1型糖尿病患者认知功能受损与低血糖初发年龄相关
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摘要
目的:探讨严重低血糖初次发作年龄对1型糖尿病患儿认知功能的影响。方法:采用韦氏智力量表,韦氏记忆量表对95名1型糖尿病患儿和75名健康儿童分别进行智商、记忆功能、注意力、感知推理能力、空间感知能力和信息处理速度进行评估。结果 :严重低血糖组在全智商分数(p<0.001),数字广度测验(p=0.024)和相似性测验分数(p<0.001)显著低于正常对照组,记忆功能测试的差异不显著。而无严重低血糖发作组与正常对照组相比,各项测试差异均未达到差异显著水平。严重低血糖早发作组(发作年龄<7岁)在视觉记忆测试结果,包括瞬时记忆(F_(1, 40)=8.03,p=0.007)和延时记忆均(F_(1, 40)=4.54, p=0.039)显著低于严重低血糖迟发作组(发作年龄≥7岁)。结论:本研究发现经历过严重低血糖发作的1型糖尿病患儿在智商水平,注意力水平和感知推理能力方面明显低于正常儿童。在1型糖尿病患者中,显示严重低血糖早发作(<7岁)的患儿比严重低血糖迟发作(≥7岁)的患儿视觉记忆功能明显降低。
Objective:To explore the impact of the age of the first severe hypoglycemia episode on the cognitive function of children with type 1 diabetes.Methods:In this study,we used the Wechsler Intelligence Scale and the Wechsler Memory Scale to evaluate intelligence quotient(IQ),memory function,attention,perceptual reasoning ability,spatial perception ability,and processing speed in children with type 1 diabetes(n=95) and healthy controls(HCs,n=75),respectively.Results:The IQ score(p<0.001),digit span test(p=0.024),and similarity test(p<0.001) were significantly lower in the severe hypoglycemia group than the healthy control group,whereas the memory function test was not.There was no significant difference between the non-severe hypoglycemia group and the healthy control group in each test.Compared with the late severe hypoglycemia group,the early severe hypoglycemia group(onset age<7 years) performed worse on the visual memory tests,including immediate visual memory(F_(1,40)=8.03,p=0.007) and delayed visual memory(F_(1,40)=4.54,p=0.039).Conclusions:Children with type 1 diabetes who experienced severe hypoglycemia had significantly lower levels of IQ,attention,and perceptual reasoning ability than healthy children.Among the patients with type 1 diabetes,the visual memory function was significantly lower in the children with early onset of severe hypoglycemia(<7 years) than the children with late onset(7≥years).
Objective:To explore the impact of the age of the first severe hypoglycemia episode on the cognitive function of children with type 1 diabetes.Methods:In this study,we used the Wechsler Intelligence Scale and the Wechsler Memory Scale to evaluate intelligence quotient(IQ),memory function,attention,perceptual reasoning ability,spatial perception ability,and processing speed in children with type 1 diabetes(n=95) and healthy controls(HCs,n=75),respectively.Results:The IQ score(p<0.001),digit span test(p=0.024),and similarity test(p<0.001) were significantly lower in the severe hypoglycemia group than the healthy control group,whereas the memory function test was not.There was no significant difference between the non-severe hypoglycemia group and the healthy control group in each test.Compared with the late severe hypoglycemia group,the early severe hypoglycemia group(onset age<7 years) performed worse on the visual memory tests,including immediate visual memory(F_(1,40)=8.03,p=0.007) and delayed visual memory(F_(1,40)=4.54,p=0.039).Conclusions:Children with type 1 diabetes who experienced severe hypoglycemia had significantly lower levels of IQ,attention,and perceptual reasoning ability than healthy children.Among the patients with type 1 diabetes,the visual memory function was significantly lower in the children with early onset of severe hypoglycemia(<7 years) than the children with late onset(7≥years).
