腹膜透析患者营养不良-炎症-心血管疾病与认知功能恶化的关系

doi:10.19723/j.issn.1671-167X.2019.03.020

Abstract

Abstract: Objective: To investigate the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and deterioration of global and specific domains of cognitive function in peritoneal dialysis (PD) patients.Methods: This was a multi-center prospective cohort study. The PD patients who met the inclusion criteria were examined with general and specific cognitive function between March 2013 and November 2013. The patients were divided into MIA0, MIA1 and MIA2 groups, according to items of “Yes” for whether or not having cardiovascular disease, serum albumin≤35 g/L or high-sensitive C-reactive protein (hs-CRP) ≥3 mg/L. After 2 years, the patients maintained on PD would be repeatedly measured with cognitive function. The Chi-square test, One-way ANOVA, Kruskal-wallis H rank sum test were used to compare the differences of clinical characteristics, biochemical data, and global and specific cognitive function parameters among the three groups at baseline, and two years later, respectively. The Bonferroni method was applied to adjust the significance level for further comparison between each two different groups. The change of score in each cognitive parameter of global and specific domains was used as dependent variable. Age, gender, education level, depression index, body-mass index, diabetes mellitus, serum sodium levels and MIA (MIA0 was control, MIA1 and MIA2 as dummy variables) were all included in the multivariable linear regression models to analyze the risk factors of the deterioration of cognitive function. The analysis for each cognitive domain was adjusted for the baseline score of the corresponding cognitive parameter. All the analyses were performed using SPSS for Windows, software version 25.0 (SPSS Inc., Chicago, IL). Results: Over two-year follow up, the prevalence of cognitive impairment increased from 20.0% to 24.7%, absolute decrease of 3MS scores were more significantly decreased in MIA2 (-3.9±12.0 vs. 1.1±6.7, P<0.01) and MIA1 group (-2.3±11.8 vs. 1.1±6.7, P<0.05) than those in MIA0 group respectively. Specific cognitive functions, included executive function (trail-making tests A and B, P=0.401,P=0.176), immediate memory (P=0.437), delayed memory (P=0.104), visuospatial skill (P=0.496), and language ability (P=0.171) remained unchanged. Advanced age, lower education, diabetes mellitus and depression were all correlated with the deterioration of one or more cognitive domains, and the patients having one item of MIA syndrome were prone to develop the deterioration of 3MS (P=0.022). Furthermore, the patients having two or more items of MIA syndrome were more likely to develop the deterioration of not only 3MS (P <0.001), but also delayed memory, visuospatial skill, and language ability (P=0.002, P=0.007, P=0.004, respectively).Conclusion: Patients with one item or above of MIA syndrome were at high-risk for the deterioration of global cognitive function. The more MIA syndrome items there were, the more specific cognitive domains deteriorated.

Key words: Peritoneal dialysis, Malnutrition, Inflammation, Cardiovascular disease, Cognitive function

CLC Number:

R459.5

Li-ping DUAN,Zhao-xia ZHENG,Yu-hui ZHANG,Jie DONG. Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients[J].Journal of Peking University(Health Sciences), 2019, 51(3): 510-518.

Figures/Tables 4

Figure 1

Table 1

Comparisons of clinical characteristics of MIA0, MIA1 and MIA2 group at baseline (n=440)"

