代谢手术对2型糖尿病患者认知功能作用的临床研究

发布时间：2018-05-09 18:33

本文选题：2型糖尿病 + 代谢手术　；参考：《第三军医大学》2017年硕士论文

【摘要】：背景和目的:糖尿病已成为威胁人类生命健康的重要危险因素。全世界有4.15亿成人糖尿病,预计到2040年将超过6.4亿。2型糖尿病(T2DM)占糖尿病患者中的比例为90-95%,心脑血管相关疾病是影响其最终结局的重要因素[1]。糖尿病微血管病变是糖尿病的常见并发症之一,有研究表明慢性高血糖导致微血管性脑损伤[2]。糖尿病患者中约有70%合并有神经病变,其中包括中枢神经病变[3]。据估计,全世界有4000万人患有老年痴呆症,这个数字预计将每20年翻一番,到2050年的超过1.1亿[4]。最常见的痴呆症是阿尔茨海默病(AD),而认知功能障碍是老年痴呆症的一个重要前驱状态[5]。轻度认知功能障碍(MCI)是介于正常衰老与痴呆之间的一种认知损伤状态,主要表现为记忆障碍,尤其是情节记忆缺陷,也可是命名障碍,但总体认知功能正常,日常生活能力正常[6]。有研究表明[7],与没有糖尿病的人群相比,随访20年里,中年糖尿病患者的认知能力会下降大约19%,存在早期认知功能障碍。代谢手术(Metabolic Surgery)曾称为减重手术,最开始是用于减重治疗的,后来人们发现它同时有降低糖尿病患者血糖的作用,因此逐渐将其用于治疗糖尿病。已有研究报道代谢手术能明显改善糖尿病患者体重、血糖、血脂、血压等,但有关其对糖尿病患者认知功能影响的研究尚欠缺。本研究拟通过观察非糖尿病患者、单纯常规药物治疗以及行代谢手术治疗的2型糖尿病患者的代谢指标和认知功能情况,横向及纵向分析2型糖尿病患者认知功能的变化特点、代谢手术治疗与常规药物治疗对2型糖尿病患者认知功能的作用及其代谢手术前后认知功能的变化情况,以进一步了解代谢手术对2型糖尿病患者认知功能的影响,为预防老年痴呆提供新的途径和方法。一、对象和方法1、研究对象2015年4月至2017年2月在大坪医院高血压内分泌科住院或门诊就诊的非糖尿病患者、单纯常规药物治疗以及于我院胃肠外科行代谢手术治疗的2型糖尿病患者共150例。其中60例为第一部分研究对象,观察2型糖尿病患者认知功能的变化特点,其余90例为第二部分研究对象,分别观察代谢手术治疗和常规药物治疗对2型糖尿病患者认知功能作用的比较及代谢手术改善2型糖尿病患者认知功能的作用。第一部分研究对象:2型糖尿病患者及非糖尿病患者各30例,共计60例,糖尿病组平均年龄43±8.8岁,男性19例,非糖尿病组平均年龄42±8.6岁,男性21例。两组研究对象在年龄、性别及教育年限上无统计学差异。第二部分研究对象:常规药物治疗的2型糖尿病患者35例,平均年龄45.8±8.5岁,男性22例;行代谢手术治疗后的2型糖尿病患者30例,平均年龄45±10岁,男性15例,平均术后随访时间为1.4年。此两组研究对象在年龄、性别及教育年限上无统计学差异。其余为我科先期评估合格后于胃肠外科行代谢手术治疗的2型糖尿病患者25例,并定期随访6月,平均年龄39±10.1岁,其中男性11例。2、方法及指标全部研究对象均由专人完成一般情况记录(包括年龄、性别、教育年限等),测定身高、体重、腰围(WC)、血压(BP)等,完成认知功能相关量表测试(具体量表见附表):包括简易精神状态量表(MMSE)、临床痴呆量表(CDR)、记忆与执行功能量表(MES)、词汇记忆测试(RAVLT)、注意力与定向力测试(连线测试TMT)、数字广度测试(DST)、语言流畅性测试(动物词汇流畅ANT)、视觉空间能力测试(画钟测试CDT);注明:记忆与执行功能量表(MES)测试包括记忆力(MES-M)与执行力(MES-E)两部分,词汇记忆测试(RAVLT)测试包括总体记忆词汇数量(RAVL)、延迟记忆(LDFR)和回顾性记忆(RVL)部分,连线测试(TMT)包括连线测试A(TMT-A)和连线测试B(TMT-B)部分,数字广度测试(DST)包括顺背(DST-顺背)和倒背(DST-倒背)部分;静脉采血查总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、超敏C反应蛋白(hs-CRP)、空腹葡萄糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)。其中手术病人手术后按时间随访完成上述所有检查。且手术病人分别在术前与术后6月随访时完善听觉事件相关诱发电位(ERP)脑电信息采集。二、结果(一)、2型糖尿病患者认知功能变化特点1.2型糖尿病患者组的FPG、HbA1c均高于非糖尿病对照组(P0.05),FINS均低于非糖尿病对照组(P0.05)。2.2型糖尿病患者的认知功能明显低于非糖尿病对照组,差异有统计学意义(P0.05),主要表现在:总体认知评估、(MMSE)、记忆与执行功能(MES-T)、记忆力(MES-M)、临床痴呆量表(CDR)方面。(二)、代谢手术对2型糖尿病患者认知功能的作用1.代谢手术治疗与常规药物治疗对2型糖尿病患者认知功能作用的比较1.1手术组与药物组患者的代谢指标BMI、WC、BP、Hb A1C、FPG、TG存在统计学差异(P0.05)。1.2手术组与药物组校正一般代谢指标之前,在MMSE、CDR、MES(MES-T,MES-M,MES-E)、RAVL、LDFR、RVL、ANT、CDT、DST方面,手术组优于药物组(P0.05);两组校正一般代谢指标之后,手术组在MES-T、MES-E、RAVL、RVL、ANT方面,显著优于药物组(P0.05)。2.前瞻性观察代谢手术改善2型糖尿病患者认知功能的作用2.1 2型糖尿病患者代谢手术后6月认知功能与术前相比,MMSE、MES-T、MES-M、RAVL、RVL、ANT、TMT-A、TMT-B、DST-顺背、DST-倒背均有改善(P0.05)。2.2 2型糖尿病患者术后6月的听觉神经诱发电位P300波波幅较术前有增高、潜伏期较术前有缩短,差异有统计学意义(P0.05)。三、结论1、2型糖尿病患者可能较易出现认知功能障碍,早期主要表现在总体认知评价以及记忆力方面。2、代谢手术改善2型糖尿病患者认知功能,如记忆力、执行力、语言流畅性、注意力与定向力等方面。3、代谢手术能明显改善反应认知功能的脑电信号P300波的波幅和潜伏期,其机制可能与代谢手术改变脑功能相关。
[Abstract]:Background and objective: diabetes has become an important risk factor for human life and health. There are 415 million adult diabetes in the world. It is expected that by 2040, more than 640 million.2 type diabetes (T2DM) is the proportion of diabetes mellitus (90-95%). Cardio cerebrovascular disease is an important factor affecting the final outcome of [1]. diabetic microvascular disease One of the common complications of diabetes, studies have shown that chronic hyperglycemia leads to microvascular brain damage in about 70% of [2]. diabetic patients with neuropathy, including central neuropathy [3]., which is estimated to have 40 million people in the world with Alzheimer's disease, which is expected to double every 20 years to more than 110 million in 2050. The most common dementia