引文
陈于宁,姚树桥,夏良伟.(2014).主观社会经济地位量表中文版测评成人样本的效度和信度.中国心理卫生杂志,28(11),869-874.doi:10.3969/j.issn.1000-6729.2014.11.013
龚耀先.(1983).修订韦氏记忆量表手册.长沙:湖南医学院出版社.
龚耀先,蔡太生.(1993).中国修订韦氏儿童智力量表手册.长沙:湖南地图出版社.
周智广.(2012).中国1型糖尿病诊治指南(pp.42-44).北京:人民卫生出版社.
Ack,M.,Miller,I.,&Weil,W.B.(1961).Intelligence of children with diabetes mellitus.Pediatrics,28(5):764-770.
American Diabetes Association.(2017).Standards of medical care in diabetes-2017.Diabetes Care,40 Suppl 1,S1-S135.
Cato M.A.,Mauras N.,Ambrosino J.,Bondurant A.,Conrad A.L.,Kollman C.,...Hershey T.(2014).Cognitive functioning in young children with type 1 diabetes.J Int Neuropsychol Soc,20(02):238-247.doi:10.1017/S1355617713001434
Dahlquist,G.,&Kallen,B.(2007).School performance in children with type 1 diabetes--a population-based register study.Diabetologia,50(5),957-964.doi:10.1007/s00125-007-0615-2
Dai,X.Y.,Ryan,J.J.,Paolo,A.M.,&Harrington,R.G.(1990).Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale(WAIS-RC)in a brain-damaged sample.Int JNeurosci,55(2-4),107-111.
Desrocher,M.,&Rovet,J.(2004).Neurocognitive correlates of type 1diabetes mellitus in childhood.Child Neuropsychol,10(1):36-52.doi:10.1076/chin.10.1.36.26241
Diabetes Control and Complications Trial Research Group.(1994).Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus:Diabetes control and complications trial.N Engl JMed,329(14):977-86.
Ferguson,S.C.,Blane,A.,Wardlaw,J.,Frier,B.M.,Perros,P.,McCrimmon,R.J.,&Deary,I.J.(2005).Influence of an early-onset age of type1 diabetes on cerebral structure and cognitive function.Diabetes Care,28(6),1431-1437.doi:10.2337/diacare.28.6.1431
Gaudieri,P.A.,Chen,R.,Greer,T.,F&Holmes,C.S.(2008).Cognitive function in children with type 1 diabetes a meta-analysis.Diabetes care,31(9):1892-1897.doi:10.2337/dc07-2132
He,J.,Ryder,A.G.,Li,S.,Liu,W.,&Zhu,X.(2018).Glycemic extremes are related to cognitive dysfunction in children with type 1 diabetes:Ameta-analysis.J Diabetes Investig.doi:10.1111/jdi.12840
Hershey,T.,Perantie,D.C.,Warren,S.L.,Zimmerman,E.C.,Sadler,M.&White,N.H.(2005).Frequency and timing of severe hypoglycemia affects spatial memory in children with type 1 diabetes.Diabetes Care,28(10):2372-2377.doi:10.2337/diacare.28.10.2372
Lin,A.,Northam,E.A.,Rankins,D.,Werther,G.A.,&Cameron,F.J.(2010).Neuropsychological profiles of young people with type 1 diabetes12 yr after disease onset.Pediatr Diabetes,11(4),235-243.doi:10.1111/j.1399-5448.2009.00588.x
Lin,A.,Northam,E.A.,Werther,G.A.,&Cameron,F.J.(2015).Risk factors for decline in IQ in youth with type 1 diabetes over the 12 years from diagnosis/illness onset.Diabetes Care,38(2),236-242.doi:10.2337/dc14-1385.
