慢性肾脏病患者认知和抑郁障碍的评估及分析

史嫣; 刘东伟; 乔颖进; 郭佳; 潘少康; 刘章锁

doi:10.3969/j.issn.1671-4091.2019.10.009

中国血液净化 >

2019 , Vol. 18 >Issue 10: 693 - 696

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.10.009

透析心理学

慢性肾脏病患者认知和抑郁障碍的评估及分析

史嫣 ,
刘东伟 ,
乔颖进 ,
郭佳 ,
潘少康 ,
刘章锁

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1.1郑州大学第一附属医院肾脏病中心，郑州大学肾脏病研究所，河南省慢性肾脏病精准诊疗重点实验室，国家肾脏疾病临床医学研究中心核心单位

收稿日期: 2018-10-04

修回日期: 2019-07-26

网络出版日期: 2019-09-27

基金资助

国家重点研发项目(No.2016YFC1305404)；科技惠民计划项目(Projiect No.162207310001）

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Assessment and analysis of the cognitive and depressive disorders in chronic kidney disease patients

SHI Yan ,
LIU Dong-Wei ,
QIAO Ying-Jin ,
GUO Jia ,
PAN Shao-Kang ,
LIU Zhang-Suo

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1Department of Nephrology, the First Affiliated Hospital of Zhengzhou University; Institute of Nephrology Research, Zhengzhou
University, Zhengzhou 450052, China

Received date: 2018-10-04

Revised date: 2019-07-26

Online published: 2019-09-27

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摘要

【摘要】目的探讨慢性肾脏病患者认知和抑郁障碍的情况，分析其可能机制。方法根据受试者的肾小球滤过率将179 例受试者分成健康对照组：eGFR＞90 ml/(min·1.73m2)，肾小球滤过率轻度下降组：30＜eGFR＜60 ml/(min·1.73m2)，肾小球滤过率重度下降组：eGFR＜30 ml/(min·1.73m2)组。用简易精神状态检查表(mini-mental state examination,MMSE)和抑郁自测量表(self-rating depression scale，SDS)评估受试者认知功能和抑郁情况，对比分析其颅脑MRI 显影，统计腔隙性脑梗死和脑白质脱髓鞘发生率。结果肾小球滤过率轻度下降组和重度下降组的MMSE 量表评分分别为26.53±0.41(c2=3.046，P=0.003)、23.47±0.94(c2=6.000，P＜0.001)和SDS 量表评分分别为39.18±1.55(c2=2.098，P=0.033)、45.6±1.93(c2=9.183，P=0.002), 与健康对照组相比差异有统计学意义；肾小球滤过率轻度下降组及重度下降组伴认知或抑郁障碍的患者腔隙性脑梗死和脑白质脱髓鞘的发生率分别为42.5%

(c2=4.482，P=0.034)、52.5% (c2=10.474，P=0.001)、50.0% (c2=4.842，P=0.028)、65.0% (c2=6.983，P=0.013),与无认知和抑郁障碍的患者相比发生率较高。结论慢性肾脏病患者出现认知和抑郁障碍的风险较高，可能与患者出现腔隙性脑梗死和脑白质脱髓鞘有关。

关键词： 慢性肾脏病; 认知障碍; 抑郁障碍; 腔隙性脑梗死; 脑白质脱髓鞘

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史嫣 , 刘东伟 , 乔颖进 , 郭佳 , 潘少康 , 刘章锁 . 慢性肾脏病患者认知和抑郁障碍的评估及分析[J]. 中国血液净化, 2019 , 18(10) : 693 -696 . DOI: 10.3969/j.issn.1671-4091.2019.10.009

Abstract

【Abstract】Objective To investigate the occurrence and mechanisms of the cognitive and depressive disorders in patients with chronic kidney disease (CKD). Methods According to glomerular filtration rate (eGFR) of the subjects, a total of 179 subjects were divided into healthy control group (eGFR＞90 ml/min/1.73m2), eGFR slight decrease group (30＜eGFR ＜60 ml/min/1.73 m2), and eGFR significant decrease group (eGFR<30 ml/min/1.73 m2). The Mini- mental State Examination (MMSE) and Self- rating Depression Scale (SDS) were used to evaluate the cognitive function and mental state of CKD patients. Brain MRI images were analyzed to calculate the rate of lacunar infarction and white matter demyelination. Results In eGFR slight decrease group and eGFR significant decrease group, the MMSE scores were 26.53±0.41 (c2=3.046, P=0.003) and 23.47±0.94 (c2=6.000, P＜0.000) respectively, and the SDS scores were 39.18±1.55 (c2=2.098, P=0.033) and 45.6±1.93 (c2=9.183, P=0.002), statistically different from the scores in control group. In the patients with cognitive and depressive disorders in eGFR slight decrease group and eGFR significant decrease group, the rates of lacunar infarction were 42.5% (c2=4.482, P=0.034) and 52.5% (c2=10.474, P=0.001) respectively, and the rates of white matter demyelination were 50.0% (c2=4.842, P=0.028) and 65.0% (c2=6.983, P=0.013) respectively, statistically higher than the rates in patients without cognitive or depressive disorders in the two groups. Conclusions The risks for cognitive impairment and depressive disorder were higher in CKD patients, possibly relating to the presence of lacunar infarction and white matter demyelination in these patients.

Key words： Chronic kidney disease; Cognitive impairment; Depressive disorder; Lacunar infarction; White matter demyelination

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