in [4]. is Blzheimer's disease (AD), and cognitive dysfunction is an important precursor of Alzheimer's disease, [5]. mild cognitive impairment (MCI), a cognitive impairment between normal aging and dementia, mainly manifested in memory disorders, especially episodic memory defects, but also named disorder. Normal physical cognitive function and normal daily life [6]. study showed that the cognitive ability of middle-aged diabetic patients decreased by about 19% and early cognitive impairment compared with those in the non diabetic group for 20 years. Metabolic surgery (Metabolic Surgery) was once called weight reduction surgery and was first used in weight reduction treatment. Later, it was used as a weight reduction treatment. It has been reported that metabolic surgery can improve the weight, blood sugar, blood lipid and blood pressure of diabetic patients. However, the study of the effects on cognitive function of diabetic patients is still deficient. This study is to observe non diabetic patients. The metabolic index and cognitive function of patients with type 2 diabetes treated with simple conventional medication and metabolic surgery. The characteristics of cognitive function in type 2 diabetes patients were analyzed horizontally and longitudinally. The cognitive function of metabolic surgery and conventional drug therapy on patients with type 2 diabetes and cognitive function before and after metabolic surgery were studied. To further understand the effect of metabolic surgery on cognitive function of patients with type 2 diabetes and to provide new ways and methods for the prevention of Alzheimer's disease. 1, object and method 1, non diabetic patients who were hospitalized in the hospital or outpatient department of the hypertension Department of endocrinology in Daping Hospital from April 2015 to February 2017. A total of 150 patients with type 2 diabetes were treated and treated with metabolic surgery in the gastrointestinal surgery of our hospital. Of them, 60 were the first part of the study. The changes in cognitive function of type 2 diabetic patients were observed. The remaining 90 cases were studied in second parts. The cognitive functions of metabolic surgery and conventional drug therapy on type 2 diabetes patients were observed respectively. Functional comparison and metabolic surgery to improve the cognitive function of patients with type 2 diabetes. The first part of the study: 30 cases of type 2 diabetes and non diabetic patients, a total of 60 cases, the average age of the diabetes group was 43 + 8.8 years, the male 19 cases, the average age of 42 + 8.6, and 21 in the non diabetic group. The study object in the two group was age and sex. There was no statistical difference in the number of years of education. Second subjects: 35 cases of type 2 diabetes, average age 45.8 + 8.5, 22 men, and 30 patients with type 2 diabetes after metabolic surgery. The average age was 45 + 10 years, and the average age was 1.4 years. The subjects of this group of subjects were age, sex, and sex. There were no statistical differences in the number of years of education. The rest were 25 cases of type 2 diabetic patients who were eligible for metabolic surgery in the gastroenterological surgery. The average age was 39 + 10.1 years old in June. The average age was 39 + 10.1 years old. Among them, the male 11 cases were.2. All the methods and indexes were recorded by the specialists (including age, sex, teaching). The height, weight, waist