维持性血液透析患者血清内脂素与认知功能障碍的相关性研究

王小琪; 刘聪慧; 马也娉; 曹倩颖; 邵枫; 李忠心

doi:10.3969/j.issn.1671-2390.2025.04.007

维持性血液透析患者血清内脂素与认知功能障碍的相关性研究

Correlation between serum Visfatin and cognitive impairment in maintenance hemodialysis patients

摘要

摘要: 目的研究维持性血液透析（maintenance hemodialysis，MHD）患者血清内脂素与认知功能障碍（cognitive impairment，CI）的相关性。方法应用横断面研究法，收集2023年7月1日至2024年1月31日首都医科大学附属北京潞河医院MHD患者的一般资料，采集患者空腹血标本，检测血清内脂素水平，应用蒙特利尔认知评估量表检测患者认知水平，根据是否合并CI将患者分为2组，比较2组患者的临床特点；应用多因素Logistic回归法分析CI的独立影响因素；应用受试者工作特征（receiver operating characteristic，ROC）曲线分析影响因素对MHD患者发生CI的预测价值。结果本研究共纳入146例MHD患者，分为非CI组（n=46）和CI组（n=100）。CI组患者的年龄［66.00（57.25，71.00）岁比45.50（40.00，56.25）岁］、合并糖尿病（56.0%比32.6%）、内脂素［13.35（7.68，24.68）μg/L比7.46（4.46，14.07）μg/L］、血糖［（11.13 ±5.34）mmol/L比（9.17 ±4.46）mmol/L］、体重指数［24.29（21.24，26.21）kg/m²比21.36（19.94，24.85）kg/m²］以及C反应蛋白［（16.60 ±23.37）mg/L比（8.24 ±10.41）mg/L］高于非CI组（P<0.05）；CI组患者受教育年限［9.00（6.00，9.00）年比12.00（9.00，12.75）年］、白蛋白（albumin，Alb）［40.35（37.70，42.18）g/L比42.15（40.28，44.58）g/L］、血肌酐［731.00（632.75，876.00）μmol/L比951.00（828.75，1102.50）μmol/L］、血钠［136.5（135.0，138.0）mmol/L比137.5（136.0，139.0）mmol/L］、血磷［（1.68 ±0.52）mmol/L比（1.90 ±0.57）mmol/L］低于非CI组，差异有统计学意义（P<0.05）；多因素Logistic回归分析发现高龄、血清内脂素升高、较低的受教育年限以及Alb水平是MHD患者发生CI的独立危险因素。ROC曲线显示，血清内脂素单独预测CI的曲线下面积（area under the curve，AUC）为0.714（P<0.01）。如果将血清内脂素、Alb、年龄和受教育年限四项指标联合起来，其预测CI的AUC为0.870，敏感度为78.0%，特异度为84.8%（P<0.01），大于任意单独指标，具有较高的预测价值。结论对于MHD患者来说，血清内脂素升高是CI的独立危险因素，可能成为预测患者发生CI的生物学指标。

Abstract: Objective To study the correlation between serum Visfatin and cognitive impairment （CI） in maintenance hemodialysis （MHD） patients.Methods It was a cross-sectional study. From July 1， 2023 to January 31， 2024， baseline characteristics of MHD patients treated in the Beijing Luhe Hospital，Capital Medical University were collected. Serum level of Visfatin was evaluated using fasting blood samples. Cognitive function was assessed using the Montreal cognitive assessment scale （MoCA）. According to the results of MoCA， the patients were divided into cognitive impairment （CI） group and non-CI group. Clinical characteristics were compared between groups. Multivariate logistic regression was employed for analyzing the independent influencing factors for CI. Receiver operating characteristic （ROC） curve was used to analyze the predictive value of influencing factors for CI in MHD patients.Results Totally 146 MHD patients were enrolled in this study and divided into non-CI group （n=46） and CI group （n=100）. Compared to the non-CI group， patients in the CI group had significantly older age ［66.00（57.25，71.00）years vs 45.50（40.00，56.25）years］， higher proportion of diabetes （56% vs 32.6%）， Visfatin level ［13.35（7.68，24.68）μg/L vs 7.46（4.46，14.07）μg/L］， blood sugar ［（11.13 ±5.34）mmol/L vs （9.17 ±4.46）mmol/L］， body mass index ［24.29（21.24，26.21）kg/m² vs 21.36（19.94，24.85）kg/m²］， and C-reactive protein［（16.60 ±23.37）mg/L vs （8.24 ±10.41）mg/L］（P<0.05）. Patients in the CI group had significantly lower education years［9.00（6.00，9.00）years vs 12.00（9.00，12.75）years］， albumin （Alb）［40.35（37.70，42.18）g/L vs 42.15（40.28，44.58）g/L］， serum creatinine ［731.00（632.75，876.00）μmol/L vs 951.00（828.75，1102.50）μmol/L］， blood sodium ［136.5（135.0，138.0）mmol/L vs 137.5（136.0，139.0）mmol/L］， and blood phosphorus ［（1.68 ±0.52）mmol/L vs（1.90 ±0.57）mmol/L］ than non-CI group （P<0.05）. Multivariate logistic regression analysis showed that increasing age， high Visfatin level， low education level and Alb level were independent risk factors for CI in MHD patients. ROC curve showed that the area under the curve （AUC） of Visfatin for predicting CI in MHD patients was 0.714 （P<0.01）， with the sensitivity of 71.7% and the specificity of 75.0%， which had high predictive value. When Visfatin， Alb， age and education level were combined， the AUC for predicting CI was 0.87， the sensitivity was 78.0% and the specificity was 84.8% （P < 0.01） which performed better in the predictive value than any single indicator.Conclusion For MHD patients， high Visfatin level is an independent risk factor for CI， which may become a biological indicator for predicting CI.

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