Variables	MIA0	MIA1	MIA2	F/χ²	P
n(%)	141 (32.0)	153(34.8)	146 (33.2)	-
Age/years, $x ?$ ±s	47.4±13.0^*	52.5±14.1	56.1±14.2^△	14.360	0.000
Male, n(%)	70(49.6)	80(52.3)	82(56.2)	1.241	0.538
PD duration/months, M(Q1,Q3)	19.7(11.1,43.4)	26.6(12.2,53.3)	26.8(9.7,53.2)	4.514	0.105
DM, n(%)	29(20.6)	31(20.3)	46(31.5)	6.575	0.037
CVD, n(%)	0 (0.0)^*	23(15.0)^#	71(48.6)^△	106.569	0.000
hs-CRP /(mg/L), M(Q1,Q3)	0.9(0.5,1.7)^*	3.1(1.0,8.4)^#	8.7(4.1,15.7)^△	201.354	0.000
Serum albumin/(g/L), $x ?$ ±s	39.8±3.0^*	36.4±5.1^#	32.3±5.6^△	91.364	0.000
Depression score/scores, $x ?$ ±s	36.9±8.6^*	40.1±9.4	42.2±9.1^△	12.034	0.000
Level of education (High school and above), n(%)	90(63.8)^*	81(52.9)^#	59(40.4)^△	15.810	0.000
BMI/(kg/m²), $x ?$ ±s	22.7±3.8	22.8±3.4	22.3±3.4	1.103	0.333
Systolic blood pressure(mmHg), $x ?$ ±s	131.0±15.7^*	136.1±18.5	138.6±20.0^△	6.292	0.002
Hemoglobin/(g/L), $x ?$ ±s	109.8±13.7	106.0±17.7^#	99.0±19.4^△	14.724	0.000
Triglycerides/(mmol/L), $x ?$ ±s	1.9±1.0	2.0±1.4	2.0±1.6	0.464	0.629
Total cholesterol/(mmol/L), $x ?$ ±s	4.8±1.0	4.8±1.1	4.6±1.2	1.077	0.341
Calcium/(mmol/L), $x ?$ ±s	2.3±0.2	2.3±0.3^#	2.2±0.3^△	11.617	0.000
Serum sodium/(mmol/L), $x ?$ ±s	139.5±2.7	138.3±11.3	139.2±3.5	1.186	0.306
RRF/(ml/min), M(Q1,Q3)	2.9(0.5,7.4)	2.0(0.0,5.6)	2.1(0.0,5.1)^△	8.030	0.018
Total kt/V, $x ?$ ±s	2.0±0.4	1.9±0.4	1.8±0.4	2.810	0.061
Total CCR/(L/w), $x ?$ ±s	60.5±19.2	57.7±17.1	57.2±17.3	1.345	0.262

Table 1

Table 2

Comparisons of cognitive function parameters of MIA0,MIA1 and MIA2 group at baseline(n=440)"

Variable	MIA0(n=141)	MIA1(n=153)	MIA2(n=146)	F/χ²	P
3MS/scores, $x ?$ ±s	89.2±7.8^*	85.1±10.4^#	79.5±15.6^△	24.734	0.000
CI, n(%)	12(8.5)	27(17.6)^#	49(33.6)^△	28.945	0.000
Trails A/s, M(Q1,Q3)	60.0(45.0,75.0)^*	69.0(46.5,96.5)^#	80.0(55.0,121.8)^△	26.029	0.000
Trails B/s, M(Q1,Q3)	130.0(100.0,199.0)	153.5(104.8,237.0)	183.0(119.3,293.0)^△	18.489	0.000
Immediate memory/scores, $x ?$ ±s	78.1±17.5	74.5±17.1^#	69.1±18.1^△	9.599	0.000
Delayed memory/scores, $x ?$ ±s	92.9±14.1	90.8±16.0^#	84.5±19.5^△	9.840	0.000
Visuospatial skill/scores, $x ?$ ±s	90.7±23.1	86.8±22.9	81.5±23.8^△	5.407	0.005
Language ability/scores, $x ?$ ±s	95.7±12.6	94.9±12.2^#	89.7±14.2^△	8.909	0.000

Table 2

Table 3

Comparisons of difference values of global and specific cognitive function parameters between MIA0, MIA1, and MIA2 group from baseline to follow-up (n=285)"

Variable	MIA0 (n=89)	MIA1 (n=106)	MIA2 (n=90)	F/χ²	P
3MS/scores, $x ?$ ±s	1.1±6.7^*	-2.3±11.8	-3.9±12.0^△	5.227	0.006
Trails A/s, M(Q1,Q3)	-6.0(-18.0,5.0)	-10.0(-32.0,5.0)	-9.5(-30.8,9.0)	1.828	0.401
Trails B/s, M(Q1,Q3)	0.0(-31.5,35.5)	-4.0(-58.0,26.0)	-6.0(-88.5,31.0)	3.469	0.176
Immediate memory/scores, $x ?$ ±s	1.4±16.6	1.9±16.0	4.5±18.4	0.829	0.437
Delayed memory/scores, $x ?$ ±s	0.5±12.9	-1.1±16.6	-4.8±21.0	2.283	0.104
Visuospatial skill/scores, $x ?$ ±s	4.1±24.3	6.1±26.1	1.7±26.5	0.703	0.496
Language ability/scores, $x ?$ ±s	3.4±12.6	-0.0±15.1	-0.4±16.4	1.775	0.171

Table 3

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Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients

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