运动行为对老年T2DM患者血清BDNF，甲基乙二醛及认知功能的影响

发布时间：2017-12-31 11:05

本文关键词：运动行为对老年T2DM患者血清BDNF，，甲基乙二醛及认知功能的影响　出处：《兰州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨老年T2DM患者的血清BDNF,MG水平,认知功能及三者之间的相互影响。方法:本研究采取频数匹配方法选取病例及正常人群进行对照。本研究选取兰州大学第二医院糖尿病2,3科老年2型糖尿病患者64例,均来自于2014年2月一2015年3月该时间段住院患者。对照组为相同时间段前往兰州大学第二医院体检中心进行健康体检的非糖尿病老年人群57例。两组均排除精神类疾病及老年痴呆等。将非糖尿病老年人群对照组与老年2型糖尿病患者病例组按照年龄、性别及文化程度进行频数匹配。(1)ELISA法检测两组的BDNF;(2)HPLC法检测MG;(3)重复性成套心理状态测验(RBANS)检测认知功能。结果:老年T2DM组患者的血清BDNF水平4.97±3.05ng/ml,MG的水平67.9nmol/L;正常老年对照组血清BDNF水平11.77±7.92ng/ml,MG的水平43.86nmol/L,两组数据相比,老年T2DM组患者的血清BDNF水平(4.97±3.05ng/ml)与非糖尿病老年人群对照组(11.77±7.92ng/ml)有明显的下降(P0.01);甲基乙二醛(MG)的水平(67.9nmol/L)比非糖尿病老年人群对照组明显升高43.86nmol/L(P0.05);并且血清MG升高的水平与血清BDNF下降水平具有一定的相关性。老年T2DM组和非糖尿病老年人群对照组相比,在认知量表标准化测验总分、视觉广度、即刻记忆、延时记忆和注意力方面的得分下降较为明显(PO.05),经过多元回归调整了年龄以及受教育程度等有可能对得分结果产生影响的因素后,血清BDNF水平的高低与认知量表标准化总分、延时记忆和注意功能的关联依然明显;老年T2DM组患者血清MG水平的高低与延迟记忆力、即刻记忆力以及量表标准化总分亦有一定的相关性,具有统计学意义(P0.05);血清BDNF水平与血清MG水平具有一定的统计相关性,且呈显著负相关(P=0.0310.05),具有一定的统计学意义。结论:1.排除受教育程度以及年龄因素T2DM极有可能是导致患者出现认知功能损伤的重要因素,并且比起类似年龄T2DM群体更易发生aMCI,并且合并出现血清MG水平的升高及血清BDNF水平的下降。2.老年T2DM患者的认知功能已经表现出与血清MG、血清BDNF的水平具有一定的统计学相关性,并且通过进一步统计学的演算,老年T2DM患者的血清MG升高与血清BDNF的下降亦有一定的关联,有可能都参与了认知功能损伤的发病过程。目的:研究运动行为对老年T2DM患者血清BDNF,MG及认知功能的影响。方法:本研究采取的是以所在的兰州大学第二医院内分泌病区、门诊以及该院体检中心为根本的,以频数匹配作为方法来选取的病例对照。本研究选取了老年2型糖尿病患者64例,均来自于2014年2月一2015年3月该时间段在兰州大学第二医院糖尿病2科,3科就诊的住院患者(为第一部分糖尿病组),同时排除精神疾病及老年痴呆等。运用行为转变理论对该老年糖尿病组制定运动以及随访计划,采取靶心率,自觉用力程度(RPE)等相关指标监控运动强度,并在每位患者手机上安装微信并教会患者使用微信运动功能。要求每人每天中等强度步行运动35-45分钟,并且每周运动不能少于5天,在运动开始时要求患者携带手机并开机使用微信运动功能,每周通过朋友圈随访统计并督促病人进行下周运动。分别在实验前,参与实验进行运动后12周,24周分别监测血清BDNF,MG及对认知功能进行测评。(1)ELISA法检测两组的BDNF;(2)HPLC法检测MG;(3)重复性成套心理状态测验(RBANS)检测认知功能。结果:(1)运动进行12周以后,患者的体重、血脂发生了不同程度的下降;认知评估中短时程记忆、长时程记忆有明显的改善,但对视觉广度、言语功能的影响不明显;运动对血清BDNF的水平有一定的提高,但是对改变血清MG的水平变化不明显。(2)运动24周以后,患者的体重、血脂继续不同程度的下降,其中LDL亦出现了明显的下降;认知评估中除了即刻记忆、延时记忆得分仍有继续的上升外,言语功能的得分亦出现了具有统计学意义的提高,但对视觉广度的影响仍不明显;此外运动24周对于血清BDNF的水平继续有提高,并且血清MG的水平出现了下降。(3)运动24周后与运动12周的指标相比,体重、血脂、血糖、认知水平得分任然持续出现改善,而且在运动12周时语言功能及血清MG无明显改善,但坚持24周的规律运动后,发现认知项目中言语功能以及血清MG的改善出现了加速的变化。(4)运动干预24周后,糖尿病组与对照组正常人群相比在即刻记忆、注意力、标准化测验总分上无明显差别,但在言语功能、长时程记忆的得分仍显著低于正常人群。且外周血BDNF、MG的水平与正常人群亦有明显差异(P0.05)(5)运动干预时间长短和BMI、TC、LDL、TG、FBG、2h PG、Hb A1c、MG浓度的变化具有一定的负相关性,即运动干预时持续的间越长,上述各值则下降的明显;与认知测验中的即刻记忆得分、言语功能得分、注意力得分、延迟记忆得分、标化总分、BDNF含量有一定的正相关,即干预时间越长,各项得分及BDNF含量有明显的增加。结论:适当的运动行为能够改善BDNF的水平,降低MG含量,并且对认知障碍的改善产生积极作用。
[Abstract]:Objective: To investigate the serum BDNF, MG levels in elderly patients with T2DM, the interaction between cognitive function and three. Methods: This study adopts frequency matching methods and cases of normal population were compared. This study selected 64 elderly diabetic 2,3 of Second Hospital Affiliated to Lanzhou University patients with type 2 diabetes patients from February 2014 to March 2015, the time period hospitalized patients. Control group for the same period of time to the Second Hospital Affiliated to Lanzhou University Medical Center for health examination of the elderly non diabetes in 57 cases. Two groups were excluded from the mental diseases and senile dementia. Non diabetic elderly control group and elderly patients with type 2 diabetes mellitus patients according to age, gender and