Lipska,B.K.,Halim,N.D.,Segal,P.N.,&Weinberger,D.R.(2002).Effects of reversible inactivation of the neonatal ventral hippocampus on behavior in the adult rat.J Neurosci,22(7),2835-2842.doi:20026195
Mc Carthy,A.M.,Lindgren,S.,Mengeling,M.A.,Tsalikian,E.,&Engvall,J.(2003).Factors associated with academic achievement in children with type 1 diabetes.Diabetes Care,26(1),112-117.doi:10.2337/diacare.26.1.112
Musen,G.,Jacobson,A.M.,Ryan,C.M.,Cleary,P.A.,Waberski,B.H.,&Weinger,K.(2008).Impact of diabetes and its treatment on cognitive function among adolescents who participated in the Diabetes Control and Complications Trial.Diabetes Care,31(10),1933-1938.doi:10.2337/dc08-0607
Perantie,D.C.,Lim,A.,Wu,J.,Weaver,P.,Warren,S.L.,Sadler,M.,...Hershey,T.(2008).Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus.Pediatr Diabetes,9(2),87-95.doi:10.1111/j.1399-5448.2007.00274.x
Perantie,D.C.,Wu,J.,Koller,J.M.,Lim,A.,Warren,S.L.,Black,K.J.,...Hershey,T.(2007).Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1diabetes.Diabetes Care,30(9),2331-2337.doi:10.2337/dc07-0351
Saykin,A.J.,Gur,R.C.,Sussman,N.M.,O’Connor,M.J.,&Gur,R.E.(1989).Memory deficits before and after temporal lobectomy:effect of laterality and age of onset.Brain Cogn,9(2),191-200.doi:10.1016/0278-2626(89)90029-8
Strudwick,S.K.,Carne,C.,Gardiner,J.,Foster,J.K.,Davis,E.A.,&Jones,T.W.(2005).Cognitive functioning in children with early onset type1 diabetes and severe hypoglycemia.J Pediatr,147(5),680-685.doi:10.1016/j.jpeds.2005.06.010
Yamada,K.A.,Rensing,N.,Izumi,Y.,De Erausquin,G.A.,Gazit,V.,Dorsey,D.A.,&Herrera,D.G.(2004).Repetitive hypoglycemia in young rats impairs hippocampal long-term potentiation.Pediatr Res,55(3),372-379.doi:10.1203/01.PDR.0000110523.07240.C1
龚耀先.(1983).修订韦氏记忆量表手册.长沙:湖南医学院出版社.
龚耀先,蔡太生.(1993).中国修订韦氏儿童智力量表手册.长沙:湖南地图出版社.
周智广.(2012).中国1型糖尿病诊治指南(pp.42-44).北京:人民卫生出版社.
Ack,M.,Miller,I.,&Weil,W.B.(1961).Intelligence of children with diabetes mellitus.Pediatrics,28(5):764-770.
American Diabetes Association.(2017).Standards of medical care in diabetes-2017.Diabetes Care,40 Suppl 1,S1-S135.
Cato M.A.,Mauras N.,Ambrosino J.,Bondurant A.,Conrad A.L.,Kollman C.,...Hershey T.(2014).Cognitive functioning in young children with type 1 diabetes.J Int Neuropsychol Soc,20(02):238-247.doi:10.1017/S1355617713001434
Dahlquist,G.,&Kallen,B.(2007).School performance in children with type 1 diabetes--a population-based register study.Diabetologia,50(5),957-964.doi:10.1007/s00125-007-0615-2
Dai,X.Y.,Ryan,J.J.,Paolo,A.M.,&Harrington,R.G.(1990).Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale(WAIS-RC)in a brain-damaged sample.Int JNeurosci,55(2-4),107-111.
Desrocher,M.,&Rovet,J.(2004).Neurocognitive correlates of type 1diabetes mellitus in childhood.Child Neuropsychol,10(1):36-52.doi:10.1076/chin.10.1.36.26241
Diabetes Control and Complications Trial Research Group.(1994).Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus:Diabetes control and complications trial.N Engl JMed,329(14):977-86.
