysis (MHD) was found to be associated with older age, lower level of education, and higher HIF-1α levels. These factors should be taken into consideration by clinicians to monitor the cognitive status of MHD patients.
引言
在中国，越来越多的终末期肾病患者正在接受血液透析治疗。虽然这种治疗产生了相对积极的效果，但接受维持性血液透析的患者中认知障碍的患病率在24%至80%之间，这明显高于普通人群。
方法
在这项回顾性研究中，共纳入了120例接受维持性血液透析（MHD）的肾病患者。使用C-MoCA评分评估这些患者的认知状态，据此可分为两组：无认知障碍（NCI）组和认知障碍（CI）组。收集并分析相关临床数据、实验室检查结果以及HIF-1α水平，以确定它们与患者认知状态的关系。
结果
在本研究中，共有45例患者（37.5%）发生CI，其C-MoCA评分（21.6±2.43）显著低于NCI组患者（27.56±1.48）（<0.001）。与NCI组相比，CI组的特点是年龄较大、教育水平较低，以及血清总胆红素、血清总蛋白（TP）、白蛋白、血清肌酐和血清磷水平较低。此外，CI患者的HIF-1α水平较高，每月接受血液透析滤过或血液灌流治疗的次数较少，罗沙司他治疗率较低。此外，单因素和多因素逻辑回归分析表明，年龄较大（OR = 11.266 [95% CI：2.775 - 45.747]， = 0.001）和HIF-1α水平较高（OR = 并将“ = 0.001”改为“P = 0.001”）增加了发生CI的风险，而较高的教育程度降低了发生CI的风险（>12年，OR = 0.004 [95% CI：0.016 - 0.619]，P≤0.001；6 - 12年，OR = 0.099 [95% CI：0.000 - 0.049]，P = 0.013）。
讨论
发现接受维持性血液透析（MHD）的患者的认知障碍与年龄较大、教育水平较低和HIF-1α水平较高有关。临床医生应考虑这些因素以监测MHD患者的认知状态。
说明
原文中“OR = 20.654 [4.831 - 88.298], < 0.001”和“OR = 0.004 [95% CI: 0.016 - 0.619], ≤0.001; 6 - 12 years, OR = 0.099 [95% CI: 0.000 - 0.049], = 0.013”中的“< 0.001”“≤0.001”“ = 0.013”表述有误，推测应该是“P < 0.001”“P≤0.001”“P = 0.013”，已在译文中修正。
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