老年2型糖尿病患者随访2年认知功能进展及相关因素研究
|
摘要
目的探讨老年2型糖尿病(T2DM)患者随访2年期间认知功能进展及相关因素。方法选取193例老年T2DM患者进行随访2年,期间失访4例,获得随访的189例患者根据糖尿病病程、用药方法及血糖控制情况分组比较随访前后各项临床指标[收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、糖化血红蛋白(HbA1C)、TC、LDL、HDL、TG]、认知功能量表测评结果的差值。结果新诊断、<1年、1～5年、>5年的4组患者随访前后发生认知障碍的比例比较,差异均有统计学意义(均P<0.05),随着病程延长,发生认知障碍的比例明显增加;除HbA1C外,4组患者随访前后其余7项临床指标差值比较,差异均无统计学意义(均P>0.05)。采用降糖药物或胰岛素治疗的两组患者随访前发生认知障碍的比例比较,差异无统计学意义(P>0.05),随访2年后比较差异有统计学意义(P<0.05);随访前后临床指标差值比较,差异均无统计学意义(均P>0.05)。血糖控制或控制不良的两组患者随访前后发生认知障碍的比例比较,差异均有统计学意义(均P<0.05),其中控制不良组高于血糖控制组;除FPG外,随访前后其余7项临床指标差值比较,差异均无统计学意义(均P>0.05)。结论随访2年期间,包含胰岛素治疗、血糖控制良好等有利于避免或减少老年T2DM患者出现认知障碍。
Objective To investigate the progress of cognitive function impairment and risk factors in elderly patients with type 2 diabetes mellitus(T2 DM) in a 2-year follow-up study. Methods One hundred and ninety-three elderly patients with T2 DM were recruited in a 2-year follow-up study. The clinical parameters [systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FPG), glycosylated hemoglobin(Hb A1 C), total cholesterol(TC), Low density lipoprotein(LDL), High density lipoprotein(HDL), triglyceride(TG)] were measured and the cognitive function was assessed before and after follow-up.Results Four patients were lost during the follow-up. The proportion of cognitive dysfunction in patients with different diabetes courses(newly diagnosed, <1 year, 1～5 years, >5 years) before and after follow-up was significantly different(P<0.05). The proportion of patients with cognitive dysfunction increased significantly as the disease progressed. The difference of above clinical parameters except Hb A1 Cwas not significantly different before and after follow-up(P >0.05). There was no significant difference in the proportion of cognitive impairment between patients with different treatment methods(hypoglycemic drug therapy, insulin therapy) before follow-up(P >0.05), and the difference was statistically significant after 2 years follow-up(P<0.05). The proportion of cognitive dysfunction in patients with well controlled blood glucose was significantly lower than those with poorly controlled before and after follow-up(P <0.05). The difference in above clinical indicators, except for FPG, between the patients with different glycemic control before and after follow-up was not statistically significant(P >0.05). Conclusion During the 2 years of follow-up, insulin therapy and good glycemic control are beneficial to reduce cognitive dysfunction in elderly T2 DM patients.
Objective To investigate the progress of cognitive function impairment and risk factors in elderly patients with type 2 diabetes mellitus(T2 DM) in a 2-year follow-up study. Methods One hundred and ninety-three elderly patients with T2 DM were recruited in a 2-year follow-up study. The clinical parameters [systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FPG), glycosylated hemoglobin(Hb A1 C), total cholesterol(TC), Low density lipoprotein(LDL), High density lipoprotein(HDL), triglyceride(TG)] were measured and the cognitive function was assessed before and after follow-up.Results Four patients were lost during the follow-up. The proportion of cognitive dysfunction in patients with different diabetes courses(newly diagnosed, <1 year, 1～5 years, >5 years) before and after follow-up was significantly different(P<0.05). The proportion of patients with cognitive dysfunction increased significantly as the disease progressed. The difference of above clinical parameters except Hb A1 Cwas not significantly different before and after follow-up(P >0.05). There was no significant difference in the proportion of cognitive impairment between patients with different treatment methods(hypoglycemic drug therapy, insulin therapy) before follow-up(P >0.05), and the difference was statistically significant after 2 years follow-up(P<0.05). The proportion of cognitive dysfunction in patients with well controlled blood glucose was significantly lower than those with poorly controlled before and after follow-up(P <0.05). The difference in above clinical indicators, except for FPG, between the patients with different glycemic control before and after follow-up was not statistically significant(P >0.05). Conclusion During the 2 years of follow-up, insulin therapy and good glycemic control are beneficial to reduce cognitive dysfunction in elderly T2 DM patients.
引文
[1]Jin HY,Baek HS,Park TS.Morphologic changes in autonomic nerves in diabetic autonomic neuropathy[J].Diabetes&Metabolism Journal,2015,39(6):461-467.DOI:10.4093/dmj.2015.39.6.461.
