胱抑素C、颈动脉硬化与老年2型糖尿病患者认知功能损害的相关性研究

发布时间：2018-05-13 04:20

本文选题：胱抑素C + 颈动脉硬化　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:研究血清胱抑素C(Cystatin C)、颈动脉硬化在评估老年2型糖尿病(Type 2 diabetes mellitus,T2DM)患者认知功能损害方面的临床价值,并分析三者之间的相关性及对认知功能损害不同区域的差异。方法:选取兰州大学第二医院内分泌代谢二科诊治的老年2型糖尿病住院患者169例,其中男性106例,女性63例,均符合WHO(1999)糖尿病诊断标准;以简易智力精神状态量表(Mini-mental state examination,MMSE)作为诊断T2DM认知损害的测评工具,诊断标准以MMSE总分≥27分为糖尿病认知功能正常组,27分为认知功能障碍组,为排除文化程度对认知的影响,受教育年限≤12年,得分再加1分。其中糖尿病认知功能正常组69例,糖尿病认知障碍组100例,对两组的性别、年龄进行匹配,比较两组间的MMSE总得分、各分项分值及一般临床资料分析,同时进行多因素非条件Logistic回归分析,比较血清Cystatin C、颈动脉硬化在老年T2DM认知障碍方面的诊断价值,同时探讨老年T2DM发生认知功能障碍的其他影响因素;颈动脉硬化以颈动脉内中膜厚度(Intima-media thickness,IMT)为诊断标准,将IMT≤1.0mm为无颈动脉内膜增厚,N=103例,IMT1.0mm为颈动脉硬化,N=66例,比较不同颈动脉硬化程度的患者与MMSE总分及各分项分值的相关性。结果:1两组间一般资料分析显示,年龄、性别、体重指数、不同降糖方案均无统计学意义(P0.05),说明各因素在两组间分配良好,而两组患高血压情况有显著统计学意义(P0.001),T2DM认知障碍组合并高血压人数明显升高。2老年T2DM认知功能正常组Cys-C水平1.04±0.49mg/L,颈动脉IMT0.96±0.18mm;老年T2DM认知障碍组Cys-C水平1.32±0.48mg/L,颈动脉IMT1.1±0.24mm,两组间数据比较,Cys-C及IMT在T2DM认知障碍组水平较高,分布差异有统计学意义(P0.001);T2DM认知功能正常组MMSE总评分28.19±0.98,T2DM认知障碍组22.49±4.01,差别有显著统计学意义(P0.001),此外,甘油三酯、高密度脂蛋白在两组间差别亦有统计学意义(P0.05),而总胆固醇、低密度脂蛋白、肌酐、尿酸的差别无统计学意义;两组间合并糖尿病情况分析,其中糖尿病病程、糖化血红蛋白、空腹血糖、胰岛素抵抗指数均有统计学意义(P0.05),糖化血红蛋白处于统计学意义的边缘(P=0.049),而餐后2小时血糖在两组间差别无统计学意义(P0.05)。3以颈动脉IMT 1.0mm为界,比较不同程度颈动脉硬化在MMSE总分及各分项分值的差异,在颈动脉IMT≤1.0mm组,MMSE总分为25.11±3.78,IMT1.0mm组,MMSE总分22.06±3.77,颈动脉IMT小的MMSE分值大,MMSE在两组间差别有统计学意义(P0.001),同时MMSE各分项包括注意力、回忆力、语言力、定向力、记忆力在两组间差别亦有统计学意义(P0.05);Cys-C与MMSE总分及各分项得分均呈负相关,其中Cys-C与MMSE总分r=-0.455,定向力r=-0.423,注意力r=-0.383,语言力r=-0.411均呈负相关(r0 P0.05),而与记忆力r=-0.142,回忆力r=-0.146的负相关处于统计学边缘(P=0.066、P=0.058);而Cys-C与IMT呈正相关(r=0.178 P=0.02)。4在0.05检验水准下,多因素非条件Logistic回归分析提示共6个变量进入方程:糖尿病病程、糖尿血红蛋白、Cys-C、IMT、合并高血压情况、使用的降糖方案,糖尿病病程(OR:0.291,95%CI:0.167-0.510,P0.001),Cys-C(OR:0.450,95%CI:0.242-0.836,P=0.012),IMT(OR:0.495,95%CI:0.264-0.925,P=0.028),糖化血红蛋白(OR:0.549,95%CI:0.361-0.834,P=0.005))与T2DM认知功能障碍危险性的关联有统计学意义。结论:T2DM认知功能损害的危险因素包括Cys-C、颈动脉IMT、高血压、糖尿病病程和糖化血红蛋白,Cys-C可能与颈动脉硬化共同作用,参与了T2DM认知障碍的发生发展。
[Abstract]:Objective: To study the clinical value of serum cystatin C (Cystatin C) and carotid arteriosclerosis in assessing cognitive impairment in elderly patients with type 2 diabetes mellitus (Type 2 diabetes mellitus, T2DM), and to analyze the correlation between the three and the differences in different areas of cognitive impairment. Methods: two families of Endocrinology and metabolism in Second Hospital Affiliated to Lanzhou University were selected. 169 cases of hospitalized elderly patients with type 2 diabetes were treated, of which 106 were male and 63 were female, all in accordance with WHO (1999) diabetes diagnostic criteria; the simple mental state scale (Mini-mental state examination, MMSE) was used as an assessment tool for the diagnosis of T2DM cognitive impairment, and the diagnostic standard was divided into the normal group of diabetes cognitive function with the total score of MMSE score more than 27, 2 7 were divided into cognitive impairment group, in order to exclude the influence of cultural degree on cognition, the number of years of education was less than 12 years, and the score was 1 points. Among them, 69 cases of diabetic cognitive function group and 100 diabetic cognitive impairment group were matched to the sex and age of the two groups, the total score of MMSE among the two groups was compared, the scores of each sub item and general clinical data were analyzed. Multifactor unconditional Logistic regression analysis was used to compare the diagnostic value of serum Cystatin C and carotid atherosclerosis in the elderly with cognitive impairment of T2DM, and to explore the other influencing factors of cognitive impairment in elderly T2DM; carotid arteriosclerosis was diagnosed as the carotid artery middle membrane thickness (Intima-media thickness, IMT) as