目的 探讨全血铜锌比值与维持性血液透析(maintenance hemodialysis,MHD)患者认知功能障碍(cognitive impairment,CI)的关系。 方法 选取2022年3月─2023年9月在徐州医科大学附属淮安医院行MHD治疗的130例患者作为研究对象，收集患者临床资料，根据蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分结果分为CI组(n=55)和认知功能正常组(n=75)。采用电感耦合等离子体质谱法检测患者全血锌、血铜水平。比较2组患者一般资料及实验室资料，分析铜锌比值与MoCA积分的相关性、MHD患者发生CI的独立影响因素以及铜锌比值对MHD患者CI的预测价值。 结果 CI组患者年龄(t=-6.161,P＜0.001)、糖尿病占比(χ2=4.240,P=0.039)、透析龄(Z=-2.131,P=0.033)、超敏C反应蛋白(Z=-2.691,P=0.007)、全血铜(Z=-4.272,P＜0.001)、铜锌比值(Z=-5.539,P＜0.001)水平高于认知功能正常组，受教育年限(Z=-4.227,P＜0.001)、肌酐(t=2.002,P=0.047)、血红蛋白(t=5.948,P＜0.001)、白蛋白(Z=-5.519,P＜0.001)、全血锌(t=4.872,P＜0.001)水平低于认知功能正常组。Spearman相关性分析显示MoCA积分与全血铜锌比值呈负相关(r=-0.509,P＜0.001)。多因素 Logistic回归分析结果显示铜锌比值(OR=1.449,95% CI:1.017～1.344,P=0.028)、年龄(OR =1.068,95% CI:1.002～1.138,P=0.044)是MHD患者CI的独立危险因素，白蛋白(OR=0.746,95%CI:0.616～0.904,P=0.003)、血红蛋白(OR=0.945,95% CI:0.906～0.987,P=0.011)是CI的独立保护因素。ROC曲线分析显示铜锌比值预测MHD患者发生CI的曲线下面积为0.785(95% CI:0.704～0.866,P＜0.001)，最佳截断值为0.15，此时敏感度和特异度分别为74.5%、76.0%。 结论 高全血铜锌比值是MHD患者发生CI的独立危险因素，对MHD患者合并CI有一定的预测价值。
Objective To explore the relationship between blood copper-zinc ratio and cognitive impairment (CI) in maintenance hemodialysis (MHD) patients. Methods A total of 130 MHD patients treated in the hemodialysis center of Huai'an Hospital Affiliated to Xuzhou Medical University between March 2022 and September 2023 were enrolled in this study. Their clinical data were collected. Based on the Montreal Cognitive Assessment (MoCA) score, the patients were divided into CI group (n=55) and normal cognitive group (n=75). Inductively coupled plasma mass spectrometry was used to measure blood zinc and copper levels. Baseline clinical and laboratory data were compared between the two groups. The correlation between copper-zinc ratio and MoCA score, the independent influence factors for the presence of CI, and the predictive value of copper-zinc ratio for CI in MHD patients were analyzed. Results Compared to the normal cognitive group, patients in the CI group had older age (t=-6.161, P<0.001), higher percentage of diabetics (c2=4.240, P=0.039), longer dialysis age (Z=-2.131, P=0.033), and higher levels of high sensitivity C-reactive protein (Z=-2.691, P=0.007), blood copper (Z=-4.272, P<0.001) and copper-zinc ratio (Z=-5.539, P<0.001), less years of education (Z=-4.227, P<0.001), and lower levels of creatinine (t=2.002, P=0.047), hemoglobin (t=5.948, P<0.001), albumin (Z=-5.519, P<0.001) and blood zinc (t=4.872, P<0.001). Spearman correlation analysis showed a negative correlation between MoCA score and the blood copper-zinc ratio (r=-0.509, P<0.001). Multivariate logistic regression analysis found that copper-zinc ratio (OR=1.449, 95% CI: 1.017～1.344) and age (OR=1.068, 95% CI: 1.002～1.138) were the independent risk factors for CI in MHD patients, while albumin (OR=0.746, 95% CI: 0.616～0.904) and hemoglobin (OR=0.945, 95% CI: 0.906～0.987) were the independent protective factors for CI (P<0.05). ROC curve analysis showed that the area under the curve of the copper-zinc ratio for predicting the presence of CI in MHD patients was 0.785 (95% CI: 0.704～0.866, P<0.001) and the optimal cut-off value was 0.15, at which the sensitivity and specificity were 74.5% and 76.0%, respectively. Conclusion Higher blood copper-zinc ratio is an independent risk factor for the development of CI in MHD patients. Blood copper-zinc ratio is useful for the prediction of CI in MHD patients.
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