肾性继发性甲状旁腺功能亢进患者血清Hcy、VCAM-1水平及其与认知功能的相关性分析

Analysis of Levels of Serum Hcy and VCAM-1 in Patients with Renal Secondary Hyperparathyroidism and Their Correlation with Cognitive Function

目的:探讨肾性继发性甲状旁腺功能亢进(SHPT)患者血清同型半胱氨酸(Hcy)、血管细胞黏附分子-1(VCAM-1)水平及其与认知功能的相关性。方法:选择2020年01月—2021年12月本院收治的发生轻度认知障碍的SHPT患者113例作为研究对象,选择同期未发生认知障碍的110例患者作为对照组,检测血清Hcy、VCAM-1水平,ROC曲线分析血清Hcy、VCAM-1对SHPT患者发生认知功能障碍的诊断价值,Logistics多因素回归分析影响SHPT患者发生认知功能障碍的危险因素。结果:与认知功能正常组比较,认知功能障碍组血液透析比例、血清iPTH、Scr、血磷、血钙、Hcy、VCAM-1水平显著升高,MoCA评分显著降低(P<0.05);血清Hcy、VCAM-1及联合诊断SHPT患者发生认知功能障碍的曲线下面积(AUC)分别为0.828、0.850、0.914;透析方式、血清iPTH、受教育年限、Hcy、VCAM-1是影响SHPT患者发生认知功能障碍的危险因素(P<0.05)。结论:SHPT患者血清Hcy、VCAM-1水平升高,与患者认知功能有关,是发生认知功能障碍的独立危险因素。

Objective:To investigate the levels of serum homocysteine(Hcy)and vascular cell adhesion molecule-1(VCAM-1)in patients with renal secondary hyperparathyroidism(SHPT)and their correlation with cognitive function.Methods:A total of 113 SHPT patients with mild cognitive impairment who were admitted to our hospital from January 2020 to December 2021 were selected as the research subjects,and 110 patients without cognitive impairment during the same period were selected as the control group,Serum Hcy and VCAM-1 levels were detected respectively.The diagnostic value of serum Hcy and VCAM-1 on cognitive dysfunction in SHPT patients was analyzed by ROC curve,and the risk factors affecting cognitive dysfunction in SHPT patients were analyzed by Logistic multivariate regression.Results:Compared with the normal cognitive function group,the hemodialysis ratio,ser⁃um iPTH,Scr,serum phosphorus,serum calcium,Hcy,VCAM-1 levels in the cognitive dysfunction group were significantly in⁃creased,and the MoCA score was significantly decreased(P<0.05).The area under the curve(AUC)of serum Hcy,VCAM-1 and combined diagnosis of cognitive dysfunction in patients with SHPT were 0.828,0.850 and 0.914,respectively;Dialysis mode,serum iPTH,years of education,Hcy and VCAM-1 were risk factors for cognitive dysfunction in patients with SHPT(P<0.05).Conclusion:Serum Hcy and VCAM-1 levels are elevated in patients with renal secondary hyperparathyroidism,which are related to cognitive function and are independent risk factors for cognitive dysfunction.