77例2型糖尿病患者轻度认知功能障碍中医证型特点及影响因素

发布时间：2018-09-09 08:18

【摘要】：[目的]通过对2型糖尿病轻度认知功能障碍患者进行证型调查,分析其与2型糖尿病认知功能正常患者证型区别,归纳研究2型糖尿病轻度认知功能障碍患者中医证型特点,寻找2型糖尿病发生轻度认知功能障碍的影响因素,明确其发病是否与中医证型的不同存在相关性,进一步探讨2型糖尿病轻度认知功能障碍患者不同证型间认知功能是否存在差异。[方法]使用蒙特利尔认知评估(Montreal cognitive Assessment,MoCA)北京量表、简易精神状态量表(MMSE量表)、临床痴呆分级量表(CDR量表)等量表,依据诊断标准和排除标准将77例2型糖尿病患者按是否存在轻度认知功能障碍分为2型糖尿病轻度认知功能障碍组和2型糖尿病认知功能正常组,中医证型分为气虚、血虚、阴虚、阳虚、肾虚、脾气虚、肺气虚、肝虚、燥热、血瘀、气郁、气郁化热、痰湿、热痰、热毒、湿热困脾、湿热下注、肝胆湿热、胃肠结热共19个证型,采用调查问卷及实验室检查的形式,收集患者的年龄、学历、身高、体重、血压、糖尿病病程、糖尿病并发症及其他合并症等一般资料,检测空腹血糖、餐后血糖、空腹C肽及胰岛素、糖化血红蛋白水平。[结果]2型糖尿病轻度认知功能障碍患者与2型糖尿病认知功能正常患者的一般情况包括:年龄、糖尿病病程、BMI、血压、空腹C肽、空腹胰岛素、糖尿病并发症及合并症无明显差异(P0.05);受教育年限与HbA1C存在差异(P0.05);认知功能方面:视空间与执行功能、注意、算数、语言、抽象、延迟回忆部分两组患者存在显著的差异(P0.01);证型特点方面:2型糖尿病轻度认知功能障碍组证型以肝虚证、气虚证、肾虚证、血瘀证、阳虚证、气郁证为主,所占比率分别为18.1%、14.3%、13.2%、12.6%、11.0%,其中肝虚证、气虚证、肾虚证、血瘀证、阳虚证、气郁证之间的认知评分不存在显著差异(P0.05);2型糖尿病认知功能正常组证型以燥热证、阴虚证、脾气虚证、痰湿证、气郁化热证、胃肠结热证、肺气虚证、肝胆湿热证为主,所占的比率分别为 17.8%、15.9%、13.1%、12.1%、9.3%、6.5%、5.6%、4.7%、4.7%、3.7%,差异无统计学意义(P0.05);2型糖尿病轻度认知功能障碍组及2型糖尿病认知功能正常组在血瘀证及燥热证的分布均有显著差异(P0.05)。[结论]2型糖尿病轻度认知功能障碍认知功能的损伤主要在视空间与执行功能、注意、算数、语言、抽象、延迟回忆方面,糖化血红蛋白水平和受教育年限是2型糖尿病患者是否发生轻度认知功能障碍的影响因素,其中糖化血红蛋白水平为危险因素,受教育年限为保护性因素;2型糖尿病轻度认知功能障碍证型以肝虚证、气虚证、肾虚证、血瘀证、阳虚证、气郁证为主;与认知功能正常的2型糖尿病患者相比,两组证型分布特点大致相似,2型糖尿病轻度认知功能障碍以血瘀证为特点,认知功能正常组以燥热证为特点,证型对认知功能影响的程度不确切。
[Abstract]:[objective] to investigate the syndromes of patients with mild cognitive dysfunction of type 2 diabetes mellitus, analyze the difference between them and the patients with normal cognitive function of type 2 diabetes mellitus, and sum up and study the characteristics of TCM syndromes in patients with mild cognitive dysfunction of type 2 diabetes mellitus. To find out the influencing factors of mild cognitive dysfunction in type 2 diabetes mellitus, and to find out whether there is correlation between the occurrence of type 2 diabetes mellitus and the different types of TCM syndromes. To further explore whether there are differences in cognitive function among different syndromes in patients with mild cognitive impairment in type 2 diabetes mellitus. [methods] using Montreal Cognitive Assessment (Montreal cognitive Assessment,MoCA) Beijing scale, Mini-Mental State scale (MMSE), Clinical dementia rating scale (CDR), etc. According to the diagnostic criteria and exclusion criteria, 77 patients with type 2 diabetes mellitus were divided into two groups according to whether there was mild cognitive dysfunction in type 2 diabetes mellitus and normal cognitive function of type 2 diabetes mellitus. The TCM syndromes were divided into qi deficiency and blood deficiency. Yin deficiency, yang deficiency, kidney deficiency, spleen qi deficiency, lung qi deficiency, liver deficiency, dryness and heat, blood stasis, qi stagnation, phlegm dampness, heat phlegm, heat toxin, damp-heat trapped spleen, damp-heat betting, liver and gallbladder damp-heat, gastrointestinal knot heat, 19 syndrome types, The patients' age, education, height, weight, blood pressure, course of diabetes, diabetic complications and other complications were collected by questionnaire and laboratory examination to detect fasting blood glucose and postprandial blood glucose. Fasting C-peptide and insulin, glycosylated hemoglobin levels. [results] the general conditions of patients with mild cognitive impairment in type 2 diabetes mellitus and normal cognitive function patients with type 2 diabetes mellitus included: age, course of