利拉鲁肽对2型糖尿病轻度认知功能障碍患者炎性因子及认知功能的影响
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摘要
目的:探讨利拉鲁肽对2型糖尿病轻度认知功能障碍患者炎性因子及认知功能的影响。方法:选取使用门冬胰岛素30治疗的2型糖尿病(T2DM)伴轻度认知功能障碍(MCI)患者86例,分为治疗组(43例)与对照组(43例),疗程1年。对照组维持原门冬胰岛素30治疗,治疗组改为利拉鲁肽治疗。治疗前和治疗12,24,36,48周末测定患者身高、体质量、血压水平,计算体重指数(BMI),并记录血糖达标[糖化血红蛋白(Hb A1c)≤8%]、低血糖情况、实验室检查(血糖、糖化血红蛋白、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平),并采用简易精神状态量表(MMSE)、蒙特利尔认知量表(MoCA)评估认知功能。结果:对照组和治疗组各完成42例和41例。治疗12,24,36,48周末,治疗组IL-1β、IL-6、TNF-α水平显著低于对照组(P<0.01),36,48周末HbA1c水平低于对照组(P<0.05),MMSE及MoCA量表评分高于对照组(P<0.05)。对照组和治疗组血糖达标率分别为76.19%(32/42)和82.93%(34/41),痴呆发生率均为0,差异均无显著意义(P>0.05);低血糖发生率分别为59.52%(25/42)和7.32%(3/41),治疗组低于对照组(P<0.01)。结论:和门冬胰岛素30相比,利拉鲁肽治疗2型糖尿病MCI患者,能更好地控制FPG、2hPG、HbA1c,降低炎性因子水平(IL-1β、IL-6、TNF-α),低血糖发生率更低,并能改善患者认知功能。
OBJECTIVE To investigate the effect of liraglutide on inflammatory factors and cognitive function in type 2 diabetic patients with mild cognitive impairment. METHODS 86 patients with type 2 diabetes mellitus(T2 DM) and mild cognitive impairment who were treated with insulin aspart 30 for 1 year were randomly divided into treatment group(43 cases) and control group(43 cases). The control group continued maintenance therapy with insulin aspart 30 and the treatment group was converted to liraglutide. Before treatment and at the end of 12, 24, 36, and 48 weeks of treatment, the height, body weight, and blood pressure levels of the patients were measured and body mass index(BMI) was calculated. Blood glucose targets [glycosylated hemoglobin(HbA1 c)≤8%], hypoglycemia, laboratory tests(blood glucose, glycosylated hemoglobin, interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor(TNF-α) levels) were recorded, and cognitive function was assessed using the Mini-Mental State Examination(MMSE) and the Montreal Cognitive Scale(MoCA). RESULTS 42 and 41 patients were completed in the control and treatment groups, respectively. At the end of 12,24 and 36,48 weeks of treatment, the levels of IL-1β, IL-6, and TNF-αin the treatment group were significantly lower than those in the control group(P<0.01), and the levels of HbA1 c at the end of 36 and 48 weeks were lower than those in the control group(P<0.05), and the scores on the MMSE and MoCA scales were higher than those in the control group after 48 weeks(P<0.05). The blood glucose compliance rates of the control group and the treatment group were 76.19%(32/42) and 82.93%(34/41), respectively, and the incidence of dementia was 0, with no significant difference(P>0.05); the incidence of hypoglycemia in the control group and the treatment group was 59.52%(25/42) and 7.32%(3/41), respectively, and the incidence of the treatment group was lower than that in the control group(P<0.01). CONCLUSION Compared to insulin aspart 30, liraglutide was more effective in the treatment of patients with type 2 diabetes mellitus with mild cognitive impairment. It can better control FPG, 2 hPG, HbA1 c and reduce inflammatory factor levels(IL-1β, IL-6, TNF-α) and incidence of hypoglycemia while improving cognitive function.
