维持性血液透析患者钙磷代谢紊乱与认知障碍的关系

The Relationship between Calcium-phosphorus Metabolism Disorder and Cognitive Impairment in Maintenance Hemodialysis Patients

目的本研究利用蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)对维持性血液透析(maintenance hemodialysis,MHD)患者进行整体的认知功能评估,探讨钙磷代谢紊乱与MHD患者发生轻度认知障碍(mild cognitive impairment,MCI)的相关性及其预测MHD相关轻度认知障碍(maintenance hemodialysis associated mild cognitive impairment,MHD-MCI)的价值。方法选取2020年6月至2021年6月在武汉大学中南医院行MHD治疗的患者,根据MoCA量表评估MHD患者整体认知功能,分为MCI组和非认知障碍(non-cognitive impairment,NCI)组,收集患者的一般临床资料及实验室指标并进行统计学比较;Spearman分析MoCA得分与钙磷代谢水平的相关性;采用Logistic回归分析MHD-MCI发生的影响因素,绘制受试者工作特征(receiver operator characteristic curve,ROC)曲线评价潜在危险因素预测MHD-MCI的价值。结果(1)本研究共纳入117例MHD患者,其中71例表现出MCI,MHD-MCI发生率为60.7%;不同的血清钙、磷水平的患者MHD-MCI发生率差异无统计学意义。随着血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平的增加,MHD-MCI发生率逐渐升高;(2)Spearman相关性分析发现,MoCA得分与iPTH、ALP水平呈负相关,相关系数分别为-0.443和-0.643,差异有统计学意义(P<0.001);(3)多因素Logistic回归分析结果显示,患糖尿病、ALP和iPTH是MHD-MCI发生的可能危险因素;(4)ROC曲线结果显示,ALP、iPTH对判断MHD-MCI均具有一定价值,经Delong检验显示ALP预测MHD-MCI的诊断效能优于iPTH(Z=2.246,P=0.0153)。结论本研究中,MHD-MCI的发生率为60.7%。研究显示,血清ALP、iPTH水平升高是MHD-MCI发生的独立危险因素;血清ALP、iPTH对预测MHD-MCI发生均具有一定价值,ALP诊断效能可能更优。

Objective To explore the correlation between calcium-phosphorus metabolism disor⁃ders and the occurrence of mild cognitive impairment(MCI)in maintenance hemodialysis(MHD)pa⁃tients and examine its value in predicting maintenance hemodialysis associated mild cognitive impairment(MHD-MCI).Methods From June 2020 to June 2021,117 MHD patients were recruited from our blood purification center.Clinical profiles and laboratory parameters were recorded.Montreal Cognitive Assessment(MoCA)scale was utilized for evaluating overall cognitive function.They were divided into two groups of cognitive impairment and non-cognitive impairment.Correlations between MoCA scores and calcium and phosphorus metabolic variables were analyzed by Spearman's method.Logistic regres⁃sion was utilized for examining the influencing factors of the occurrence of MHD-MCI.Receiver operatng characteristic(ROC)curve was plotted for evaluating the value of potential risk factors in predicting MHD-MCI.Results Among them,71 patients developed MCI with an incidence rate of 60.7%.No statistical difference existed in the incidence of MHD-MCI in patients with different serum levels of cal⁃cium(Ca)and phosphorus(P).With a rising serum level of iPTH/ALP(intact parathyroid hormone/al⁃kaline phosphatase),the incidence of MHD-MCI gradually increased.Spearman’s correlation analysis revealed that MoCA score was negatively correlated with serum level of iPTH/ALP.The correlation co⁃efficients were-0.443 and-0.643 respectively and the difference was statistically significant(P<0.001).Multivariate Logistic regression indicated that diabetes mellitus and serum level of ALP/iPTH were possible risk factors for MHD-MCI.ROC curve results implied that serum levels of iPTH and ALP had some value for judging MHD-MCI.Delong test showed that ALP was superior to iPTH in predict⁃ing MHD-MCI(Z=2.246,P=0.0153<0.05).Conclusion The incidence of MHD-MCI is 60.7%.El⁃evated serum levels of ALP and iPTH are independent risk factors for the occurrence of MHD-MCI.Se⁃rum ALP/iPTH has some value for predicting the occurrence of MHD-MCI and ALP may offer a better diagnostic performance.