抑郁程度对2型糖尿病共病抑郁患者血糖波动与认知功能影响及机制分析

摘要

目的 探讨抑郁程度对2型糖尿病共病抑郁患者血糖波动与认知功能的影响,并分析其氧化应激及炎性反应水平.方法 选择2型糖尿病合并抑郁患者120例,分为重度抑郁组(35例)、中度抑郁组(85例),取同期2型糖尿病患者60例作为对照组.入院后24h内检测血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、超氧化物歧化酶(SOD)、丙二醛(MDA)与总抗氧化能力(TAOC)水平.放射免疫法测量患者抑制前8:00、16:00点以及抑制后8:00、血皮质醇(COR)浓度.评估患者入院72 h内血糖水平标准差(SDBG)、日内平均血糖波动幅度(MAGE)、餐后血糖波动幅度(MPPGE),进行临床广泛应用的简易智能状态量表(MMSE)、伦敦塔(TOL)、霍普金斯词汇学习测验-语言记忆(HVLT-R)评估患者认知功能受损程度.结果 中度抑郁共病组、重度抑郁共病组患者血清IL-6、TNF-α、CRP、MDA、SDBG、MAGE、MPPGE在不同时间点血COR浓度高于对照组(P＜0.05),血清SOD、TAOC水平以及TOL、HVLT-R、MMSE评分低于对照组(P＜0.05).重度抑郁共病组患者亚临床甲状腺功能减低发生率、额叶灰质密度减低与皮层下白质高密度区发病率高于其余两组(P＜0.05).结论 2型糖尿病共病抑郁患者抑郁程度与其血糖波动幅度、氧化应激与炎性反应、认知功能损伤存在一定相关性.%Objective To explore the effects and mechanism for depressive level on blood glucose fluctuation and cognitive function in patients with type 2 diabetes mellitus comorbid depression.Methods A total of 120 patients with type 2 diabetes mellitus comorbid depression divided into severe depression group (n =35) and moderate depression group (n =85),and 60 patients with type 2 diabetes mellitus in control group were selected and examined levels of serum interleukin-6 (IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein (CRP),superoxide dismutase (SOD),malondialdehyde (MDA) and total antioxidant capacity (TAOC) in 24 hours after hospitalization.They were examined with concentration of blood cortisol (COR) by radioimmunoassay method at 8 o'clock,16 o'clock before and 8 o'clock after dexamethasone suppression test.They were examined with standard deviation of blood glucose (SDBG),24 h mean amplitude of glycemic excursions (MAGE),mean amplitude of postprandial glycemic excursions(MPPGE) by dynamic blood glucose monitor and assessed with Mini Mental State Examination(MMSE),Tower of London(TOL),Hopkins Verbal Learning Test-Revised(HVLT-R) for cognitive impairment in 72 hours after hospitalization.Results At all time points,the levels of IL-6,TNF-α,CRP,MDA,SDBG,MAGE,MPPGE in severe depression group and moderate depression group were all significantly higher than those in control group (P ＜ 0.05) and levels of SOD,TAOC,scores of TOL,HVLT-R,MMSE in two depression groups were significantly lower than those in control group(P ＜0.05).The morbidity rate of subclinical hypothyroidism,density decrease of frontal lobe gray matter and morbidity rate of high density area of subcortical white matter in severe depression group were all significantly higher than those in moderate depression group and control group (P ＜ 0.05).Conclusion The level of depression is to some extent correlated with fluctuation of blood glucose,oxidative stress,inflammatory reaction,cognitive impairment in the patients with type 2 diabetes mellitus comorbid depression.