2型糖尿病患者认知功能障碍与糖尿病血管并发症的相关性研究

发布时间：2018-02-02 14:43

  本文关键词： 2型糖尿病 轻度认知障碍 糖尿病血管并发症　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景伴随经济社会的发展,2型糖尿病(T2DM)和痴呆(dementia)的发病率均明显升高,成为全球性的重要公共卫生问题,轻度认知功能障碍(mild cognitive impairment, MCI)是介于正常老龄化和痴呆之间的过渡状态,是发展成痴呆的重要“前驱信号”。尽管大量研究表明T2DM与MCI密切相关,但MCI与糖尿病血糖控制及血管并发症的关系在不同研究人群中得出的结论并不完全一致。研究目的分析合并MCI的T2DM患者及认知功能正常的T2DM患者各项代谢指标的差异,探讨T2DM患者患MCI的危险因素以及MCI与T2DM患者血糖控制情况和糖尿病血管并发症的相关性。研究方法对2014年1月——2014年10月期间于威海市立医院内分泌科住院40岁以上的T2DM患者根据蒙特利尔认知评估量表(MoCA)进行认知功能评分,以26分作为MCI的标准,分为MCI组和对照组,每组患者各200例。比较两组间空腹血糖(FBG)、餐后2小时血糖(2hPG)、空腹胰岛素(FINS).糖化血红蛋白(HbAlc)、颈动脉内中膜厚度(IMT)、同型半胱氨酸(Hcy)、尿微量白蛋白(Alb)以及吸烟、饮酒等指标的差异,分析MoCA评分的影响因素以及MCI发生的危险因素。以7%为临界值将所有研究对象分为血糖控制达标组(HbAlc≤7)和血糖控制不良组(HbAlc7),分析两组间各种代谢指标和MoCA评分的差异,探讨MCI在血糖控制中的作用。以尿微量蛋白≥30mg/L为临界值将所有研究对象分为糖尿病肾病组(DN组)和对照组,分析两组间各项指标的差异,探讨MCI在DN发生中的作用。根据是否患糖尿病视网膜病变(DR),将研究对象分为DR组和对照组,对比两组间的差异并分析MCI在DR发生中的作用。根据IMT≥1mm为临界值,将研究对象分为IMT增厚组和对照组,对比两组间的差异并分析MCI在IMT增厚中的作用。结果1.MCI组HbAlc、Hcy、总胆固醇(TC)、非高密度脂蛋白(non-HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿Alb、胱抑素C(Cyc)、IMT, DN及DR患病率、吸烟率均较对照组显著升高,高密度脂蛋白胆固醇(HDL-C)较对照组显著降低(所有P0.05)。2.多元线性逐步回归分析示HbAlc、Hcy、non-HDL-C、IMT、TG、尿Alb均与MoCA呈负相关,是MoCA评分的危险因素(所有P0.05)。二元logistic回归分析示HbAlc、Hcy、non-HDL-C、尿Alb、DR、IMT、吸烟是T2DM患者发生MCI的危险因素(OR=I.396、1.134、1.690、1.003、2.239、1.253、1.670)。3. HbAlc7组Hcy、尿Alb、 MCI及DN患病率均较HbAlc≤7组明显升高(P0.05), MoCA评分较HbAlc≤7组明显降低(P0.05); Logistic回归分析示,在校正了BMI、Hcy、non-HDL-C、胰岛素抵抗、吸烟等因素后,MCI(OR=I.370,P=0.008)仍是HbAlc7的危险因素。4.DN组的MoCA评分较对照组明显降低,Hcy、Cr、尿Alb、Cyc、 HbAlc、MCI患病率、吸烟率、IMT均较对照组明显升高(P0.05)；Logistic回归分析示,在校正了糖尿病病程、HbAlc、Hey、吸烟、IMT等因素后,MCI (OR=1.534,P=0.019)仍是DN的危险因素。5.DR组MoCA评分及FINS低于非DR组,MCI患病率高于非DR组(P0.05)；Logistic回归分析示在校正了糖尿病病程、尿Alb、FINS、吸烟、IMT等因素后,MCI (OR=1.206,P=0.038仍是DR的危险因素。6.Logistic回归分析示在校正了糖尿病病程、HbAlc、Hcy、吸烟、TG、LDL等因素后,MCI (OR=1.632, P=0.028)仍是IMT增厚的危险因素。结论1.T2DM伴MCI患者代谢紊乱情况较单纯T2DM者更加严重,HbAlc、Hey、 non-HDL-C、吸烟及IMT增厚可能是T2DM患者伴发MCI的危险因素。2.在中老年T2DM人群中,合并MCI的患者可能更容易发生血糖控制不良、DR及IMT增厚(动脉粥样硬化)。
[Abstract]:Background with the development of economy and society, type 2 diabetes mellitus (T2DM) and Alzheimer's disease (dementia) incidence increased significantly, has become an important global public health problem, mild cognitive impairment (mild cognitive, impairment, MCI) between normal aging and dementia between the transition state, is an important precursor signal "development dementia. Although a large number of studies show that T2DM and MCI are closely related, but the relationship between MCI and blood glucose control and vascular complications of diabetes in different research groups in the conclusion is not entirely consistent. The purpose of the study is to analysis differences of metabolism indexes in patients with T2DM T2DM patients with normal cognitive function and combined with MCI, to investigate the risk of MCI patients T2DM factors and MCI and blood glucose control in patients with T2DM and diabetic vascular complications. The correlation research methods on January 2014, October 2014 in Weihai City Hospital Department of Endocrinology hospital over 40 T2DM patients according to Montreal cognitive assessment scale (MoCA) were scored with 26 points as the standard of MCI, divided into MCI group and control group, there were 200 cases in each group. The comparison between two groups of fasting blood glucose (FBG), 2 hour postprandial blood glucose (2hPG) fasting insulin, glycosylated hemoglobin (FINS). (HbAlc), carotid artery intima-media thickness (IMT), homocysteine (Hcy), urinary albumin (Alb), smoking, drinking and other indicators of differences, risk factors and MCI. The effect of MoCA score. 7% of the critical value all subjects were divided into control group (HbAlc = 7) blood glucose control and poor glycemic control group (HbAlc7), analysis of differences between the two groups of various metabolic indicators and scores of MoCA, to explore the role of MCI in glucose control. The urine protein is more than 30mg/L critical value of all the research objects were divided into sugar 灏跨梾鑲剧梾缁，

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