Ferguson,S.C.,Blane,A.,Wardlaw,J.,Frier,B.M.,Perros,P.,McCrimmon,R.J.,&Deary,I.J.(2005).Influence of an early-onset age of type1 diabetes on cerebral structure and cognitive function.Diabetes Care,28(6),1431-1437.doi:10.2337/diacare.28.6.1431
Gaudieri,P.A.,Chen,R.,Greer,T.,F&Holmes,C.S.(2008).Cognitive function in children with type 1 diabetes a meta-analysis.Diabetes care,31(9):1892-1897.doi:10.2337/dc07-2132
He,J.,Ryder,A.G.,Li,S.,Liu,W.,&Zhu,X.(2018).Glycemic extremes are related to cognitive dysfunction in children with type 1 diabetes:Ameta-analysis.J Diabetes Investig.doi:10.1111/jdi.12840
Hershey,T.,Perantie,D.C.,Warren,S.L.,Zimmerman,E.C.,Sadler,M.&White,N.H.(2005).Frequency and timing of severe hypoglycemia affects spatial memory in children with type 1 diabetes.Diabetes Care,28(10):2372-2377.doi:10.2337/diacare.28.10.2372
Lin,A.,Northam,E.A.,Rankins,D.,Werther,G.A.,&Cameron,F.J.(2010).Neuropsychological profiles of young people with type 1 diabetes12 yr after disease onset.Pediatr Diabetes,11(4),235-243.doi:10.1111/j.1399-5448.2009.00588.x
Lin,A.,Northam,E.A.,Werther,G.A.,&Cameron,F.J.(2015).Risk factors for decline in IQ in youth with type 1 diabetes over the 12 years from diagnosis/illness onset.Diabetes Care,38(2),236-242.doi:10.2337/dc14-1385.
Lipska,B.K.,Halim,N.D.,Segal,P.N.,&Weinberger,D.R.(2002).Effects of reversible inactivation of the neonatal ventral hippocampus on behavior in the adult rat.J Neurosci,22(7),2835-2842.doi:20026195
Mc Carthy,A.M.,Lindgren,S.,Mengeling,M.A.,Tsalikian,E.,&Engvall,J.(2003).Factors associated with academic achievement in children with type 1 diabetes.Diabetes Care,26(1),112-117.doi:10.2337/diacare.26.1.112
Musen,G.,Jacobson,A.M.,Ryan,C.M.,Cleary,P.A.,Waberski,B.H.,&Weinger,K.(2008).Impact of diabetes and its treatment on cognitive function among adolescents who participated in the Diabetes Control and Complications Trial.Diabetes Care,31(10),1933-1938.doi:10.2337/dc08-0607
Perantie,D.C.,Lim,A.,Wu,J.,Weaver,P.,Warren,S.L.,Sadler,M.,...Hershey,T.(2008).Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus.Pediatr Diabetes,9(2),87-95.doi:10.1111/j.1399-5448.2007.00274.x
Perantie,D.C.,Wu,J.,Koller,J.M.,Lim,A.,Warren,S.L.,Black,K.J.,...Hershey,T.(2007).Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1diabetes.Diabetes Care,30(9),2331-2337.doi:10.2337/dc07-0351
Saykin,A.J.,Gur,R.C.,Sussman,N.M.,O’Connor,M.J.,&Gur,R.E.(1989).Memory deficits before and after temporal lobectomy:effect of laterality and age of onset.Brain Cogn,9(2),191-200.doi:10.1016/0278-2626(89)90029-8
Strudwick,S.K.,Carne,C.,Gardiner,J.,Foster,J.K.,Davis,E.A.,&Jones,T.W.(2005).Cognitive functioning in children with early onset type1 diabetes and severe hypoglycemia.J Pediatr,147(5),680-685.doi:10.1016/j.jpeds.2005.06.010
Yamada,K.A.,Rensing,N.,Izumi,Y.,De Erausquin,G.A.,Gazit,V.,Dorsey,D.A.,&Herrera,D.G.(2004).Repetitive hypoglycemia in young rats impairs hippocampal long-term potentiation.Pediatr Res,55(3),372-379.doi:10.1203/01.PDR.0000110523.07240.C1