MHD患者血Hcy、PTH、β2-MG与认知障碍的相关性研究
A Study on the Correlation between Hcy, PTH, β2-MG and Cognitive Im-pairment in Maintenance Hemodialysis Patients
摘要: 认知障碍在慢性肾脏病(chronic kidney disease, CKD)患者的所有阶段都很常见,大多数接受维持性血液透析(maintenance hemodialysis, MHD)治疗的终末期肾病(end stage renal disease, ESRD)患者通常患有某种程度的认知功能障碍,这会损害他们的服药依从性和生活质量,认知障碍可能导致长期的不良后果,包括痴呆和死亡。与普通人群相比,MHD患者轻度认知障碍(mild cognitive im-pairment, MCI)患病率较高,据报道接受血液透析的ESRD患者认知障碍发生率高达70%,MCI被认为是MHD患者全因死亡率的独立预测因子。因此,积极控制MHD患者认知障碍的危险因素,早发现、早干预对于提高MHD患者生活质量有重要意义。
Abstract: Cognitive impairment is common in all stages of chronic kidney disease (CKD) patients, and most end-stage renal disease (ESRD) patients who re-ceive maintenance hemodialysis (MHD) treatment typically suffer from some degree of cognitive impairment, which can impair their medication adherence and quality of life. Cognitive impairment may lead to long-term adverse consequences, Including dementia and death. Compared with the general population, MHD patients have a higher incidence of mild cognitive impairment (MCI), with a reported incidence of 70% in ESRD patients undergoing hemodialysis. MCI is considered an inde-pendent predictor of all-cause mortality in MHD patients. Therefore, actively controlling the risk factors of cognitive impairment in MHD patients, early detection and intervention are of great sig-nificance for improving the quality of life of MHD patients.
文章引用:李晓莉, 巴应贵. MHD患者血Hcy、PTH、β2-MG与认知障碍的相关性研究[J]. 亚洲急诊医学病例研究, 2023, 11(2): 47-52. https://doi.org/10.12677/ACREM.2023.11208

参考文献

[1] Tian, X., Xia, X., Yu, H., Chen, H., Jiang, A., Xin, L., et al. (2022) Cognitive Dysfunction and Its Risk Factors in Pa-tients Undergoing Maintenance Hemodialysis. Neuropsychiatric Disease and Treatment, 18, 2759-2769. [Google Scholar] [CrossRef
[2] 朱越, 刘同强. 维持性血液透析老年患者认知障碍相关因素研究进展[J]. 中国老年学杂志, 2022, 42(3): 741-743.
[3] Jongsiriyanyong, S. and Limpawattana, P. (2018) Mild Cogni-tive Impairment in Clinical Practice: A Review Article. The American Journal of Alzheimer’s Disease & Other Demen-tias, 33, 500-507. [Google Scholar] [CrossRef] [PubMed]
[4] Iadecola, C. (2013) The Pathobiology of Vascular Dementia. Neuron, 80, 844-866. [Google Scholar] [CrossRef] [PubMed]
[5] Kalaria, R.N., Akinyemi, R. and Ihara, M. (2016) Stroke Injury, Cognitive Impairment and Vascular Dementia. Biochimica et Biophysica Acta, 1862, 915-925. [Google Scholar] [CrossRef] [PubMed]
[6] Iadecola, C., Park, L. and Capone, C. (2009) Threats to the Mind: Aging, Amyloid, and Hypertension. Stroke, 40, S40-S44. [Google Scholar] [CrossRef
[7] Kalaria, R.N. (2009) Linking Cerebrovascular Defense Mechanisms in Brain Ageing and Alzheimer’s Disease. Neurobiology of Aging, 30, 1512-1514. [Google Scholar] [CrossRef] [PubMed]
[8] Jessen, S.B., Mathiesen, C., Lind, B.L. and Lauritzen, M. (2017) Interneuron Deficit Associates Attenuated Network Synchronization to Mismatch of Energy Supply and De-mand in Aging Mouse Brains. Cerebral Cortex, 27, 646-659. [Google Scholar] [CrossRef] [PubMed]
[9] 丁小燕. 北京市社区血管性认知障碍的流行病学调查及其危险因素分析[D]: [硕士学位论文]. 北京: 中国中医科学院, 2022.