education level were frequency matched (1. BDNF ELISA) were detected in two groups; (2) MG HPLC detection method; (3) repeatability complete mental state test (RBANS) cognitive function test. Results: the elderly group T2DM The level of serum BDNF 4.97 + 3.05ng/ml, the level of 67.9nmol/L MG; normal elderly control group serum BDNF levels was 11.77 + 7.92ng/ml, the level of 43.86nmol/L MG, compared two groups of data, the level of serum BDNF in elderly patients in the T2DM group (4.97 + 3.05ng/ml) and non diabetic elderly control group (11.77 + 7.92ng/ml) decreased significantly B two (P0.01); methyl aldehyde (MG) level (67.9nmol/L) than non-diabetic elderly control group significantly increased 43.86nmol/L (P0.05); and the level of serum BDNF and elevated serum MG level decreased with a certain correlation. Compared with T2DM in the elderly group and non diabetic elderly control group, the cognitive scale standardized test the total score, visual span, immediate memory, delayed memory and attention scores decreased obviously (PO.05), after multivariate regression adjusted for age and education level are likely to score the results The influence of the factors, serum BDNF level and cognitive scale standardization association scores, delayed memory and attention function is still evident in elderly patients in the T2DM group; the serum level of MG and delay memory, immediate memory and scale standardized scores have a certain correlation with statistical significance (P0.05); serum the level of BDNF and the level of serum MG has certain statistical correlations, and showed significant negative correlation (P=0.0310.05), with statistical significance. Conclusion: 1. out of education and age factors of T2DM may be an important factor leading to cognitive impairment in patients with T2DM and compared with similar age groups are more prone to aMCI, and with the increase of serum MG level and serum BDNF level of.2. decreased in elderly patients with T2DM cognitive function has been demonstrated with serum MG, serum BDNF level has a certain Statistical correlation, and through further statistical calculation of serum MG in elderly patients with T2DM also increased is related to decreased and serum BDNF, may be involved in the pathogenesis of cognitive impairment. Objective: To study the behaviors of elderly T2DM patients serum BDNF, MG and cognitive function. Methods: This study adopted is located in Second Hospital Affiliated to Lanzhou University endocrine ward, outpatient and hospital medical center as the fundamental, as to frequency matching method to select case control. This study selected 64 cases of elderly patients with type 2 diabetes, from February 2014 to March 2015 this period of time in the Second Hospital Affiliated to Lanzhou University 2 diabetes department, inpatient hospital (3 for the first part, diabetes group) while excluding mental illness and dementia. The use of behavioral change theory for the elderly diabetes group for movement And follow-up plan, take the target rate, degree of perceived exertion (RPE) exercise intensity monitoring and other related indicators, and in each patient on the installation