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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
王琳,李博,李宝柱,吴琨,张烜.轻度认知功能障碍与老年2型糖尿病及糖尿病前期的相关性[J].中华老年多器官疾病杂志,2019,18(10):747~752
轻度认知功能障碍与老年2型糖尿病及糖尿病前期的相关性
Correlation of mild cognitive impairment with elderly type 2 diabetes mellitus and pre-diabetes
投稿时间:2019-05-09  
DOI:10.11915/j.issn.1671-5403.2019.10.162
中文关键词:  老年人;糖尿病,2型;糖尿病前期;轻度认知功能障碍
英文关键词:aged; diabetes mellitus, type 2; pre-diabetic state; mild cognitive impairment This work was supported by the Scientific Research Project of Beijing Hepingli Hospital
基金项目:北京市和平里医院院级科研项目(2018-1-8)
作者单位E-mail
王琳 北京市和平里医院神经内科,北京 100013  
李博 北京市和平里医院神经内科,北京 100013 13691089898@139.com 
李宝柱 北京市和平里医院神经内科,北京 100013  
吴琨 北京市和平里医院神经内科,北京 100013  
张烜 北京市和平里医院神经内科,北京 100013  
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中文摘要:
      目的 探讨轻度认知功能障碍(MCI)与老年2型糖尿病(T2DM)及糖尿病前期(又称糖调节受损,IGR)的相关性。方法 选取2018年1月至2018年12月在北京市和平里医院神经内科就诊年龄为60~80岁的T2DM患者,另选取同期IGR患者30例,及来院进行体检的健康人群30名(对照组)。收集并比较3组受试者MCI发生率、一般资料及相关临床指标。根据是否存在MCI将T2DM患者分为MCI亚组(39例)及非MCI亚组(21例),同时将IGR患者分为MCI亚组(14例)及非MCI亚组(16例)。比较T2DM及IGR患者各亚组间临床资料。应用SPSS 17.0统计软件进行数据处理。多因素logistic回归法分析老年T2DM及IGR患者发生MCI的独立影响因素。结果 与对照组[30.0%(9/30)]比较,IGR[46.7%(14/30),P=0.002]及T2DM组[65.0%(39/60),P=0.004]MCI患病率显著升高;与IGR组比较,T2DM组患者MCI患病率亦显著升高(P=0.006)。与对照组比较,IGR组及T2DM组患者教育年限和蒙特利尔认知评估量表(MoCA)评分显著降低,低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1C)、空腹血糖(FBG)、餐后2小时血糖(PBG)显著升高;与IGR组比较,T2DM组患者MoCA评分显著降低,HbA1C、FBG、PBG显著升高,差异均有统计学意义(P<0.05)。单因素分析显示,与对应的非MCI亚组比较,T2DM及IGR患者的MCI亚组年龄、收缩压(SBP)、LDL-C、HbA1C、FBG均显著升高,同时受教育年限及MoCA评分显著降低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,老年T2DM及IGR患者发生MCI的相同独立危险因素为年龄(OR=1.104,95%CI 1.026~1.132,P=0.023;OR=2.001,95%CI 1.296~2.134,P=0.038)、FBG(OR=2.138,95%CI 0.283~6.132,P=0.042;OR=0.986,95%CI 0.010~2.448,P<0.001)和LDL-C(OR=3.382,95%CI 1.613~8.206,P=0.008;OR=2.682,95%CI 1.983~5.751,P=0.022),相同的独立保护因素为受教育年限(OR=1.688,95%CI 0.172~3.394,P=0.002;OR=1.692,95%CI 0.187~3.412,P=0.003)。结论 T2DM患者发生MCI的风险较高,这种趋势自IGR阶段就开始出现,故需对老年IGR患者及早控制FBG和LDL-C水平。
英文摘要:
      Objective To explore the correlation between mild cognitive impairment (MCI) and elderly type 2 diabetes mellitus (T2DM) and pre-diabetes (impaired glucose regulation, IGR). Methods The elderly T2DM patients (60-80 years old) admitted to our department from January to December 2018 were recruited, and 30 IGR patients and 30 healthy people (control group) for physical examination in the same period were enrolled. The incidence of MCI, general data and related clinical indices were collected and compared among the 3 groups. According to the existence of MCI, the T2DM patients were divided into MCI subgroup (n=39) and non-MCI subgroup (n=21 cases), and IGR patients were also assigned into MCI (n=14) and non-MCI subgroup (n=16). The clinical data were compared between the MCI and non-MCI subgroup in T2DM group and IGR group. SPSS statistics 17.0 was used for data processing. Multivariate logistic regression analysis was employed to explore the independent influencing factors of MCI in elderly patients with T2DM or IGR. Results Compared with that of the control group [30.0%(9/30)], the incidence rate of MCI was significantly higher in the IGR group [46.7%(14/30), P=0.002] and T2DM group [65.0%(39/60), P=0.004], and it was obviously higher in the latter group than the former group (P=0.006). Compared with control group, IGR group and T2DM group had significantly shorter educational length and lower score of Montreal cognitive assessment (MoCA) scale, and increased levels of low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin Alc (HbA1c), fasting blood glucose (FBG) and postprandial 2-hour blood glucose (PBG). What′s more, MoCA score was reduced while the levels of HbA1c, FBG and PBG were increased significantly in the T2DM group than the IGR group (P<0.05). Univariate analysis showed that age, systolic blood pressure (SBP), and levels of LDL-C, HbA1c and FBG were significantly higher, while education length was shorter and MoCA score was lower in the MCI subgroups than those of corresponding non-MCI subgroups in both T2DM group and IGR group (P<0.05). Multiple logistic regression analysis showed that age (OR=1.104,5%CI 1.026-1.132, P=0.023; OR=2.001,5%CI 1.296-2.134, P=0.038), FBG (OR=2.138,5%CI 0.283-6.132, P=0.042; OR=0.986,5%CI 0.010-2.448, P<0.001) and LDL-C (OR=3.382, 95%CI 1.613-8.206, P=0.008; OR=2.682,5%CI 1.983-5.751, P=0.022) were the same independent risk factors, while educational years was the same independent protective factors (OR=1.688,5%CI 0.172-3.394, P=0.002; OR=1.692, 95%CI 0.187-3.412, P=0.003) for MCI in the elderly T2DM and IGR patients. Conclusion The elderly T2DM patients are at high risk of MCI. This trend has appeared since the IGR stage. Therefore, it is necessary to control the levels of FBG and LDL-C in elderly patients with IGR as early as possible.
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