[10] 王文婷. 104例ACI患者继发血管性认知障碍影响因素回归模型构建及分析[J]. 医学理论与实践, 2023, 36(3): 372-376. [Google Scholar] [CrossRef
[11] 张博, 郭倩, 贾晓鑫. 高血压合并腔隙性脑梗死认知障碍特点及影响因素分析[J]. 神经损伤与功能重建, 2020, 15(12): 737-739, 744. [Google Scholar] [CrossRef
[12] Barbay, M., Taillia, H., Nedelec-Ciceri, C., Arnoux, A., Puy, L., Wiener, E., et al. (2017) Vascular Cognitive Impairment: Advances and Trends. Revue Neurologique (Paris), 173, 473-480. [Google Scholar] [CrossRef] [PubMed]
[13] Yoon, J.A., Kim, D.Y., Sohn, M.K., Lee, J., Lee, S.G., Lee, Y.S., et al. (2017) Factors Associated with Improvement or Decline in Cognitive Function after an Ischemic Stroke in Korea: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BMC Neurology, 17, Article No. 9. [Google Scholar] [CrossRef] [PubMed]
[14] 肖锟婷, 苏春燕, 李湘萍, 陆悦, 李利, 刘宇. 透析患者认知功能损害的研究进展[J]. 护理管理杂志, 2016, 16(2): 112-114.
[15] 汤晓静, 陈楠, 戎殳, 陈晓农, 倪兆慧, 张伟明, 等. 高通量血液透析与常规血液透析联合血液透析滤过的临床疗效对比研究[J]. 中国血液净化, 2019, 18(7): 486-490.
[16] 何佳丽, 等. 中国维持性血液透析患者并发认知障碍危险因素的meta分析[J]. 现代临床医学, 2023, 49(2): 115-119.
[17] Ansari, R., Mahta, A., Mallack, E. and Luo, J.J. (2014) Hyperhomocysteinemia and Neurologic Disorders: A Review. Journal of Clinical Neurology, 10, 281-288. [Google Scholar] [CrossRef] [PubMed]
[18] Stea, T.H., Mansoor, M.A., Wandel, M., Uglem, S. and Frolich, W. (2008) Changes in Predictors and Status of Homocysteine in Young Male Adults after a Dietary Intervention with Vege-tables, Fruits and Bread. European Journal of Nutrition, 47, 201-209. [Google Scholar] [CrossRef] [PubMed]
[19] Joosten, E. (2001) Homocysteine, Vascular Dementia and Alz-heimer’s Disease. Clinical Chemistry and Laboratory Medicine, 39, 717-720. [Google Scholar] [CrossRef
[20] Ostrakhovitch, E.A. and Tabibzadeh, S. (2015) Homocysteine in Chronic Kidney Disease. Advances in Clinical Chemistry, 72, 77-106. [Google Scholar] [CrossRef] [PubMed]
[21] 陈萍, 侯朝铭, 高静, 柏丁兮, 王浩, 陈昕羽, 等. 小剂量叶酸降低H型高血压患者高同型半胱氨酸及其MTHFR C677T基因多态性的研究[J]. 中国医药指南, 2022, 20(18): 68-70. [Google Scholar] [CrossRef
[22] 梁丽君, 张改改, 冯新星. 高同型半胱氨酸血症对老年2型糖尿病患者预后的影响[J]. 中国分子心脏病学杂志, 2022, 22(6): 5027-5033. [Google Scholar] [CrossRef
[23] 张艳. 高血压前期和高同型半胱氨酸血症的心血管风险[J]. 中国社区医师, 2023, 39(4): 7-9.
[24] Van Guldener, C., Stam, F. and Stehouwer, C.D. (2005) Hyperho-mocysteinaemia in Chronic Kidney Disease: Focus on Transmethylation. Clinical Chemistry and Laboratory Medicine, 43, 1026-1031. [Google Scholar] [CrossRef
[25] Makita, Y., Moczulski, D.K., Bochenski, J., Smiles, A.M., Warram, J.H., Krolewski, A.S., et al. (2003) Methylenetetrahydrofolate Reductase Gene Polymorphism and Susceptibility to Dia-betic Nephropathy in Type 1 Diabetes. American Journal of Kidney Diseases: The Official Journal of the National Kid-ney Foundation, 41, 1189-1194. [Google Scholar] [CrossRef
[26] Vaccaro, O., Perna, A.F., Mancini, F.P., et al. (2000) Plasma Homocysteine and Microvascular Complications in Type 1 Diabetes. Nutrition, Metabolism & Cardiovascular Diseases, 10, 297-304.