diabetes, BMIs, blood pressure, fasting C-peptide, fasting insulin, There was no significant difference in diabetic complications and complications (P0.05); there were differences between the years of education and HbA1C (P0.05); cognitive function: visual space and executive function, attention, arithmetic, language, abstraction, There were significant differences between the two groups in delayed recall (P0.01), the syndrome types of mild cognitive dysfunction of type 2 diabetes mellitus were liver deficiency, Qi deficiency, Kidney deficiency, Blood stasis, Yang deficiency, Qi stagnation. The ratios were 18.1C 14.3B and 12.60.There were no significant differences in the cognitive scores between liver deficiency syndrome, qi deficiency syndrome, kidney deficiency syndrome, blood stasis syndrome, yang deficiency syndrome and qi stagnation syndrome. (P0.05) there was no significant difference in the cognitive function of type 2 diabetes mellitus with dryness and heat syndrome, yin deficiency syndrome, spleen qi deficiency syndrome, and there was no significant difference between them (P0.05) the cognitive function of type 2 diabetes mellitus was characterized by dryness and heat syndrome, yin deficiency syndrome, spleen qi deficiency syndrome, and there was no significant difference between them (P0.05). Phlegm and dampness syndrome, qi stagnation and heat transfer syndrome, gastrointestinal knot heat syndrome, lung qi deficiency syndrome, liver and gallbladder dampness and heat syndrome, The ratios of 17.8R 15.9g and 12.1g were 9.3and 6.55.6and 4.7cm, respectively. There was no significant difference in the distribution of blood stasis and heat dryness (P0.05) between the mild cognitive impairment group of type 2 diabetes mellitus and the normal cognitive function group of type 2 diabetes mellitus (P0.05). The distribution of blood stasis syndrome and heat dryness syndrome in type 2 diabetes mellitus were significantly different (P0.05), and there was no significant difference between the two groups in the distribution of blood stasis syndrome and dryness heat syndrome (P0.05), and there was no significant difference between the two groups (P0.05). [conclusion] the impairment of cognitive function in type 2 diabetes mellitus with mild cognitive impairment is mainly related to visual space and executive function, attention, arithmetic, language, abstraction and delayed recall. The level of glycosylated hemoglobin and the years of education are the influencing factors of mild cognitive impairment in type 2 diabetes mellitus, and the level of glycosylated hemoglobin is the risk factor. The number of years of education was a protective factor. The main types of mild cognitive dysfunction in type 2 diabetes mellitus were liver deficiency, qi deficiency, kidney deficiency, blood stasis, yang deficiency and qi depression, compared with type 2 diabetes with normal cognitive function. The distribution characteristics of syndrome types in the two groups were similar to those in type 2 diabetes mellitus. The mild cognitive dysfunction of type 2 diabetes mellitus was characterized by blood stasis syndrome, while that of normal cognitive function group was characterized by dryness and heat syndrome, and the degree of influence of syndrome type on cognitive function was not exact.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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