血清sFas、sFasl水平与2型糖尿病患者认知功能、抑郁状态的相关性研究

发布时间：2018-08-26 16:46

【摘要】：目的:本研究通过检测2型糖尿病(Type 2 diabetes mellitus,T2DM)患者及健康对照组人群血清s Fas(soluble fas)、s Fasl(soluble fas ligand)水平,同时使用可重复的成套神经心理状态测量量表(Repeatable battery for the assessment of neuropsychological status,RBANS量表)对病例组2型糖尿病患者及健康对照组人群进行认知功能评定,使用抑郁自评量表(Self-Rating Depression Scale,SDS量表)对入组2型糖尿病患者及健康对照组人群进行抑郁状态评定,并通过检测病例组2型糖尿病患者一般资料及生化指标,进行统计学分析,来探讨2型糖尿病患者血清s Fas、s Fasl水平变化及其认知功能、抑郁状态情况,并进一步探讨血清s Fas、s Fasl水平与2型糖尿病患者认知功能及抑郁状态的相关性及其可能机制。方法:选取2013年3月~2014年3月期间,河北省唐山市唐山工人医院内分泌二科住院的2型糖尿病患者63例设为病例组,健康体检中心选取68例血糖值及糖化血红蛋白值正常者设为健康对照组。收集两组对象年龄(age)、性别(sex)、学历(education)、病程(course)、体重指数(Body Mass Index,BMI)等一般资料及空腹血糖(Fasting plasma glucose,FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High-density lipoprotein,HDL-C)、低密度脂蛋白(Low-density lipoprotein,LDL-C)等生化指标。病例组另外进行空腹胰岛素(Fasting insulin,FINS)测定,用于计算胰岛素抵抗指数(Homeostasis model assessment of insulin resistance,HOMA-IR)。同时测定研究对象血清s Fas、s Fasl水平并进行统计分析比较。根据RBANS量表评分评定两组研究对象认知功能,根据抑郁自评量表(SDS)评分比较两组研究对象抑郁状态。并进行病例组血清s Fas、s Fasl水平与其余各项指标的单因素相关性分析及多元逐步回归分析。结果:1病例组与健康对照组比较结果①两组一般资料与临床生化指标比较结果:病例组较健康对照组FPG、Hb A1C、TC、TG水平升高,HDL水平降低,差异具有统计学意义(P0.05)。(见Table 1,Fig.1-Fig.5)②两组血清s Fas和s Fasl水平比较结果:病例组血清s Fas水平较健康对照组水平升高,血清s Fasl水平较健康对照组水平下降,差异具有统计学意义(P0.05)。(见Table 2,Fig.6-Fig.7)③两组认知功能比较结果:病例组即时记忆、视觉空间、延时记忆和RBANS总分较健康对照组评分低,差异具有统计学差异(P0.05),而言语功能、注意力则无统计学差异(P0.05)。(见Table 3,Fig.8-Fig.11)④两组抑郁量表评分比较结果:病例组抑郁评分较健康对照组评分高,差异具有统计学意义(P0.05)。(见Table 4,Fig.12)2病例组各指标相关分析及多元逐步回归分析结果:①病例组血清s Fas和s Fasl水平与临床生化指标的相关性分析:血清s Fas水平与FINS、HOMA-IR、Hb A1c呈正相关(P0.05)。血清s Fasl水平与FPG、FINS、HOMA-IR呈负相关(P0.05)。(见Table 5)多元逐步回归分析结果进一步显示:校正了混杂因素影响后,s Fas仍与HOMI-IR呈正相关(t=3.249,P=0.002)。s Fasl仍与HOMA-IR呈负相关(t=-2.299,P=0.025)。(见Table 8-Table 9,Fig.13-Fig.14)②病例组血清s Fas、s Fasl水平与其认知功能的相关性分析:血清s Fas水平与RBANS量表中的子项目视觉空间及RBANS量表总分呈负相关(P0.05)。血清s Fasl水平与RBANS量表总分呈正相关(P0.05)。(见Table 6)进一步行认知功能总分、各子项目与其余各指标的多元逐步回归分析结果显示:校正了混杂因素影响后(1)RBANS量表总分与HOMA-IR(t=-3.61,P=0.001)、Age(t=-2.65,P=0.010)、s Fas(t=-2.309,P=0.024)呈负相关。(见Table 10,Fig.15-Fig.16)(2)即时记忆与年龄(t=-3.312,P=0.002)、HOMA-IR(-3.007,P=0.004)呈负相关。(3)视觉空间与s Fas(t=-2.537,P=0.014)呈负相关。(4)言语功能与HOMA-IR(t=-2.905,P=0.005)呈负相关。(5)注意力与HOMA-IR(t=-3.534,P=0.001)呈负相关,与教育(t=2.321,P=0.024)呈正相关。(6)延时记忆与HOMA-IR(t=-5.145,P0.001)、年龄(t=-2.589,P=0.012)呈负相关。③病例组血清s Fas、s Fasl水平与其SDS评分的相关性分析:血清s Fas水平与SDS评分呈正相关(P0.05)。(见Table 7)多元逐步回归分析结果显示:校正了混杂因素影响后,SDS评分仍与HOMA-IR(t=2.538,P=0.014)、Age(t=2.759,P=0.008)、s Fas(t=3.062,P=0.003)呈正相关。(见Table 11,Fig.17-Fig.18)结论:1 2型糖尿病患者血清s Fas水平升高,s Fasl水平降低,表明2型糖尿病患者s Fas/s Fasl系统存在异常改变。2 2型糖尿病患者存在认知功能损伤,易伴发抑郁状态。3 2型糖尿病患者血清s Fas水平与认知功能障碍及抑郁的发生密切相关。
[Abstract]:AIM: To investigate the serum levels of s Fas (soluble fas), s Fasl (soluble Fas ligand) in type 2 diabetes mellitus (T2DM) patients and healthy controls, and to use a repeatable Repeatable battery for the assessment of neuropsychological status (RBANS). Cognitive function of type 2 diabetes mellitus patients and healthy control group was assessed. Self-Rating Depression Scale (SDS) was used to assess depressive status of type 2 diabetes mellitus patients and healthy control group. The general data and biochemical indexes of type 2 diabetes mellitus patients were tested. Statistical analysis was conducted to investigate the changes of serum s Fas and s Fasl levels and their cognitive function, depression status in patients with type 2 diabetes mellitus, and to further explore the correlation between serum s Fas and s Fasl levels and cognitive function and depression status in patients with type 2 diabetes mellitus. Sixty-three patients with type 2 diabetes mellitus hospitalized in the Department of Endocrinology of Shandong Workers Hospital were divided into the case group and 68 patients with normal blood glucose and glycosylated hemoglobin were selected as the healthy control group. Fasting plasma glucose (FPG), glycosylated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and other biochemical indicators. The case group was also fasting insulin (Fasting insulin, LDL-C). In, FINS