The highly prevalent cognitive impairment in hemodialysis patients is associated with all-cause mortality; however, the role of different cognitive domain impairments in this association is still not clarified. Our objective was to determine the association between cognitive domain impairment and all-cause mortality in elderly adult patients undergoing hemodialysis. We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. Baseline data were collected, and a series of neuropsychological batteries covering 5 domains of cognitive function were included for the assessment of cognitive function. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V), the patients were classified as normal, mild, and major cognitive impairment for global and domain cognitive function, then followed up for 1 year. Kaplan–Meier survival analysis was used to compare the difference in the cumulative survival rate in different cognitive domains. A multivariate Cox proportional hazards regression analysis was used to determine the association between global or domain cognitive impairment and all-cause mortality. A total of 613 patients were enrolled, the mean age was 63.82 ± 7.14 years old, and 42.1% were women. After 49.53 ± 8.42 weeks of follow-up, 69 deaths occurred. Kaplan–Meier plots demonstrated a significant association of cognitive impairment in memory, executive function, attention, and language domains with all-cause death. Multivariate Cox regression analysis showed that mild and major impairment of global cognition (HR = 2.89 (95% CI, 1.01–8.34), p = 0.049 and HR = 4.35 (95% CI, 1.55–12.16), p = 0.005, respectively), executive cognitive domain (HR = 2.51 (95% CI, 1.20–5.24), p = 0.014; HR = 3.91 (95% CI, 1.70–9.03), p = 0.001, respectively), and memory cognitive domain (HR = 2.13 (95% CI, 1.07–4.24), p = 0.031; HR = 3.67 (95% CI, 1.71–7.92), p = 0.001, respectively) were associated with all-cause mortality. Combined impairment of 3, 4, and 5 cognitive domains was associated with all-cause mortality [HR = 5.75 (95% CI, 1.88–17.57), p = 0.002; HR = 12.42 (95% CI, 3.69–41.80), p < 0.001; HR = 13.48 (95% CI, 3.38–53.73), p < 0.001, respectively]. We demonstrate an association between the executive and memory cognitive domain impairment and all-cause mortality in hemodialysis patients. Our data suggest that the impairments in these cognitive domains might help in the early identification of hemodialysis patients at risk of death.

Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.

目的 探讨老年血液透析患者臂踝动脉脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)与认知功能障碍的相关性.方法 选择2019年1?3月首都医科大学附属北京世纪坛医院及北京市南口医院的血液透析患者266例,根据中文版蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分将患者分为认知功能正常组88例(MoCA≥26分)和认知功能障碍组178例(MoCA＜26分).收集相关临床资料,采用多因素logis-tic回归分析影响因素,用ROC曲线分析baPWV的预测效能.结果 与认知功能正常组比较,认知功能障碍组年龄、糖尿病和脑卒中比例、baPWV水平更高,透析时间更长,受教育程度和血红蛋白更低(P＜0.01).多元logistic回归显示,年龄、受教育程度、糖尿病、透析时间、血红蛋白、baPWV与认知功能障碍独立相关(OR=1.09,95％CI:1.04～1.14、OR=0.84,95％CI:0.73?0.97、OR=3.72,95％CI:1.60～8.68、OR=1.03,95％CI:1.01?1.04、OR=0.94,95％CI:0.91?0.97、OR=1.38,95％CI:1.23～1.56,P＜0.05,P＜0.01).baPWV评估患者认知功能的ROC曲线下面积为0.793,临界值为15.30 m/s(P＜0.01).结论 baPWV增高是老年血液透析患者认知功能障碍发生的独立风险因素,该指标对认知功能障碍具有较佳的预测作用.

