血清可溶性E-选择素水平与2型糖尿病患者认知功能障碍的相关性研究

摘要

目的 探讨血清可溶性E-选择素(soluble E-selectin,sE-selectin)水平与2型糖尿病患者认知功能障碍的相关性.方法 检测80例2型糖尿病患者(病例组)及同期80例健康者(对照组)的血清sE-selectin水平,并收集所有研究对象的一般资料,包括年龄、性别、受教育年限、体质量指数(body mass index,BMI)、病程等,以及生化指标,包括超敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)、同型半胱氨酸(homocysteine,Hcy)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting serum lisulin,FIN)、糖化血红蛋白(hemoglobin A1 c,HbA1 c)、总胆固醇(total cholesterol,TC)、三酰甘油(Triglycerides,TG)、高密度脂蛋白胆固醇(high density lipoprotein,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein,LDL-C)等.计算稳态胰岛素评价指数(homeostasis model assessment-insulin resistance,HOMA-IR)并进行可再次检测的成套神经心理状态测量量表(Repeatable Battery for the Assessment of Neuropsyehological Status,RBANS)评分.采用酶联免疫吸附法检测sE-selectin浓度,比较2组sE-selectin浓度及认知功能是否存在差异,并分析sE-selectin与认知功能的相关性.将病例组进一步分为高sE-selectin浓度水平组和低sE-selectin浓度水平组,比较2组之间认知功能是否存在差异.结果 ①与对照组比较,病例组病程长,BMI、FPG、HbA1c、TC、TG、LDL-C、hsCRP、Hcy、HOMA-IR、sE-selectin浓度水平较高(P＜0.05);②与对照组比较,病例组RBANS即时记忆、语言功能、注意力、延迟记忆评分以及总分降低(P＜0.05);③在病例组中,与高sE-selectin浓度水平组相比,低sE-selectin浓度水平组即时记忆、视觉广度、语言功能、延迟记忆评分以及总分降低(P＜0.05);④在T2DM患者中,sE-selectin浓度与HOMA-IR呈正相关,与即刻记忆、言语功能、注意力、延迟记忆、总分呈负相关,差异有统计学意义(P＜0.05).结论 sE-selectin可能参与了2型糖尿病患者认知功能障碍的发生发展过程.%Objective To investigate the association of level of serum soluble E-selectin(sE-selectin) with cognitive deficits in type 2 diabetes mellitus(T2DM) patients.Methods Enzymelinked immunosorbent assay is used to determine the sE-selectin level in 80 cases of patientsand 80 controls without T2DM from the Medical Examination Center.The data on demographic characteristics including age,gender,education,body mass index(BMI) and duration of illness were recored.Clinical parameters including high-sensitivity C-reactive protein (hsCRP),Homocysteine(Hcy),fasting plasma glucose (FPG),fasting serum lisulin (FIN),hemoglobin A1 c(HbA1 c),total cholesterol(TC),Triglycerides(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C) and homeostasis model assessment-insulin resistance(HOMA-IR) were collected.Cognitive performance was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) which consists of five subtests including immediate memory,visuospatial constructional,language,attention and delayed memory;and the scores from the above five subtests were scaled together to create a total score.Difference in RBANS scores was compared between the T2DM group and control group.T2DM patients were divided into high sE-selectin level group and low sE-selectin level group according to the median level of sE-selectin,and the difference in cognitive function was compared between the two groups.Results Serum FPG,HbA1c,TC,TG,LDL-C,hsCRP,Hcy,HOMA-IR levels,BMI,and the level of sE-selectin of the T2DM patients were higher than those of the controls(P＜0.05).RBANS scores were lower in the T2DM patients than in the controls on the total score and all subtests(P＜ 0.05) expect for constructional of RBANS.In the T2DM patients,immediate memory,visuospatial constructional,language,delayed memory and total score of the patients with low sE-selectin were lower than those of the patients with high sE-selectin(P＜0.05).In T2DM patients,sE-selectin concentration was positively correlated with HOMA-IR and negatively correlated with immediate memory,language,attention,delayed function and total score,the difference was statistically significant (P＜ 0.05).Conclusion sE-selectin may be involved in the occurrence and development of cognitive dysfunction in patients with T2DM patients.