目的 研究阿尔茨海默病（AD）患者血清中铁死亡相关谷胱甘肽（GSH）、谷胱甘肽过氧化酶4（GPX4）、同型半胱氨酸（Hcy）、血清铁水平的变化，分析其与认知功能的相关性；评价血清铁死亡相关指标对AD的诊断价值。 方法 选取就诊于新疆医科大学第二附属医院住院的AD患者37例，同期住院无认知障碍人群35例。对所有受试者进行神经心理学评估，并检测血清GSH、GPX4、Hcy、血清铁的水平。比较两组的一般资料，分析GSH、GPX4、Hcy、血清铁与简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评分的相关性，采用单因素和多因素二元logistic回归分析探讨AD的影响因素，构建其预测模型，绘制受试者工作特征（ROC）曲线评价预测模型对AD的诊断价值。 结果 （1）与对照组比较，AD组的血清GSH水平（23.573 ± 8.862）μmol/L和GPX4水平（21.767 ± 9.609）μU/mL均显著降低（P < 0.05），对照组血清GSH、GPX4的相应水平分别为（34.380 ± 19.673）μmol/L和（31.345 ± 10.553）μU/mL。两组血清铁及Hcy水平比较，差异无统计学意义（P > 0.05）。（2）血清中GPX4与MMSE评分（r = 0.233，P = 0.049）、MoCA评分（r = 0.296，P = 0.011）呈正相关，血清铁与MoCA评分（r = 0.252，P = 0.033）呈正相关。（3）多因素二元logitic回归分析示BMI（OR = 0.794，P < 0.05）和血清GPX4（OR = 0.917，P < 0.05）是AD发生的保护因素。血清GPX4水平诊断AD的曲线下面积（AUC）为0.766（95%CI：0.656 ~ 0.877），灵敏度为67.6%，特异度为77.1%，截断值（cut-off）为44.7（P < 0.05）；联合BMI和GPX4水平诊断AD的AUC值为0.815（95%CI：0.715 ~ 0.914），灵敏度为81.1%，特异度为77.1%（P < 0.05）。 结论 （1）AD患者血清GSH和GPX4水平降低。（2）血清GPX4和血清铁水平与其认知功能呈正相关。（3）BMI和血清GPX4是AD的影响因素，且其与联合因素构建的预测模型对AD具有一定的预测价值。

Objective investigate the changes in the expression levels of ferroptosis-related glutathione （GSH）， glutathione peroxidase 4 （GPX4）， homocysteine （Hcy）， and serum iron in the serum of patients with Alzheimer's disease （AD）， analyze their correlation with cognitive function， and evaluate the diagnostic value of serum ferroptosis-related indicators for AD. Methods Thirty-seven patients with AD hospitalized in the Second Affiliated Hospital of Xinjiang Medical University and 35 individuals without cognitive impairment hospitalized during the same period were selected. Neuropsychological assessments were conducted on all patients in the AD group and the control group， and the levels of serum GSH， glutathione peroxidase 4 （GPX4）， homocysteine （Hcy）， and serum iron were detected. The general data of the two groups were compared. The correlations between GSH， GPX4， Hcy， serum iron， and the scores of the Mini-Mental State Examination （MMSE） and the Montreal Cognitive Assessment （MoCA） were analyzed. Univariate and multivariate binary Logistic regression analyses were employed to explore the influencing factors of AD and construct its predictive model. The receiver operating characteristic （ROC） curve was plotted to evaluate the diagnostic value of the prediction model for AD. Results （1） When compared to the control group， the serum levels of GSH （23.573 ± 8.862 μmol/L） and GPX4 （21.767 ± 9.609 μU/mL） in the AD group were significantly lower （P < 0.05）. In the control group， the corresponding levels were GSH （34.380 ± 19.673 μmol/L） and GPX4 （31.345 ± 10.553 μU/mL）. There was no statistically significant difference in the serum levels of iron and Hcy between the two groups （P > 0.05）. （2） Serum GPX4 was positively correlated with MMSE （r = 0.233， P = 0.049） and MoCA （r = 0.296， P = 0.011）， and serum iron was positively correlated with MoCA （r = 0.252， P = 0.033）. （3） Multivariate binary Logistic regression analysis indicated that body mass index （BMI） （OR = 0.794， P < 0.05） and serum GPX4 （OR = 0.917， P < 0.05） were protective factors for the onset of AD. The area under the curve （AUC） for diagnosing AD using serum GPX4 levels was 0.766 （95%CI： 0.656 ~ 0.877）， with a sensitivity of 67.6% and a specificity of 77.1%， and the cut - off value was 44.7 （P < 0.05）. The AUC value for diagnosing AD by combining BMI and GPX4 levels was 0.815 （95%CI： 0.715 ~ 0.914）， with a sensitivity of 81.1% and a specificity of 77.1% （P < 0.05）. Conclusions （1） The expression levels of serum GSH and GPX4 vary between AD patients and the control group. Specifically， these levels are lower in AD patients than in the control group. （2） Serum GPX4 and serum iron are positively correlated with cognitive function. （3） BMI and serum GPX4 are influencing factors of AD， and the prediction model constructed by their combined factors has a certain predictive value for AD.