尿毒症脑病患者临床特点与危险因素分析

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目的:比较尿毒症脑病(uremic encephalopathy,UE)患者与尿毒症患者的临床特点,以明确尿毒症脑病患者的独立危险因素。方法:回顾性分析广州医科大学附属第二医院2014年1月至2019年1月期间入院的符合慢性肾病(chronic kidney disease,CKD)5期诊断标准的患者,其中所有符合尿毒症脑病诊断标准者为尿毒症脑病组,以性别、年龄、发病时长相匹配为原则,选取与尿毒症脑病组的同一期间住院的主要诊断为CKD 5期的非尿毒症脑病患者为非尿毒症脑病组。采用n t检验和卡方检验比较两组患者的临床基线资料、化验与影像学结果;采用Logistic回归分析尿毒症脑病的独立危险因素。n 结果:共收集尿毒症脑病组患者70例,非尿毒症脑病组患者70例。尿毒症脑病组患者中存在饮酒史、慢性阻塞性肺疾病和多囊肾病史的比例均较非尿毒症脑病组高(n P0.05);尿毒症脑病组患者中头颅CT或MRI结果显示存在脑软化灶或白质病变的比例均较非尿毒症脑病组高,差异有统计学意义(n P<0.05)。尿毒症脑病组中血中性粒/淋巴细胞比值(NLR)与尿酸(UA)均高于非尿毒症脑病组(n P<0.05),而血血红蛋白(ALB)与游离T3(FT3)水平均低于非尿毒症脑病组(n P<0.05)。Logistic回归模型分析显示,血NLR、FT3和ALB水平是尿毒症脑病患者的独立危险因素。n 结论:头颅影像中常出现的脑软化灶和脑白质病变是尿毒症脑病患者区别于CKD 5期未发生脑病患者的变化特点。NLR、FT3和ALB水平是尿毒症脑病患者的独立危险因素。“,”Objective:To analyze and compare clinical characteristics and risk factors of patients with uremic encephalopathy (UE).Methods:A retrospective analysis was performed from January 2014 to January 2019 in our hospital. Seventy patients diagnosed with chronic kidney disease (CKD) at the end stage (according to diagnosis standard of CKD) complicated with UE were classified into the UE group. In principle matching with sex, age and duration of disease, seventy patients with chronic kidney disease at the end stage but without UE were classified into the non-UE group (NUE group). The demographic data, laboratory examination, CT or MRI examination were recorded and analyzed by using n t or χ n 2 test. In addition, independent risk factors of patients with UE were analyzed by using Logistic model.n Results:A total of 70 patients in the UE group and 70 patients in the NUE group were collected. The proportion of patients with a history of alcohol comsumption, chronic obstructive pulmonary disease and polycystic kidney disease were higher in the UE group than in the NUE group (n P0.05). The proportion of cerebral focus and lesions for brain white matter revealed by head CT or MRI in the UE group were significantly higher than that in the NUE group (n P<0.05). The serum NLR and UA levels in the UE group were higher than those in the NUE group (n P<0.05), but the serum ALB and FT3 levels in the UE group were lower than those in the NUE group (n P<0.05). Logistic regression analysis showed that serum NLR, ALB and FT3 levels were independent risk factors for UE patients.n Conclusions:Cerebral focus and lesions for brain white matter revealed by CT or MRI are typical abnormal in UE patients. The serum NLR, FT3 and ALB levels are independent risk factor for UE patients.
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