老年糖尿病轻度认知损害患者认知功能减退影响因素分析

摘要

目的 分析影响老年2型糖尿病轻度认知损害(MCI)患者认知减退的多种因素及其可能存在的交互作用,以期更加全面评估患者预后,指导临床治疗.方法 采用巢式病例-对照研究方法,由612例患有轻度认知功能障碍的2型糖尿病患者组成随访队列,按照年龄、性别、文化程度1∶1匹配后形成认知减退组和对照组,采用单因素分析结合多因素分析的方法确定患者认知减退的影响因素.采用相加效应模型分析影响因素间的交互作用.结果 非在婚包括未婚、离异、丧偶、分居等(OR=2.237,95％CI:1.022～4.896)、喜欢待在家里(OR=2.267,95％CI:1.177～4.366)、不常读书看报(OR=2.819,95％CI:1.276～7.839)、合并高血压(OR=3.298,95％CI:1.417～7.675)、吸烟(OR=2.927,95％CI:1.237～6.925)、饮酒(OR=2.439,95％CI:1.116～7.211)、糖尿病微血管病变(OR=2.895,95％CI:1.227～6.830)、糖尿病病程长(OR=3.672,95％CI:1.552～8.687)、血糖控制水平差(OR=3.418,95％CI:1.226～9.529),均是患者发生认知功能减退的危险因素；糖尿病微血管病变与吸烟、饮酒之间的交互作用,其归因效应百分比分别为68.9％、32.9％,超相对危险比分别为10.621、7.238.结论 吸烟、饮酒与糖尿病微血管病变对患者认知减退存在正交互作用.%Objective To analyze the cognitive function impairment factors and their interactions in elderly type 2 diabetes mellitus patients with mild cognitive impairment,in order to fully evaluate the prognosis and guide the clinical treatment.Methods A total of 612 elderly type 2 diabetes patients with mild cognitive impairment were selected in this nested case-control study.Patients were divided into the cognitive decline group and the control group matched for age,sex,culture degree and paired for observation.Risk factors for cognitive function decline were determined by single factor analysis and multivariate analysis methods.The interactions between factors were analyzed by additive effects model.Results The risk factors for cognitive function decline were non married,preferring to stay at home,less reading,hypertension,smoking,alcohol,diabetic microangiopathy,long diabetes duration,hyperglycemia (OR=2.237,2.267,2.819,3.298,2.927,2.439,2.895,3.672,3.418,95％CI:1.022-4.896,1.177-4.366,1.2767.839,1.417-7.675,1.237-6.925,1.116-7.211,1.227-6.830,1.552-8.687,1.226-7.894,respectively).Diabetic microangiopathy had a interaction with smoking and drinking,their percentages of AP (AB) were 68.9％,32.9％ and relative risk ratios of RERI were 10.621,7.238 respectively.Conclusions Diabetic microangiopathy has a positive interaction with smoking,and drinking in elderly type 2 diabetes mellitus with mild cognitive impairment.