2型糖尿病并发轻度认知功能障碍相关危险因素的研究

发布时间：2018-08-29 13:07

【摘要】：目的探讨2型糖尿病并发轻度认知功能障碍(MCI)的相关危险因素,为此类患者的早期诊断、早期干预提供依据。方法选择2010年10月至2011年10月到郑州大学第一附属医院老年病科,年龄55-72岁的2型糖尿病患者共62例。依据神经心理学测评的认知功能,以MOCA评分26分为界,将62例糖尿病患者分为认知正常组(NC组)30例和轻度认知功能障碍组(MCI组)32例。采集所有患者一般临床资料,实验室检测空腹血糖、胰岛素、糖化血红蛋白、甘油三酯(TG)、总胆同醇(TC)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),超声探查颈动脉内膜中层厚度(intimal-medial thickness,IMT)。采用成组t检验和多重线性逐步回归进行统计分析。结果 1.MCI组HbAlc、IMT、TC、TG、LDL-C、HOMA-IR和DR发生率高于NC组,HDL-C低于NC组(均P0.05)；年龄、性别、血压、病程、DN发生率组间无明显差别。 2.以MoCA评分为因变量,以HbAlc, TG、TC、HDL-C、LDL-C、IMT、 HOMA-IR、DR史为自变量,进行多重线性逐步回归分析,结果显示IMT、HOMA-IR、HDL-C和MoCA评分密切相关(F=31.766,P0.001),其标准回归系数分别为0.335(P＝0.006)、0.408(P=0.004)、0.305(P=0.010)(均P0.05)。从决定系数可知,三个自变量可以解释结果变量的变异的76.7%。结论 1.MCI组的HbAlc、IMT、TC、TG、LDL-C和HOMA-IR以及DR发生率明显高于NC组,HDL-C明显低于对照组,提示糖尿病轻度认知功能障碍的患者,血管病变、胰岛素抵抗、血糖血脂代谢紊乱均比糖尿病认知正常患者的程度更为严重,可能增加了认知功能障碍的危险性。 2.随着颈动脉内中膜厚度的增加、胰岛素抵抗指数的增加和高密度脂蛋白胆固醇的降低,认知功能测评得分降低；IMT、HOMA-IR、HDL-C是影响MoCA评分的主要危险因素。
[Abstract]:Objective to investigate the risk factors of type 2 diabetes mellitus complicated with mild cognitive impairment (MCI) and to provide evidence for early diagnosis and early intervention. Methods A total of 62 patients with type 2 diabetes aged from 55 to 72 years old from October 2010 to October 2011 were selected from the geriatric department of the first affiliated Hospital of Zhengzhou University. According to the cognitive function measured by neuropsychology, 62 diabetic patients were divided into two groups: normal cognitive group (NC) (30 cases) and mild cognitive impairment (MCI group) (32 cases). General clinical data of all patients were collected, fasting blood glucose, insulin, glycosylated hemoglobin were measured in laboratory. Triglyceride, (TG), (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), carotid intima-media thickness (intimal-medial thickness,IMT). Group t test and multiple linear stepwise regression were used for statistical analysis. Results the incidence of HbAlc,IMT,TC,TG,LDL-C,HOMA-IR and DR in 1.MCI group was higher than that in NC group (P 0.05), and there was no significant difference in age, sex, blood pressure, course of disease and DN incidence between two groups. Multiple linear stepwise regression analysis was carried out with MoCA score as dependent variable and HbAlc, TG,TC,HDL-C,LDL-C,IMT, HOMA-IR,DR history as independent variable. The results showed that IMT,HOMA-IR,HDL-C and MoCA scores were closely correlated (F0. 006), and the standard regression coefficients were 0.335 (P0. 006), 0. 408 (P0. 004) and 0. 305 (P0. 010) (P0.05). From the determinative coefficient, the three independent variables can explain the variation of the result variable 76. 7%. Conclusion the incidence of HbAlc,IMT,TC,TG,LDL-C, HOMA-IR and DR in the 1.MCI group is significantly higher than that in the NC group. The results suggest that the patients with mild cognitive impairment of diabetes mellitus have vascular disease and insulin resistance. The metabolic disorder of blood glucose and lipids was more serious than that of diabetic cognitive normal patients, which may increase the risk of cognitive dysfunction. 2. With the increase of carotid intima-media thickness, the increase of insulin resistance index and the decrease of high density lipoprotein cholesterol (HDL-C), the lower scores of cognitive function test and HDL-C were the main risk factors affecting the MoCA score.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R587.1;R749.2

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