钙化调节因子与维持性血液透析患者认知功能障碍的相关性研究

罗洁羽; 丁梓峻; 张春江; 金鑫; 郝文娟; 赵丹

doi:10.3969/j.issn.1671-2390.2025.04.003

钙化调节因子与维持性血液透析患者认知功能障碍的相关性研究

Study of correlation between calcification regulatory factors and cognitive impairment in maintenance hemodialysis patients

摘要

摘要: 目的探讨血清去磷酸化未羧化的基质Gla蛋白（dephosphorylated uncarboxylated matrix Gla protein，dp-ucMGP）及血清骨形态发生蛋白2（bone morphogenetic protein-2，BMP-2）与维持性血液透析（maintenance hemodialysis，MHD）患者认知功能障碍（cognitive impairment，CI）的关系。方法选择2021年6月1日至2023年4月30日在石河子大学第一附属医院及石河子市人民医院行MHD的患者254例。收集患者一般及实验室资料，采用中文版蒙特利尔认知评估量表（Chinese version of montreal cognitive assessment，C-MoCA）对所有患者进行认知功能评估，并采用酶联免疫吸附试验检测患者血清dp-ucMGP及BMP-2水平。结果纳入的254例患者中，C-MoCA量表筛选出CI患者192例。CI组患者年龄［57.0（50.0，67.7）岁比48.0（35.0，54.0）岁］、收缩压［137（129，148）mmHg比134（125，142）mmHg］（1 mmHg=0.133 kPa）、女性比例（40.1%比22.6%）、高血压比例（76.6%比45.2%）、受教育年限（≤6年：30.7%比4.8%；>6，≤9年：41.2%比27.4%）、血清dp-ucMGP［9.05（7.81，10.71）μg/L比5.95（4.43，7.21）μg/L］及BMP-2水平［114.72（101.07，140.44）ng/L比89.65（74.17，101.74）ng/L］高于NCI组患者（P<0.05），而受教育年限（>9，<13年：20.3%比45.2%；≥13年：7.8%比22.6%）低于NCI组患者（P<0.05）。二元Logistic回归分析显示年龄、收缩压、血清dp-ucMGP及BMP-2水平与MHD患者CI相关（P<0.05）。Spearman相关分析显示MHD患者血清dp-ucMGP水平与C-MoCA评分、视空间与执行功能、注意、语言、抽象、延迟回忆、定向呈负相关（P<0.05）。血清BMP-2水平与C-MoCA评分、视空间与执行功能、命名、注意、语言、抽象及延迟回忆呈负相关（P<0.05）。结论血清dp-ucMGP及BMP-2是MHD患者发生CI的危险因素，并且其水平可能与CI严重程度有关。

Abstract: Objective To evaluate the correlation of serum dephosphorylated uncarboxylated matrix Gla protein （dp-ucMGP） and bone morphogenetic protein-2 （BMP-2） with cognitive impairment （CI） in maintenance hemodialysis （MHD） patients.Methods Two hundred and fifty-four MHD patients in the First Affiliated Hospital of Shihezi University and Shihezi People's Hospital from June 1， 2021 to April 30， 2023 were selected. The general and laboratory data of the patients were collected. Cognitive function was evaluated with the Chinese version of Montreal Cognitive Assessment Scale （C-MoCA）. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum dp-ucMGP and BMP-2.Results Among the 254 patients included， 192 patients with CI were screened by the C-MoCA scale. Patients in the CI group had significantly older age ［57.0（50.0，67.7）years vs 48.0（35.0，54.0）years］， higher systolic blood pressure ［SBP， 137（129，148）mmHg vs 134（125，142）mmHg， 1 mmHg=0.133 kPa］， female proportion （40.1% vs 22.6%）， proportion of hypertension （76.6% vs 45.2%）， years of education （≤6 years： 30.7% vs 4.8%； >6， ≤9 years： 41.2% vs 27.4%）， serum dp-ucMGP ［9.05（7.81，10.71）μg/L vs 5.95（4.43，7.21）μg/L］， and serum BMP-2［114.72（101.07，140.44）ng/L vs 89.65（74.17，101.74）ng/L］， but lower proportion of high education level （>9， <13 years： 20.3% vs 45.2%； ≥13 years： 7.8% vs 22.6%） than those in the non-CI group （P<0.05）. Binary Logistic regression analysis suggested that age， SBP and serum dp-ucMGP and BMP-2 were significantly correlated with CI in MHD patients （P<0.05）. Spearman correlation analysis showed that serum dp-ucMGP was negatively correlated with the C-MoCA score， and the scores of visuospatial/executive， attention， language， abstraction， delayed recall and orientation dimensions（P<0.05）. Serum BMP-2 was negatively correlated with the C-MoCA score， and the scores of visuospatial/executive， naming， attention， language， abstraction and delayed recall dimensions（P<0.05）.Conclusion Serum dp-ucMGP and BMP-2 are risk factors for CI in MHD patients， and their levels may be related to the severity of CI.

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