摘要目的:探讨中老年维持性血液透析（maintenance hemodialysis，MHD）患者透析治疗过程中脑血流量变化对认知功能减退的影响。方法:该研究为前瞻性队列研究，选择2023年1月至2023年6月在首都医科大学附属北京世纪坛医院接受MHD治疗中老年（年龄≥50岁）患者为研究对象，收集患者一般临床资料。采用经颅多普勒（transcranial Doppler，TCD）血流分析仪监测患者血液透析过程中不同时间点大脑中动脉（middle cerebral artery，MCA）平均血流速度（mean flow velocity，MFV），并以此作为评估脑血流量指标，计算透析过程中MFV变化值ΔMFV（透析前MFV-透析后MFV）。采用完整神经心理学测试量表评估患者基线及入组12个月后的认知功能。采用多因素线性回归模型分析ΔMFV与认知功能下降之间的关系。结果:该研究共纳入121例MHD患者，男性97例，年龄（63.63±8.44）岁，透析龄（55.08±54.73）个月。TCD监测结果显示，透析过程中MFV呈显著下降趋势（ P<0.05）。与基线评估值相比，MHD患者入组12个月后的总体认知（蒙特利尔认知评估量表-北京版）、记忆力（复杂图形测验-记忆）、执行功能（斯特鲁普色词测验-计数）、注意力（符号数字模式测验）及视空间功能（复杂图形测验-复制）评分值显著下降（均 P<0.05），执行功能（连线测验-B和斯特鲁普色词测验-时间）评分值显著上升（均 P<0.05）。多因素线性回归分析结果显示，总体认知功能（未标准化系数 B=0.066，95% CI 0.018～0.113， P=0.007）及记忆力（听觉词语学习测验5）（ B=0.050，95% CI 0.004～0.097， P=0.035）、执行功能［连线测验-B（ B=-1.955，95% CI -3.453~ -0.457， P=0.011）；斯特鲁普色词测验-计数（ B=0.298，95% CI 0.112～0.484， P=0.002）；斯特鲁普色词测验-时间（ B=-1.371，95% CI -2.303～-0.439， P=0.004）］认知评分与透析过程中MFV下降率独立相关。 结论:血液透析过程中脑血流量减少与多个认知域的认知功能下降显著相关，透析过程中反复发生的脑血流量减少可能是中老年MHD患者认知功能下降的重要风险因素之一，对记忆和执行域的影响尤为显著。

abstractsObjective:To investigate the effect of intradialytic cerebral blood flow (CBF) fluctuation on cognitive decline in middle-aged and elderly maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. MHD patients aged ≥50 years from Beijing Shijitan Hospital were enrolled from January 2023 to June 2023. Middle cerebral artery mean flow velocity (MFV) was serially monitored via transcranial Doppler (TCD) during dialysis sessions. Cognitive function was assessed at baseline and after 12-month follow-up using standardized neuropsychological tests: montreal cognitive assessment (MoCA), auditory verbal learning test (AVLT 5), complex figure test (CFT), trail making test-B (TMT-B), Stroop color and word test (SCWT), and symbol digit modalities test (SDMT). ΔMFV was calculated as pre-to-post dialysis MFV difference. Multivariable linear regression was used to analyze the association of ΔMFV and cognition.Results:A total of 121 MHD patients were recruited with an age of (63.63±8.44) years. There were 97 males (80.2%), and the dialysis vintage was (55.08±54.73) months. Significant intradialytic MFV reductions were observed ( P<0.05). At 12 months, cognitive decline manifested in global cognition (MoCA), memory (CFT-memory), executive function (TMT-B, SCWT-C, SCWT-T), attention (SDMT), visuospatial ability (CFT-copy)(all P<0.05). Multivariable linear regression analysis revealed ΔMFV independently predicted declines in: MoCA ( B=0.066, 95% CI 0.018-0.113, P=0.007), AVLT5 ( B=0.050, 95% CI 0.004-0.097, P=0.035), TMT-B ( B=-1.955, 95% CI -3.453--0.457, P=0.011), SCWT-C ( B=0.298, 95% CI 0.112-0.484, P=0.002), SCWT-T ( B=-1.371, 95% CI -2.303--0.439, P=0.004). Conclusions:Hemodialysis induces acute CBF reductions detectable by TCD. Cumulative intradialytic CBF fluctuations may accelerate cognitive deterioration in middle-aged and elderly MHD populations, particularly affecting memory and executive domains.