Objective: To explore the correlation between extracellular water/body cell mass (ECW/BCM) ratio and cognitive impairment (CI) in patients on maintenance hemodialysis (MHD). Methods: A multicenter, cross-sectional study was conducted in Guizhou Province. All adult MHD patients in hemodialysis centers of 18 hospitals in Guizhou Province between June and October 2020 were included. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. The ECW and BCM was derived from bioelectrical impedance, and the ECW/BCM ratio was calculated. The patients were divided into four groups based on the quartile of ECW/BCM ratio. Multivariate logistic regression analysis and subgroup analysis were conducted. Results: A total of 3 160 patients were included in the final analysis, of which 761 (24.1%) developed CI. There were 1 868 males (59.1%) and 1 292 females (40.9%), and the mean age was (55±15) years. Multivariate logistic regression analysis showed that the risk of CI in ECW/BCM Q3 group was 1.55 times (95%CI: 1.03-2.34, P=0.035) of that in group Q1, while the risk of CI in Q4 group was 1.62 times of that in group Q1 (95%CI: 1.05-2.51, P=0.029). Subgroup analysis showed that there was an interaction between previous cerebrovascular event and ECW/BCM on CI (P for interaction=0.04). Patients with a previous history of cerebrovascular events had a higher risk of CI than those without. Among those with no previous cerebrovascular events, the risk of CI in group Q4 was 1.62 times of that in group Q1 (95%CI: 1.19-2.20), while the risk of CI in group Q4 was 7.17 times of that in group Q1 (95%CI: 1.59-32.35) in those with previous cerebrovascular events. Conclusion: Increased ECW/BCM ratio is associated with increased CI risk in patients with MHD, and the risk was more obvious in those with previous history of cerebrovascular events.
目的： 探讨细胞外水与体细胞质量比值（ECW/BCM）与维持性血液透析（MHD）患者认知功能障碍（CI）的相关性。 方法： 多中心横断面研究，纳入于2020年6至10月在贵州省18家血液透析中心行MHD治疗的患者。通过简易智力状态检查（MMSE）量表评估认知功能。采用人体成分测量仪检测的ECW与BCM计算ECW/BCM，依据ECW/BCM四分位数将患者分为4组（Q1~Q4组）。采用多因素logistic 回归模型分析ECW/BCM与CI的关系，并进行亚组分析。 结果： 最终纳入3 160例MHD患者，男1 868例（59.1%），女1 292例（40.9%），年龄（55±15）岁。其中，761例（24.1%）发生了CI。多因素logistic 回归模型分析结果显示，Q3组患者发生CI的风险为Q1组的1.55倍（95%CI：1.03~2.34，P=0.035），Q4组患者发生CI的风险为Q1组的1.62倍（95%CI：1.05~2.51，P=0.029）。亚组分析结果显示，既往脑血管事件史与ECW/BCM存在交互作用（P交互=0.040），调整相关混杂因素后，高ECW/BCM与CI发生的风险在既往有脑血管事件史患者中更高。在既往无脑血管事件的患者中，Q4组发生CI的风险是Q1组的1.62倍（95%CI：1.19~2.20），而在既往有脑血管事件的患者中，Q4组发生CI的风险是Q1组的7.17倍（95%CI：1.59~32.35）。 结论： 高ECW/BCM可增加MHD 患者的CI风险，且在既往有脑血管事件史的患者中更加明显。.