2型糖尿病患者认知障碍特点及其影响因素的研究

摘要

目的 探讨2型糖尿病患者(T2DM)认知障碍的特点,并分析与其危险因素及血清胰岛素样生长因子-1(IGF-1)水平的相关性. 方法 收集2011年11月至2012年3月入住我院内分泌科的T2DM患者78例,根据蒙特利尔认知评估(MoCA)结果分为认知障碍组(39例)和非认知障碍组(39例).记录一般临床资料,测定血脂、糖化血红蛋白(HbAlc)、空腹血糖(FBG)和空腹胰岛素(FBI)水平,计算胰岛素抵抗指数(HOMA-IR),并采用酶联免疫吸附法(ELISA)测定血清IGF 1的浓度. 结果 认知障碍组患者的受教育度为(8.94±4.13)年,非认知障碍组患者的受教育度为(12.65±2.50)年,二者相比差异具有统计学意义(P=0.004);认知障碍组的HbAlc为(9.7±1.3)％,非认知障碍组的HbAlc为(8.0±1.3)％,二者相比差异有统计学意义(P=0.001);认知障碍组的IGF-1为(122.6±11.6)mmol/L,非认知障碍组的IGF-1为(139.3±9.6) mmol/L,二者相比差异具有统计学意义(P=0.037).此外,认知障碍组的视结构技能、命名、语言、抽象、延迟回忆和定向能力明显下降(P＜0.05和P＜0.01),且MoCA评分与三酰甘油、总胆固醇、低密度脂蛋白胆固醇、HbAlc、FBI和HOMA-IR呈负相关(r分别为-0.498、-0.411、-0.414、-0.452、-0.449和-0.539,P＜0.05),而与受教育程度和IGF-1呈正相关(r为0.579、0.491,P＜0.05). 结论 T2DM认知损伤以视结构技能、语言、记忆和执行功能为主,与受教育程度低、血糖控制不佳、血脂代谢紊乱及胰岛素抵抗密切相关.此外,血清IGF-1减少也是参与认知障碍的重要因素.%Objective To investigate the characteristics of cognitive impairment in patients with type 2 diabetes mellitus (T2DM),and to analyze the correlation of T2DM with its risk factors and serum insulin like growth factor-1 (IGF-1) levels Methods A total of 78 hospitalized patients with T2DM at our hospital from November 2011 to March 2012 were divided into the cognitive impairment group (n=39) and the non-cognitive impairment group (n=39) according to Montreal Cognitive Assessment (MoCA) scores,and general clinical data were collected.Levels of blood lipids,glycosylated hemoglobin (HbAlc),fasting blood glucose (FBG),fasting blood insulin (FBI) and other biochemical indicators were detected,insulin resistance index (HOMA-IR) scores were calculated,and serum IGF-1 levels were determined by the enzyme-linked immunosorbent assay (ELISA).Results The education levle was (8.94±4.13) years for the cognitive impairment group and (12.65[2.50) years for the non-cognitive impairment group,and there was a statistically significant difference between the two groups (P=0.004).HbAlc levels were (9.69 ± 1.25) and (7.96 ± 1.31) for the cognitive impairment group and the non-cognitive impairment group,respectively,and were statistically difference between the two groups (P =0.001).Serum IGF-1 levels were (122.60±11.56) mmol/L and (139.32±9.57) mmol/L in the cognitive impairment group and the non-cognitive impairment group,respectively,and had a statistically significant difference between the two groups (P =0.037).Additionally,compared with the non-cognitive impairment group,scores on visuospatial ability,naming,language,abstraction,delayed recall and orientation were lower in the cognitive impairment group (P＜[0.05 or 0.01).Moreover,MoCA scores were negatively correlated with TC,LDL-C,TG,HbAlc,FBI levels and HOMA IR (r=0.498,-0.411,0.414,-0.452,-0.449,-0.539,respectively,P＜0.05 for all),and positively correlated with education lcvcl and IGF 1 level (r=0.579 and 0.491,respectively,P＜0.05 for both) Conclusions Cognitive impairment caused by T2DM is prominent in visuospatial ability,language,memory and executive functions,and is closely related to poor education,poor glycemic control,dyslipidemia and insulin resistance.Furthermore,decreased serum IGF-1 levels might be a risk factor for diabetic cognitive impairment.