of WeChat mobile phone and use WeChat motor function of patients. The church required per person per day of moderate intensity exercise 35-45 minutes walk, and not less than 5 days a week, for patients to carry mobile phone and start to use WeChat motor function at the beginning of the movement, a circle of friends through the follow-up statistics and urge patients next week exercise. Respectively before the experiment, 12 weeks in the experimental exercise after 24 weeks respectively monitoring serum BDNF, MG and evaluation of cognitive function. (1) BDNF ELISA was detected in two groups; (2) the detection of MG HPLC method; (3) repeatability complete mental state test (RBANS) cognitive function test. Results: (1) after exercise for 12 weeks, the weight of the patient, the decreased blood lipid; short-term memory cognitive assessment in a long time The long-term memory has improved significantly, but the breadth of vision, speech function is not obvious; the level of exercise on serum BDNF has been improved to a certain extent, but the change of serum MG level change is not obvious. (2) 24 weeks later, the patient's body weight, blood lipids to different degrees of decline, which also appeared in LDL a significant decline in cognitive assessment; in addition to immediate memory, delayed memory score is still on the rise, speech function scores also had statistically significant increase, but the impact on the breadth of vision is still not clear; in addition to exercise for 24 weeks for serum BDNF levels continue to improve, and the level of serum MG the decline. (3) compared to exercise after 24 weeks and 12 weeks of exercise index weight, blood lipid, blood glucose, scores of cognitive level still continued to improve and in the exercise for 12 weeks when the language function and serum MG had no obvious improvement, but insist on 24 weeks Regular exercise, found that cognitive project and improve speech function of serum MG appeared to accelerate the change. (4) after 24 weeks of exercise intervention, diabetes group attention in the immediate memory, compared with the control group, normal group, there was no significant difference between the standard test scores, but in language, the long term memory scores is still lower than that of normal people. And peripheral blood BDNF, MG levels and normal people also have obvious difference (P0.05) (5) exercise intervention duration and BMI, TC, LDL, TG, FBG, 2h PG, Hb A1c, has negative correlation with certain MG concentration changes, namely continuous exercise intervention the longer the value decreased significantly; and the scores of cognitive tests of immediate memory, verbal function score, attention scores, delayed memory score, standard score, there is a positive relationship between the content of BDNF, namely, the longer the intervention, the scores were increased and the content of BDNF. Conclusion: appropriate exercise behavior can improve the level of BDNF, reduce the content of MG, and have a positive effect on the improvement of cognitive impairment.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2

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