was used to calculate the Homeostasis model assessment of insulin resistance (HOMA-IR). Serum levels of s Fas and s Fasl were measured and compared statistically. The cognitive function of the two groups was assessed according to the RBANS scale, and the self-rating depression scale (SDS) was used to compare the two groups. Result: 1. Comparison between case group and healthy control group. Results: The general data of two groups and clinical biochemical indexes were compared. Results: The levels of FPG, Hb A1C, TC, TG in case group were higher than those in healthy control group, HDL was higher. The level of serum s Fas and s Fasl in the case group was higher than that in the healthy control group, and the level of serum s Fasl was lower than that in the healthy control group, the difference was statistically significant (P 0.05). (See Table 2, Fig.6-Fig.7) Results: The scores of immediate memory, visual space, delayed memory and RBANS in the case group were lower than those in the healthy control group (P 0.05), but there was no significant difference in speech function and attention (P 0.05). (See Table 3, Fig.8-Fig.11) The results of correlation analysis and multiple stepwise regression analysis showed that: (1) The correlation analysis of serum s Fas and s Fasl levels with clinical biochemical indicators in case group: Serum s Fas levels were positively correlated with FINS, HOMA-IR, Hb A1c (P 0.05). Serum s Fasl levels were positively correlated with FPG, FI. NS, HOMA-IR was negatively correlated (P 0.05). (See Table 5) Multivariate stepwise regression analysis further showed that after correction for confounding factors, s Fasl was still positively correlated with HOMI-IR (t = 3.249, P = 0.002). s Fasl was negatively correlated with HOMA-IR (t = - 2.299, P = 0.025). (See Table 8-Table 9, Fig. 13-Fig. 14) Correlation analysis: Serum s Fasl level was negatively correlated with the sub-item visual space and the total score of the RBANS scale (P 0.05). Serum s Fasl level was positively correlated with the total score of the RBANS scale (P 0.05). (See Table 6). Further, the total score of cognitive function was calculated, and the results of multiple stepwise regression analysis showed that the sub-items and the other indicators were correlated. (1) The total score of RBANS was negatively correlated with HOMA-IR (t = - 3.61, P = 0.001), Age (t = - 2.65, P = 0.010), Fas s (t = - 2.309, P = 0.024). (see Table 10, Fig. 15-Fig. 16) (2) Immediatmemory and age (t = - 3.312, P = 0.312, P = 0.002), HOMA-IR (- 3.007, P = 0.007, P = 0.004) Ag (t = - 2.65, P = 0.010 0 0 0 0 0 0 0 0 0 0), Fas (t = - 2.309, P = 0.309, P = 0.024) Fas (see Table 10, Fig. 15 537, P = 0.014) was negatively correlated. Language function was negatively correlated with HOMA-IR (t =-2.905, P = 0.005). (5) Attention was negatively correlated with HOMA-IR (t =-3.534, P = 0.001), and was positively correlated with education (t = 2.321, P = 0.024). (6) Delayed memory was negatively correlated with HOMA-IR (t =-5.145, P = 0.001), age (t =-2.589, P = 0.012). 3. Fas s and Fas s levels were negatively correlated with serum SDS scores. Fas levels were positively correlated with SDS scores (P 0.05). (See Table 7) Multivariate stepwise regression analysis showed that SDS scores were positively correlated with HOMA-IR (t = 2.538, P = 0.014), Age (t = 2.759, P = 0.008), and s Fas (t = 3.062, P = 0.003). (See Table 11, Fig. 17-Fig. 18) Conclusion: Serum s Fas levels in type 2 diabetes mellitus were elevated and s Fas levels were positively correlated. The decrease of Fasl level indicates that there are abnormal changes in the s Fas/s Fasl system in type 2 diabetes mellitus. 2 Type 2 diabetes mellitus patients have cognitive impairment and are prone to depression. 3 Type 2 diabetes mellitus patients'serum s Fas level is closely related to cognitive impairment and depression.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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