the diagnostic criterion, and IMT < 1. Mm had no carotid intima intima thickening, N=103 cases, IMT1.0mm as carotid arteriosclerosis, N=66 cases, and compared the correlation between the total scores of different carotid atherosclerosis and the total score of MMSE. Results: 1 the general data analysis between the two groups showed that age, sex, body mass index, and different hypoglycemic schemes were not statistically significant (P0.05), indicating that the factors were two The group distribution was good, but the two groups of hypertension had significant statistical significance (P0.001), the combination of T2DM cognitive impairment and the number of hypertension increased significantly in the normal group of.2 aged T2DM cognitive function, Cys-C level was 1.04 + 0.49mg/L, the carotid IMT0.96 + 0.18mm, the Cys-C level of the elderly T2DM cognitive impairment group was 1.32 + 0.48mg/L, the carotid IMT1.1 = two groups were between the two groups. The level of Cys-C and IMT in T2DM cognitive impairment group was higher, and the distribution difference was statistically significant (P0.001), the total MMSE score of T2DM cognitive function group was 28.19 + 0.98, T2DM cognitive impairment group was 22.49 + 4.01, and the difference was statistically significant (P0.001), in addition, the difference of glycerol three ester and high density lipoprotein in the two groups was also statistically significant (P0.) 05), there was no significant difference in total cholesterol, low density lipoprotein, creatinine and uric acid. The analysis of diabetes in the two groups was statistically significant (P0.05) in the course of diabetes, glycated hemoglobin, fasting blood glucose, and insulin resistance index (P=0.049), and 2 hours postprandial blood. The difference between the two groups was not statistically significant (P0.05).3 with the IMT 1.0mm of the carotid artery as the boundary. The difference in the total MMSE score and the score of different degrees of carotid atherosclerosis was compared. In the IMT < 1.0mm group, the total score of MMSE was 25.11 + 3.78, IMT1.0mm group, MMSE total score of 22.06 + 3.77, and the IMT fraction of the carotid artery was large. There was a statistical difference between the two groups. Learning significance (P0.001), at the same time, each sub item of MMSE includes attention, memory, language force, orientation and memory, and there are also significant differences between the two groups (P0.05); Cys-C has a negative correlation with the total score of MMSE and the scores of each sub item, of which Cys-C and MMSE total score r=-0.455, directional force r=-0.423, attention r=-0.383, and linguistic force r=-0.411 are negatively correlated (R0) 05), and the negative correlation between memory r=-0.142 and memory r=-0.146 was on the edge of Statistics (P=0.066, P=0.058); while Cys-C and IMT were positively correlated (r=0.178 P=0.02).4 at 0.05 test levels, multiple factor non conditional Logistic regression analysis suggested that 6 variables entered the equation: diabetes course, diabetic hemoglobin, Cys-C, IMT, combined with hypertension There was a statistically significant correlation between the glucose lowering program (OR:0.291,95%CI:0.167-0.510, P0.001), Cys-C (OR:0.450,95%CI:0.242-0.836, P=0.012), IMT (OR:0.495,95%CI:0.264-0.925, P=0.028), glycosylated hemoglobin (OR:0.549,95%CI:0.361-0.834, P=0.005)) and the risk of T2DM cognitive dysfunction. The risk factors include Cys-C, carotid IMT, hypertension, the course of diabetes and glycosylated hemoglobin, and Cys-C may be associated with carotid atherosclerosis and participate in the development of T2DM cognitive impairment.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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