老年2型糖尿病认知功能障碍患者r血清炎症因子与脑影像学病理改变的相关性研究

摘要

目的 观察2型糖尿病认知功能障碍患者血清炎症因子、叶酸、同型半胱氨酸(HCY)水平与脑影像学病理改变的相关性.方法 搜集2013年12月至2014年12月南京鼓楼医院老年科住院的60岁以上患者,分为2型糖尿病痴呆组66例和单纯痴呆组43例.行神经心理量表评估,检测血清炎症因子、HCY、叶酸及基因水平;经磁共振海马薄层平扫及波普观察患者海马高度、脉络膜裂大小、胶质细胞增生及神经元退变.结果与单纯痴呆组相比,糖尿病痴呆组患者的蒙特利尔认知评估(MoCA)评分下降;血清白细胞介素(IL)-1β、IL-6及HCY水平上升,叶酸水平降低,叶酸基因分布不同;海马高度、NAA/Cr减少,脉络膜裂、MI/Cr增加.IL-1β、HCY、脉络膜裂是糖尿病痴呆组的独立危险因素.结论 老年2型糖尿病痴呆患者的海马体积萎缩 ,神经元退变及胶质细胞增生 ,其认知功能与血清IL-1β、HCY水平及脉络膜裂大小密切相关.%Objective To evaluate the relationship of serum inflammation factors ,homocysteine and brain metabolism of elderly patients with type 2 diabetes in the pathogenesis of cognitive dysfunctio .Methods Collec-ting from December 2013 to December 2014 Nanjing Drum Tower Hospital Geriatric inpatients aged over 60 ,with reference to the diagnostic criteria for diabetes and cognitive impairment in type 2 diabetes patients were divided in-to 66 groups dementia and dementia alone group 43 .Observation :In general ,inflammatory markers (IL-6 ,IL-1β,CRP) ,homocysteine ,serum folate gene;Neuropsychological Assessment Scale (including :MMSE ,MoCA , ADL ,HAMD);hippocampal MRI measurement (hippocampus height ,fissure size ,NAA /Cr ,MI/Cr) .Results Compared with the pure dementia group ,diabetes dementia group of patients with MoCA score decreased ;ser-um IL-1 ,IL-6 and beta HCY level increased ,decreased levels of folic acid ,folic acid of different gene distribution ;hippocampus height ,NAA/Cr decreased ,MI/Cr increased ,the choroidal fissure .IL-1 beta ,HCY and choroidal fissure were independent risk factors for diabetic dementia .Conclusion Compared with pure dementia patients , the cognitive function in elderly dementia patients with type 2 diabetes decreased hippocampus volume atrophy , neuronal degeneration (NAA/Cr decrease) and gliosis (MI/Cr increase) ,which may be associated with inflamma-tion and hyperhomocysteinemia .