Objective:To investigate the association between cognitive impairment and all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis (HD).Methods:A prospective cohort study was conducted. Patients from 11 HD centers in Beijing between April and June 2017 were enrolled. Baseline data were collected, and a series of neuropsychological batteries covered 5 domains of cognitive function were applied for the assessment of cognitive function. The patients were then classified as normal and cognitive impairment groups according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V) and followed-up until June 2018. The clinical characteristics of the two groups of patients were compared. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the independent influencing factors of all-cause mortality, to determine the relationship between cognitive impairment and different cognitive domain impairments and all-cause death.Results:A total of 613 patients were enrolled, of which 496(80.91%) patients had cognitive impairment. Compared with the normal cognitive function group, the patients in the cognitive impairment group tended to be older, longer dialysis vintage, a higher proportion of diabetes, hypertension, and stroke, increased serum iPTH level, and lower education level and urea clearance index (Kt/V) (all P<0.05). After (49.53±8.42) weeks of follow-up, Kaplan-Meier survival analysis showed that the cumulative survival rate of cognitive impairment group was significantly lower than that of cognitive normal group (Log-rank χ2=8.610, P=0.003). Multivariate Cox regression analysis showed that history of diabetes ( HR=2.742, 95% CI 1.598-4.723, P<0.001), coronary heart disease ( HR=1.906, 95% CI 1.169-3.108, P=0.010), dialysis vintage (every increase of 1 month, HR=1.007, 95% CI 1.003-1.011, P=0.001), serum level of albumin (every increase of 1 g/L, HR=0.859, 95% CI 0.809-0.912, P<0.001), cognitive impairment ( HR=2.719, 95% CI 1.088-6.194, P=0.032) were independently associated with all-cause mortality. Multivariate Cox regression analysis on different cognitive domains also indicated that memory impairment ( HR=2.571, 95% CI 1.442-4.584, P<0.001), executive function impairment ( HR=3.311, 95% CI 1.843-5.949, P=0.001) and three, four, five domains combined impairment ( HR=5.746, 95% CI 1.880-17.565, P=0.002; HR=12.420, 95% CI 3.690-41.802, P<0.001; HR=13.478, 95% CI 3.381-53.728, P<0.001) were independently related to all-cause mortality. Conclusions:Cognitive impairment is an independent risk factor of all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis, and the risk is significantly increased in patients with the impairment of the domains of memory, executive function, or in the combination of three to five cognitive domains.

目的:探究老年慢性心力衰竭患者应用磷酸肌酸钠对心功能和BNP的影响.方法:选取98例2019年3月-2020年3月期间本院接诊的慢性心力衰竭老年患者,奇偶数法均分为对照组(常规抗心衰治疗)、研究组(磷酸肌酸钠),比较两组治疗前后心功能、BNP水平与6-MWT状况.结果:治疗前后相比,两组心功能各参数指标均改善(P<0.05),但与对照组相比,研究组LVEDV、LVESV更小,心输出量、每搏输出量更大(t=3.08、5.61、2.69、2.14,P<0.05).治疗前后两组BNP水平、hs-CRP水平、6-MWT显著改善(P<0.05),但研究组BNP、hs-CRP水平比对照组更低、6-MWT距离比对照组更远(t=5.13、2.41、11.76,P<0.05).研究组疗效比对照组疗效更佳(χ2=4.35,P<0.05).结论:在治疗老年慢性心力衰竭时,采取磷酸肌酸钠,不仅能够显著改善患者心功能,还可以降低BNP水平,增加6-MWT距离,整体疗效更佳.

目的:探讨维持性血液透析患者应用醛固酮受体拮抗剂对心血管系统的影响作用.方法:2019年1-12月收治进行维持性血液透析治疗的心血管系统疾病患者60例,随机分为两组,各30例.对照组采用常规对症治疗;研究组采用常规对症联合醛固酮受体拮抗剂治疗.比较两组心功能改善程度、6 min步行距离及醛固酮和脑钠肽水平.结果:研究组治疗后左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、搏输出量(SV)指标水平均低于对照组,左心射血分数(LVEF)指标水平高于对照组,差异有统计学意义(P<0.05);研究组6 min步行距离长于对照组,差异有统计学意义(P<0.05);研究组醛固酮和脑钠肽水平改善程度均优于对照组,差异有统计学意义(P<0.05).结论:联合选用醛固酮受体拮抗剂对维持性血液透析患者进行治疗的整体疗效显著,可有效改善患者心功能,缓解患者临床症状,降低醛固酮和脑钠肽水平.

目的 探究女性出现复发尿路感染的原因.方法 选择到我院就诊的126例出现复发性尿路感染症状的女性患者为研究对象.所有患者停用抗生素治疗约1周,对患者实施尿检,并开展细菌药敏试验;对患者实施B超检测,若B超检测之后提示有肾脏结构异常、结石或者积水情况,则需要对其实施静脉肾盂造影.观察126例患者中段尿培养结果 以及感染细菌对抗生素的耐药情况,分析其出现复发性尿路感染的原因.结果 126例患者中,共出现96株致病菌,其中79株为细菌,而造成患者出现复发性尿路感染症状的原因是多种多样的.结论 及早对经过治疗依然出现复发性尿路感染症状的患者进行泌尿系、妇科及尿液细菌学检查,明确复发尿路感染的原因,有针对性地开展治疗及预防,可降低尿路感染复发率.