[2]Jin L,Li YP,Feng Q,et al.Cognitive deficits and Alzheimer-like neuropathological impairments during adolescence in a rat model of type 2 diabetes mellitus[J].Neural Regeneration Research,2018,13(11):1995.DOI:10.4103/1673-5374.239448.
[3]Ono S,Ono Y,Matsui H,et al.Impact of clinic follow-up visits on body weight control in people with prediabetes or diabetes mellitus:Japanese nonelderly cohort study[J].Family Practice,2017,34(5):552-557.DOI:10.1093/fampra/cmx016.
[4]Muntner P,Krousel-Wood M,Hyre AD,et al.Antihypertensive prescriptions for newly treated patients before and after the main antihypertensive and lipid-lowering treatment to prevent heart attack trial results and seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure guidelines[J].Hypertension(Dallas,Tex:1979),2009,53(4):617-623.DOI:10.1161/HYPERTENSIONAHA.108.120154.
[5]Callisaya ML,Beare R,Moran C,et al.Type 2 diabetes mellitus,brain atrophy and cognitive decline in older people:a longitudinal study[J].Diabetologia,2018:1-11.DOI:10.1007/s00125-018-4778-9.
[6]田荣,贾秀丽.简易智能精神状态检查量表检测对痴呆患者临床护理的指导作用[J].临床医学研究与实践,2018,3(17):159-160.
[7]郁芳芳,王兰,刘澄英,等.蒙特利尔认知评估量表在筛查COPD患者轻度认知功能障碍的价值[J].临床肺科杂志,2018,1(11):2045-2047.
[8]张扬,毕涌,陈为安,等.蒙特利尔认知量表评估帕金森病患者认知功能障碍的信度和效度[C].丽水:2014年浙江省神经病学学术年会,2014.
[9]Demakakos P,Muniz-Terrera G,Nouwen A.Type 2 diabetes,depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers:A prospective cohort study[J].Plo S One,2017,12(4):e0175827.DOI:10.1371/journal.pone.0175827.
[10]李妍平.2型糖尿病患者轻度认知功能障碍的随访研究[C].昆明:昆明医学院,2008.
[11]Chen J,Zhang J,Liu X,et al.Abnormal subcortical nuclei shapes in patients with type 2 diabetes mellitus[J].European Radiology,2017,27(10):4247-4256.DOI:10.1007/s00330-017-4790-3.
[12]Ben AE,Eldor R,Korczyn AD,et al.Type 2 diabetes mellitus and impaired renal function are associated with brain alterations and poststroke cognitive decline[J].Stroke,2017,48(9):2368-2374.DOI:10.1161/STROKEAHA.117.017709.
[13]Demakakos P,Muniz-Terrera G,Nouwen A.Type 2 diabetes,depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers:A prospective cohort study[J].Plo S One,2017,12(4):e0175827.DOI:10.1161/STRO-KEAHA.117.017709.
[14]Tumminia A,Vinciguerra F,Parisi M,et al.Type 2 Diabetes Mellitus and Alzheimer's Disease:Role of Insulin Signalling and Therapeutic Implications[J].Int J Mol Sci,2018,19(11):e3306.DOI:10.3390/ijms19113306.
[15]Palta P,Carlson MC,Crum RM,et al.Diabetes and Cognitive Decline in Older Adults:The Ginkgo Evaluation of Memory Study[J].The Journals of Gerontology Series A,Biological Sciences and Medical Sciences,2017,73(1):123-130.DOI:10.1093/gerona/glx076.
[16]张蕾,刘军,严翠丽.老年2型糖尿病患者胰岛素治疗护理管理[C].上海:第三届上海国际护理大会,2017.
[17]赵鹤,邵华,牛一民,等.糖尿病治疗药物改善阿尔兹海默病患者认知障碍的研究现状[J].中国临床药理学杂志,2017,33(23):2493-2496.
[18]Groeneveld O,Reijmer Y,Heinen R,et al.Brain imaging correlates of mild cognitive impairment and early dementia in patients with type 2 diabetes mellitus[J].Nutrition,Metabolism,and Cardiovascular Diseases,2018,8(2):1253-1260.DOI:10.1016/j.numecd.2018.07.008.
[19]Yaffe K,Blackwell T,Whitmer RA,et al.Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women[J].The Journal of Nutrition,Health&Aging,2006,10(4):293-295.
[20]Zhang JZ,Jing L,Ma AL,et al.Hyperglycemia increased brain ischemia injury through extracellular signal-regulated protein Kinase[J].Pathology,Research and Practice,2006,202(1):31-36.DOI:10.1016/j.prp.2005.10.002.
[21]Lachmann G,Feinkohl I,Borchers F,et al.Diabetes,but Not Hypertension and Obesity,Is Associated with Postoperative Cognitive Dysfunction[J].Dementia and Geriatric Cognitive Disorders,2018,46(3-4):193-206.DOI:10.1159/000492962.