OBJECTIVE To investigate the effect of liraglutide on inflammatory factors and cognitive function in type 2 diabetic patients with mild cognitive impairment. METHODS 86 patients with type 2 diabetes mellitus(T2 DM) and mild cognitive impairment who were treated with insulin aspart 30 for 1 year were randomly divided into treatment group(43 cases) and control group(43 cases). The control group continued maintenance therapy with insulin aspart 30 and the treatment group was converted to liraglutide. Before treatment and at the end of 12, 24, 36, and 48 weeks of treatment, the height, body weight, and blood pressure levels of the patients were measured and body mass index(BMI) was calculated. Blood glucose targets [glycosylated hemoglobin(HbA1 c)≤8%], hypoglycemia, laboratory tests(blood glucose, glycosylated hemoglobin, interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor(TNF-α) levels) were recorded, and cognitive function was assessed using the Mini-Mental State Examination(MMSE) and the Montreal Cognitive Scale(MoCA). RESULTS 42 and 41 patients were completed in the control and treatment groups, respectively. At the end of 12,24 and 36,48 weeks of treatment, the levels of IL-1β, IL-6, and TNF-αin the treatment group were significantly lower than those in the control group(P<0.01), and the levels of HbA1 c at the end of 36 and 48 weeks were lower than those in the control group(P<0.05), and the scores on the MMSE and MoCA scales were higher than those in the control group after 48 weeks(P<0.05). The blood glucose compliance rates of the control group and the treatment group were 76.19%(32/42) and 82.93%(34/41), respectively, and the incidence of dementia was 0, with no significant difference(P>0.05); the incidence of hypoglycemia in the control group and the treatment group was 59.52%(25/42) and 7.32%(3/41), respectively, and the incidence of the treatment group was lower than that in the control group(P<0.01). CONCLUSION Compared to insulin aspart 30, liraglutide was more effective in the treatment of patients with type 2 diabetes mellitus with mild cognitive impairment. It can better control FPG, 2 hPG, HbA1 c and reduce inflammatory factor levels(IL-1β, IL-6, TNF-α) and incidence of hypoglycemia while improving cognitive function.
引文
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[10] Li M,Ma L,Fan Y,et al.Effects of insulin on patients with type 2 diabetes mellitus with mild cognitive impairment [J].Chin J Integrative Med Cardiovascular Cerebrovascular Dis(中西医结合心脑血管病杂志),2016,14(20):2417-2420.
[2] Wu YM,CAI Y.Study on tumor necrosis factor-alpha and interleukin-6 and interleukin--8 levels in serum and cerebrospinal fluid of patients with alzheimer's disease [J].Chin General Practice(中国全科医学),2010,13 (33) :3738-3740.
[3] Liao Y,Guan ZZ.Research progress on inflammatory response in the pathogenesis of alzheimer's disease [J].Chin J Gerontol(中国老年学杂志),2011,1(31) :351-354.
[4] Diabetes society of the Chinese medical association.Guidelines for the prevention and treatment of type 2 diabetes in China (2010 edition)[J].Chin J Diabetes(中国糖尿病杂志),2012,20 (1) :S1-S5.
[5] Petersen RC,Doody R,Kurz A et al.Current concepts in Mild cognitive impairment[J].Arch Neurol,2001,58(12):1985-1992.
[6] Mckhann GM,Knopman DS,Chertkow H,et al.The national institute on aging and the alzheimer's association diagnostic guidelines writing group:Recommendation of diagnostic criteria for alzheimer's disease-related mild cognitive impairment[J].Chin J Neurol(中华神经科杂志),2012,45(5):345-355.
[7] Chen S,Liu AR,An FM,et al.Amelioration of neurodegenerative changes in cellular and rat models of diabetes-related Alzheimer's disease by exendin-4[J].Age (Dordr),2012,34(5):1211-1224.
[8] Zhang M,Zhang L,Li TZ,et al.Effects of liraglutide on cognitive function in patients with type 2 diabetes and its possible mechanism [J].Chin J Diabetes(中华糖尿病杂志),2014,6(2):91-96.
[9] Cai XS,Tan ZG,Li JJ,et al.Glucagon-like peptide-1(GLP-1)treatment ameliorates cognitive impairment by attenuating Arcexprcssion in type 2 diabetic rats[J].Med Sci Monit,2017,8(23):4334-4342.
[10] Li M,Ma L,Fan Y,et al.Effects of insulin on patients with type 2 diabetes mellitus with mild cognitive impairment [J].Chin J Integrative Med Cardiovascular Cerebrovascular Dis(中西医结合心脑血管病杂志),2016,14(20):2417-2420.