[27] Luzzi, S., Cherubini, V., Falsetti, L., Viticchi, G., Silvestrini, M., Toraldo, A., et al. (2022) Homo-cysteine, Cognitive Functions, and Degenerative Dementias: State of the Art. Biomedicines, 10, Article No. 2741. [Google Scholar] [CrossRef] [PubMed]
[28] Cajavilca, C.E., Gadhia, R.R. and Roman, G.C. (2019) MTHFR Gene Mutations Correlate with White Matter Disease Burden and Predict Cerebrovascular Disease and Demen-tia. Brain Sciences, 9, Article No. 211. [Google Scholar] [CrossRef] [PubMed]
[29] Garibotto, G., Cherubini, V., Falsetti, L., Viticchi, G., Silvestrini, M., Toraldo, A., et al. (2023) Homocysteine Exchange across Skeletal Muscle in Patients with Chronic Kidney Disease. Physiological Reports, 11, e15573.
[30] 贾娇坤, 刘艳芳, 张佳, 赵性泉, 鞠奕. 血清同型半胱氨酸与认知障碍的相关性研究[J]. 中国医学前沿杂志(电子版), 2022, 14(7): 15-20.
[31] Angelini, A., Cappuccilli, M.L., Magnoni, G., Croci Chiocchini, A.L., Aiello, V., Napoletano, A., et al. (2021) The Link between Homocysteine, Folic Acid and Vita-min B12 in Chronic Kidney Disease. Giornale Italiano di Nefrologia, 38.
[32] Zhou, H., Zhong, X., Chen, B., Wu, Z., Zhang, M., Mai, N., et al. (2020) Interactive Effects of Elevated Homocysteine and Late-Life Depression on Cognitive Impairment. Journal of Affective Disorders, 277, 212-217. [Google Scholar] [CrossRef] [PubMed]
[33] 贾凤玉, 孙钢. 甲状旁腺激素与认知功能[J]. 肾脏病与透析肾移植杂志, 2019, 28(5): 469-473.
[34] Jiang, W., Hu, C.Y., Li, F.L., Hua, X.G., Huang, K, Zhang, X.J., et al. (2020) Elevated Parathyroid Hormone Levels and Cognitive Function: A Systematic Review. Archives of Gerontology and Ger-iatrics, 87, Article ID: 103985. [Google Scholar] [CrossRef] [PubMed]
[35] Koh, E.S., Lee, K., Kim, S.H., Kim, Y.O., Jin, D.C., Song, H.C., et al. (2015) Serum beta2-Microglobulin Predicts Mortality in Peritoneal Dialysis Patients: A Prospective Cohort Study. American Journal of Nephrology, 42, 91-98. [Google Scholar] [CrossRef] [PubMed]
[36] Villeda, S.A., Luo, J., Mosher, K.I., Zou, B., Britschgi, M., Bieri, G., et al. (2011) The Ageing Systemic Milieu Negatively Regulates Neurogenesis and Cognitive Function. Nature, 477, 90-94. [Google Scholar] [CrossRef] [PubMed]
[37] Smith, L.K., He, Y., Park, J.S., Bieri, G., Snethlage, C.E., Lin, K., et al. (2015) beta2-Microglobulin Is a Systemic Pro-Aging Factor That Impairs Cognitive Function and Neurogenesis. Nature Medicine, 21, 932-937. [Google Scholar] [CrossRef] [PubMed]
[38] Murray, A.M. (2008) Cognitive Impairment in the Aging Dialysis and Chronic Kidney Disease Populations: An Occult Burden. Advances in Chronic Kidney Disease, 15, 123-132. [Google Scholar] [CrossRef] [PubMed]
[39] Gao, R., Li, G., Yang, R., Yuan, H. and Zhang, S. (2018) Hippo-campal beta2-Microglobulin Mediates Sepsis-Induced Cognitive Impairment. Molecular Medicine Reports, 17, 7813-7820. [Google Scholar] [CrossRef] [PubMed]
[40] Glynn, M.W., Elmer, B.M., Garay, P.A., Liu, X.B., Needleman, L.A., El-Sabeawy, F., et al. (2011) MHCI Negatively Regulates Synapse Density during the Establishment of Cortical Connections. Nature Neuroscience, 14, 442-451. [Google Scholar] [CrossRef] [PubMed]
[41] Elmer, B.M. and McAllister, A.K. (2012) Major Histocompatibility Complex Class I Proteins in Brain Development and Plasticity. Trends in Neurosciences, 35, 660-670. [Google Scholar] [CrossRef] [PubMed]
[42] 田云凤. 红细胞分布宽度、β2-微球蛋白与维持性血液透析患者认知障碍的相关性研究[D]: [硕士学位论文]. 太原: 山西医科大学, 2022.
[43] 田晓琳. 维持性血液透析的ESRD患者的认知障碍及其与脑小血管病的关系[D]: [博士学位论文]. 天津: 天津医科大学, 2019.
[44] 张香如. 维持性血液透析患者的心理状况与生活质量及认知功能的相关研究[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2011.