[2]Jin L,Li YP,Feng Q,et al.Cognitive deficits and Alzheimer-like neuropathological impairments during adolescence in a rat model of type 2 diabetes mellitus[J].Neural Regeneration Research,2018,13(11):1995.DOI:10.4103/1673-5374.239448.
[3]Ono S,Ono Y,Matsui H,et al.Impact of clinic follow-up visits on body weight control in people with prediabetes or diabetes mellitus:Japanese nonelderly cohort study[J].Family Practice,2017,34(5):552-557.DOI:10.1093/fampra/cmx016.
[4]Muntner P,Krousel-Wood M,Hyre AD,et al.Antihypertensive prescriptions for newly treated patients before and after the main antihypertensive and lipid-lowering treatment to prevent heart attack trial results and seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure guidelines[J].Hypertension(Dallas,Tex:1979),2009,53(4):617-623.DOI:10.1161/HYPERTENSIONAHA.108.120154.
[5]Callisaya ML,Beare R,Moran C,et al.Type 2 diabetes mellitus,brain atrophy and cognitive decline in older people:a longitudinal study[J].Diabetologia,2018:1-11.DOI:10.1007/s00125-018-4778-9.
[6]田荣,贾秀丽.简易智能精神状态检查量表检测对痴呆患者临床护理的指导作用[J].临床医学研究与实践,2018,3(17):159-160.
[7]郁芳芳,王兰,刘澄英,等.蒙特利尔认知评估量表在筛查COPD患者轻度认知功能障碍的价值[J].临床肺科杂志,2018,1(11):2045-2047.
[8]张扬,毕涌,陈为安,等.蒙特利尔认知量表评估帕金森病患者认知功能障碍的信度和效度[C].丽水:2014年浙江省神经病学学术年会,2014.
[9]Demakakos P,Muniz-Terrera G,Nouwen A.Type 2 diabetes,depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers:A prospective cohort study[J].Plo S One,2017,12(4):e0175827.DOI:10.1371/journal.pone.0175827.
[10]李妍平.2型糖尿病患者轻度认知功能障碍的随访研究[C].昆明:昆明医学院,2008.
[11]Chen J,Zhang J,Liu X,et al.Abnormal subcortical nuclei shapes in patients with type 2 diabetes mellitus[J].European Radiology,2017,27(10):4247-4256.DOI:10.1007/s00330-017-4790-3.
[12]Ben AE,Eldor R,Korczyn AD,et al.Type 2 diabetes mellitus and impaired renal function are associated with brain alterations and poststroke cognitive decline[J].Stroke,2017,48(9):2368-2374.DOI:10.1161/STROKEAHA.117.017709.
[13]Demakakos P,Muniz-Terrera G,Nouwen A.Type 2 diabetes,depressive symptoms and trajectories of cognitive decline in a national sample of community-dwellers:A prospective cohort study[J].Plo S One,2017,12(4):e0175827.DOI:10.1161/STRO-KEAHA.117.017709.
[14]Tumminia A,Vinciguerra F,Parisi M,et al.Type 2 Diabetes Mellitus and Alzheimer's Disease:Role of Insulin Signalling and Therapeutic Implications[J].Int J Mol Sci,2018,19(11):e3306.DOI:10.3390/ijms19113306.
[15]Palta P,Carlson MC,Crum RM,et al.Diabetes and Cognitive Decline in Older Adults:The Ginkgo Evaluation of Memory Study[J].The Journals of Gerontology Series A,Biological Sciences and Medical Sciences,2017,73(1):123-130.DOI:10.1093/gerona/glx076.
[16]张蕾,刘军,严翠丽.老年2型糖尿病患者胰岛素治疗护理管理[C].上海:第三届上海国际护理大会,2017.
[17]赵鹤,邵华,牛一民,等.糖尿病治疗药物改善阿尔兹海默病患者认知障碍的研究现状[J].中国临床药理学杂志,2017,33(23):2493-2496.
[18]Groeneveld O,Reijmer Y,Heinen R,et al.Brain imaging correlates of mild cognitive impairment and early dementia in patients with type 2 diabetes mellitus[J].Nutrition,Metabolism,and Cardiovascular Diseases,2018,8(2):1253-1260.DOI:10.1016/j.numecd.2018.07.008.
[19]Yaffe K,Blackwell T,Whitmer RA,et al.Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women[J].The Journal of Nutrition,Health&Aging,2006,10(4):293-295.
[20]Zhang JZ,Jing L,Ma AL,et al.Hyperglycemia increased brain ischemia injury through extracellular signal-regulated protein Kinase[J].Pathology,Research and Practice,2006,202(1):31-36.DOI:10.1016/j.prp.2005.10.002.
[21]Lachmann G,Feinkohl I,Borchers F,et al.Diabetes,but Not Hypertension and Obesity,Is Associated with Postoperative Cognitive Dysfunction[J].Dementia and Geriatric Cognitive Disorders,2018,46(3-4):193-206.DOI:10.1159/000492962.