糖尿病临床研究

　　【摘要】 目的 探讨2型糖尿病(T2DM)患者轻度认知障碍(MCI)相关的影响因素。 方法 采用蒙特利尔认知评估(MoCA)(北京版)量表作为认知的测评工具。选取T2DM患者226例，经MoCA量表评估，<26分者132例为T2DM+MCI组，≥26分者94例为单纯T2DM(T2DM)组。收集并比较两组的人口统计学和临床资料。用超声多普勒仪检查双下肢动脉血管的异常并计算踝肱指数(ABI)。用多功能彩超诊断颈动脉内-中膜厚度(C-IMT)或有无动脉粥样硬化(AS)斑块。 结果 两组年龄、SBP、T2DM病程、教育程度、胱抑素-C(Cys-C)、血尿酸(SUA)、FPG、BUN、载脂蛋白A(ApoA)含量和载脂蛋白B(ApoB)含量比较差异有统计学意义(P<0.05或P<0.01)。T2DM+MCI组双下肢动脉异常者87.4%， CIMT>1.1 mm或有粥样硬化斑块者67.9%，T2DM组分别为29.7%、33.6%(χ2分别为19.337、16.553)，两组比较差异有统计学意义(P<0.01);T2DM组大学以上学历者28.7%，T2DM+MCI组为15.9%，两组比较差异有统计学意义(P<0.05)。Logistic多元回归分析显示，文化程度、年龄、SBP和T2DM病程是MCI的影响因素。 结论 T2DM患者的病程、年龄、SBP可能是MCI的危险因素，文化程度可能是MCI的保护因素。

　　【关键词】糖尿病，2型;轻度认知障碍;蒙特利尔认知评估

　　【Abstract】Objective To study the factors that influence mild cognitive impairment (MCI) in patients with type 2 diabetes (T2DM). Methods The Montreal cognitive assessment (MoCA) (Beijing) scale was used to assess cognitive function. A total of 226 T2DM patients were divided into two groups based on MoCA scores： < 26 points was defined as MCI (T2DM+MCI group, n=132), ≥26 points was considered as normal cognitive function (T2DM group, n=94). Demographic and clinical data were collected and compared between the two groups. The lower extremity arteries were examined by Doppler ultrasound and ankle-brachial indexes (ABIs) were calculated. Multifunction ultrasound was used to evaluate carotid artery intima-media thickness (C-IMT) or the presence of atherosclerosis (AS) plaques. Results There were significant differences on age, duration of T2DM, education degree, SBP, FPG, BUN, ApoA and ApoB levels between the two groups (P<0.05 or P<0.01). The proportions of abnormality in lower extremity arteries and carotid arteries (CIMT > 1.1 mm or presence of AS plaque) were significantly higher in T2DM+MCI group than in T2DM group (87.4 % vs 29.7%, and 67.9% vs 33.6%, respectively; χ2=19.337 and 16.553, respectively) (P<0.01). The proportion of patients having a college degree or above in T2DM+MCI group was significantly higher than in T2DM group (28.7% vs 15.9%, P<0.05). Logistic regression analysis showed that education, age, SBP and duration of T2DM were influencing factors of cognitive impairment. Conclusion T2DM course, age, SBP might be risk factors for cognitive impairment in T2DM patients, and high degree of education may be protective factors of cognitive impairment.

　　【Key words】Diabetes mellitus，type 2;Mild Cognitive Impairment (MCI);Montreal cognitive assessment (MoCA)