补体C3水平与终末期肾病患者认知功能障碍的相关性研究

    Correlation between serum complement C3 levels and cognitive dysfunction in patients with endstage renal disease

      摘要
    • 摘要: 目的 探究补体C3水平及其他危险因素与终末期肾病患者认知功能障碍的相关性。方法 收集92例2019年7月至2021年7月在安徽医科大学第一附属医院肾脏内科住院的终末期肾病患者的一般病例资料及实验室检查结果，并使用免疫比浊法检测血清补体C3、C4水平，采用蒙特利尔认知量表（montreal cognitive assessment，MoCA）评估认知功能水平，根据MoCA得分将患者分为认知功能障碍组（MoCA得分<26分）及非认知功能障碍组（MoCA得分≥26分），将两组的一般及实验室资料、量表得分、血清补体C3、C4水平进行组间对比，使用多因素Logistic逐步回归分析探究血清补体C3是否为认知功能障碍的独立影响因素。结果 92例终末期肾病患者中55例出现认知功能障碍，发生率为59.78%。认知功能障碍组与非认知功能障碍组间资料对比结果示年龄、受教育年限、血肌酐、估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、血磷、钙磷乘积、血清白蛋白、预后营养指数、总胆固醇、低密度脂蛋白胆固醇、血清铁、C反应蛋白（C-reactive protein，CRP）、汉密尔顿焦虑量表（hamilton anxiety scale，HAMA）得分、汉密尔顿抑郁量表（hamilton depression scale，HAMD）得分差异均具有统计学意义（P<0.05）；血清补体水平组间比较，补体C3水平差异有统计学意义（P<0.05），但血清补体C4水平差异无统计学意义（P>0.05）；多因素Logistic逐步回归分析结果示除受教育年限（OR=0.792，P=0.032）、抑郁程度（OR=1.252，P=0.006）、eGFR水平（OR=0.745，P=0.005）外，血清补体C3水平（OR=1.041，P=0.021）也是终末期肾病患者认知功能的独立影响因素。血清补体C3升高是终末期肾病患者认知功能障碍的独立危险因素。结论 终末期肾病患者认知功能障碍的发生率较高，受多种因素的影响，其中血清补体C3水平升高可能与其认知功能障碍的发生密切相关。

       

      Abstract: Objective To explore the correlation between complement level of C3,other risk factors and cognitive dysfunction in patients with end-stage renal disease(ESRD). Methods From July 2019 to July 2021,medical records and laboratory examinations were collected from 92 ESRD patients. Serum levels of C3 and C4 were detected by immunoturbidimetry. The Montreal Cognitive Assessment scale(MoCA)was employed for assessing the level of cognitive function. According to MoCA score, they were divided into two groups of cognitive impairment(MoCA score <26)and non-cognitive impairment(MoCA score ≥ 26). General profiles,laboratory parameters,scale scores and serum levels of complements C3 and C4 of two groups were compared. Multivariate Logistic stepwise regression analysis was utilized for examining whether or not serum level of complement C3 was an independent influencing factor of cognitive dysfunction. Results Among them,55(59. 78%)had cognitive dysfunction. Differences in age,education duration,serum creatinine,estimated glomerular filtration rate(eGFR),serum phosphorus,calcium-phosphorus product,serum albumin,prognosis of nutrition index,total cholesterol,low-density lipoprotein cholesterol,serum iron,C-reactive protein(CRP)and HAMA/HAMD score were statistically significant(P<0. 05). Inter-group comparison of serum complement level indicated that serum level of complement C3 had statistical significance(P<0. 05)while serum level of complement C4 had no statistical significance (P>0. 05). Multivariate Logistic stepwise regression analysis revealed that except for education duration(OR=0. 792,P=0. 032),depression degree(OR=1. 252,P=0. 006)and eGFR level(OR=0. 745,P=0. 005),serum level of complement C3(OR=1. 041, P=0. 021)was also an independent influencing factor of cognitive function. Elevated serum level of complement C3 was an independent risk factor for cognitive dysfunction in ESRD patients. Conclusion The incidence of cognitive dysfunction remains high in ESRD patients and it is affected by many factors. And a rising serum level of complement C3 may be closely correlated with the occurrence of cognitive dysfunction.

       

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