目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者血清锌水平与左心室舒张功能障碍(left ventricular diastolic dysfunction，LVDD)的相关性。 方法 单中心横断面研究，选择2018年6月～2020年12月连云港市第一人民医院血液净化中心96例MHD患者作为研究对象。采用火焰原子吸收法检测血清锌水平。根据心脏超声检查结果将二尖瓣舒张早期峰流速(E)二尖瓣环舒张早期运动速度(e’)比值(E/e’)＞15或e’＜7cm/s定义为LVDD组(n=52)和非LVDD组(n=44)。比较LVDD组和非LVDD组患者临床资料、实验室指标和超声心动图参数差异。MHD患者血清锌水平与其他指标的关系采用Pearson和Spearman相关分析。影响MHD患者LVDD的因素采用多因素Logistic回归分析。血清锌对MHD患者LVDD的诊断价值采用ROC分析。 结果 LVDD组患者血清锌水平为(90.15±10.44)μg/dl，低于非LVDD组患者的(107.42±11.57)μg/dl，差异有统计学意义(t=7.618，P＜0.001)。相关性分析结果显示：MHD患者血清锌水平与血红蛋白呈正相关(r=0.263，P =0.017)，与二尖瓣舒张早期峰流速(E)与二尖瓣环舒张早期运动速度(e’)比值(E/e’)、舒张末期左心房直径(left atrial diameter，LAD)呈负相关(r =-0.447，P＜0.001；r =-0.243，P=0.028)。ROC曲线结果显示：血清锌水平预测MHD患者LVDD的曲线下面积(area under curve，AUC)为0.817(95%CI：0.728～0.892，P=0.015)，预测临界值为95.85μg/dl，敏感度为78.44%，特异度为76.02%。多因素Logistic回归分析结果显示低血清锌水平是影响MHD患者LVDD的独立危险因素(OR=2.014，95%CI：1.414～7.015，P=0.005)。 结论 较低的血清锌水平是MHD患者发生LVDD的独立危险因素，血清锌可作为早期筛查MHD患者LVDD的一项有效的血清学标志物。
Objective To study the relationship between serum zinc level and left ventricular diastolic dysfunction (LVDD) in patients with maintenance hemodialysis (MHD), and to explore the feasibility of serum zinc for early prediction of LVDD in MHD patients. Methods This was a single centered and cross-sectional study. A total of 96 MHD patients in the Blood Purification Center of Lianyungang First People's Hospital from Jun 2018 to Dec 2020 were recruited as the research objects. Serum zinc level was measured by flame atomic absorption spectrometry. According to the results of echocardiography, the patients were divided into LVDD group (n=52) and non-LVDD group (n=44). The clinical data, laboratory indexes and echocardiographic parameters were compared between LVDD group and non-LVDD group. The relationship between serum zinc level and other indexes in MHD patients was analyzed by Pearson and Spearman correlation methods. The factors affecting LVDD in MHD patients were analyzed by multivariate logistic regression. The diagnostic value of serum zinc for LVDD in MHD patients was analyzed by ROC. Results Serum zinc level in LVDD group was (90.15±10.44) μg/dl, lower than that in non-LVDD group (107.42±11.57) μg/dl, and the difference was statistically significant (t=7.618, P<0.001). Correlation analyses showed that serum zinc level in MHD patients was positively correlated with hemoglobin (r=0.263, P=0.017), and negatively correlated with E/E' (r=-0.447, P<0.001) and left atrial diameter (LAD) (r=-0.243, P=0.028). ROC curve showed that the area under curve (AUC) of serum zinc level in predicting LVDD in MHD patients was 0.817 (95% CI: 0.728~0.892, P=0.015), the predicted cutoff value was 95.85 μg/dL, the sensitivity was 78.44%, and the specificity was 76.02%. Multivariate logistic regression showed that lower serum zinc level was an independent risk factor for LVDD in MHD patients (OR=2.014, 95% CI: 1.414~7.015, P=0.005). Conclusion Lower serum zinc level is an independent risk factor for LVDD in MHD patients. Serum zinc may be an effective serological marker for predicting LVDD in MHD patients.
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