维持性血液透析患者血浆Aβ、P-tau181水平与认知功能障碍的相关性研究

Correlation between plasma Aβand P-tau181 levels and cognitive impairment in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者血浆β样淀粉样蛋白(Aβ)、磷酸化tau181蛋白(P-tau181)水平与认知功能障碍(CI)的相关性。方法122例MHD患者根据蒙特利尔认知评估量表(MoCA)评分分为CI组(MoCA评分<26分,47例)和非CI组(MoCA评分≥26分,75例)。采用酶联免疫吸附试验检测血浆Aβ、P-tau181水平,并比较2组临床资料。Spearman分析MHD患者MoCA评分与血浆Aβ、P-tau181水平的相关性。二元Logistic回归分析MHD患者并发CI的影响因素。应用受试者工作特征(ROC)曲线分析血浆Aβ、P-tau181水平诊断MHD患者并发CI的价值。结果与非CI组比较,CI组患者高血压比例、受教育年限和舒张压降低,糖尿病比例、P-tau181和Aβ水平升高(P<0.05)。MHD患者血浆Aβ、P-tau181水平与MOCA评分均呈负相关(r_(s)分别为-0.343,-0.402,P<0.05)。Logistic回归分析结果显示,P-tau181、Aβ升高是MHD患者并发CI的危险因素。ROC曲线显示,血浆Aβ、P-tau181及两者联合诊断MHD患者并发CI的曲线下面积分别为0.725、0.752、0.801,三者诊断价值差异无统计学意义。结论MHD患者血浆中Aβ、P-tau181水平升高与患者CI的发生相关,两者对MHD患者并发CI具有较好的诊断价值。

Objective To investigate the correlation between plasmaβ-like amyloid(Aβ),phosphorylated tau181 protein(P-tau181)levels and cognitive impairment(CI)in patients on maintenance hemodialysis(MHD).Methods One hundred and twenty-two MHD patients were divided into the CI group(MoCA score<26,n=47)and the non-CI group(MoCA score≥26,n=75)according to Montreal Cognitive Assessment Scale(MoCA)score.Plasma Aβand P-tau181 levels were measured using enzyme-linked immunosoradsorption assay.The clinical data were compared between the two groups of patients.Spearman's analysis was used to analyze the correlation between MoCA score and plasma Aβand P-tau181 levels in MHD patients.Binary Logistic regression was used to analyze influencing factors of concurrent CI in MHD patients.The value of plasma Aβ,P-tau181 levels in diagnosing concurrent CI in MHD patients was analyzed by applying the receiver operating characteristic curve(ROC).Results Compared with the non-CI group,patients in the CI group had lower proportions of hypertension,years of education and diastolic blood pressure,and higher proportions of diabetes,P-tau181 and Aβlevels(P<0.05).Plasma Aβand P-tau181 levels were negatively correlated with MOCA scores in MHD patients(r_(s)=-0.343,-0.402,respectively,P<0.05).Logistic regression analysis showed that elevated P-tau181 and Aβwere risk factors for concurrent CI in MHD patients.ROC curves showed that the areas under the curves for plasma Aβ,P-tau181 and the combination of the two for diagnosis of concurrent CI in MHD patients were 0.725,0.752 and 0.801,respectively.The difference in diagnostic value between the three was not statistically significant.Conclusion Elevated plasma levels of Aβand P-tau181 are correlated with the occurrence of CI in MHD patients,and both have good diagnostic value for CI in patients with MHD.