circumference (WC), blood pressure (BP) and so on were measured, and the cognitive function related scale was tested (specific table), including the simple mental state scale (MMSE), the clinical dementia scale (CDR), the memory and execution function scale (MES), the vocabulary memory test (RAVLT), the attention and orientation test (connection test TMT), and the digital breadth. Test (DST), language fluency test (animal vocabulary fluency ANT), visual spatial ability test (CDT); note: memory and execution function scale (MES) tests include two parts of memory (MES-M) and execution (MES-E), and lexical memory test (RAVLT) test including total memory vocabulary (RAVL), delayed memory (LDFR) and retrospective memory (RV). L) part, the connection test (TMT) includes the line test A (TMT-A) and the connection test B (TMT-B) part. The digital breadth test (DST) includes the CIS back (DST- CIS back) and the backback (DST- inverted back) part; the venous blood collection of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low density lipoprotein, hypersensitive reactive protein, and Vitis Vitis Glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C). All of the patients were followed up to complete the above examination after operation. And the patients were followed up and followed up in June to improve the auditory evoked potential (ERP) EEG information. Two, results (1), the characteristics of cognitive function changes in type 2 diabetic patients were 1.2. The FPG and HbA1c of patients with type 2 diabetes were higher than those of non diabetic control group (P0.05). The cognitive function of FINS was lower than that of non diabetic control group (P0.05), and the difference was significantly lower than that of non diabetic control group (P0.05), mainly in total cognitive assessment, (MMSE), memory and execution function (MES-T), memory (MES), and memory (MES). -M, clinical dementia scale (CDR). (two) the role of metabolic surgery on cognitive function in type 2 diabetic patients 1. the comparison of cognitive function between metabolic surgery and conventional medication for patients with type 2 diabetes mellitus, 1.1, WC, BP, Hb A1C, FPG, and TG (P0.05).1.2 operation group MMSE, CDR, MES (MES-T, MES-M, MES-E), RAVL, MES-T, MES-M, MES-E, RAVL, LDFR, ANT, CDT, DST, the operation group is superior to the drug group before the drug group corrects the general metabolic index. Cognitive function of patients with type 2.12 diabetes mellitus after metabolic surgery in June, cognitive function compared with preoperative, MMSE, MES-T, MES-M, RAVL, RVL, ANT, TMT-A, TMT-B, DST- CIS back, DST- inverted back all have improved (P0.05).2.2 2 diabetic patients after the auditory nerve evoked potential increased in June, the latency is shorter than before the operation, The difference was statistically significant (P0.05). Three, conclusion the patients with type 1,2 diabetes may be more likely to have cognitive impairment, early mainly in the overall cognitive evaluation and memory.2. Metabolic surgery improves the cognitive function of type 2 diabetic patients, such as memory, execution, verbal fluency, attention and orientation,.3, metabolic surgery. It can obviously improve the amplitude and latency of P300 wave of EEG signal in response to cognitive function, and its mechanism may be related to metabolic surgery and brain function.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R656.6

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