老年2型糖尿病患者血清BDNF、内脏脂肪素与认知功能障碍的相关性
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摘要
目的探讨老年2型糖尿病患者血清脑源性神经营养因子(BDNF)、内脏脂肪素与认知功能障碍的相关性。方法选取2016年7月至2017年8月本院收治的72例老年2型糖尿病患者作为研究对象,根据是否存在认知功能障碍将患者分为2组,2型糖尿病合并认知功能障碍组(A组)和单纯2型糖尿病组(B组)。另选择同期健康体检者40例为对照组(C组)。检测两组患者糖脂代谢指标、内脏脂肪素及BDNF等指标。利用logistic回归分析认知功能障碍危险因素,应用Pear-son相关性分析内脏脂肪素、BDNF与认知功能之间的关系。结果⑴三组受试者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、空腹血糖(FPG)、糖化红蛋白(Hb A1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、内脏脂肪素水平由高到低依次为A组> B组> C组(P <0. 05),三组受试者高密度脂蛋白胆固醇(HDL-C)、BDNF表达水平及蒙特利尔认知评估(MoCA)评分由高到低依次为C组> B组> A组(P <0. 05);⑵logistic回归分析显示内脏脂肪素、HOMA-IR、BDNF是影响老年2型糖尿病认知功能的危险因素;⑶相关性分析显示,MoCA评分与内脏脂肪素、HOMA-IR呈负相关,MoCA评分与BDNF呈正相关; HOMA-IR与内脏脂肪素呈正相关,与BDNF呈负相关。结论老年2型糖尿病患者的认知功能与血清内脏脂肪素、BDNF有一定相关性,内脏脂肪素升高、BDNF下降均可能导致认知功能障碍。
Objective To investigate the correlation of serum brain derived neurotrophic factor( BDNF),visceral adipose and cognitive dysfunction in elderly patients with type 2 diabetes. MethodsFrom July 2016 to August 2017,72 patients with type 2 diabetes in our department of inpatient were select-ed as subjects. According to whether there was cognitive dysfunction,they were divided into 2 groups,type2 diabetes mellitus combined with cognitive impairment group( A group) and simple type 2 diabetes group( B group). Another 40 healthy persons in the same period were selected as the control group. The indexesof glycolipid metabolism,visceral adipose and BDNF were measured in two groups. The logistic regressionanalysis was used to analyze the risk factors of cognitive dysfunction,and the relationship between visceraladipose,BDNF and cognitive function was analyzed by Pearson correlation. Results ⑴ The total choles-terol( TC),triglyceride( TG),low density lipoprotein cholesterol( LDL-C),fasting insulin( FINS),fast-ing blood glucose( FPG),glycosylated hemoglobin( Hb A1 c),fasting insulin( FINS),insulin resistanceindex( HOMA-IR),and visceral fat hormone level of the three groups were from high to low in A group >B group > C group( P < 0. 05); while the high density lipoprotein cholesterol( HDL-C),the expressionlevel of BDNF and Montreal Cognitive Assessment( MoCA) score of the three groups were from high to lowin C group > B group > A group( P < 0. 05); ⑵ The logistic regression analysis showed that visfatin,HO-MA-IR,BDNF for the risk of cognitive impairment factors in elderly patients with type 2 diabetes; ⑶ Corre-lation analysis showed that the score and visceral fat MoCA and HOMA-IR were negatively correlated withthe MoCA score was positively related to BDNF; HOMA-IR and visfatin was positively correlated,negativelycorrelated with BDNF. Conclusions The cognitive function of elderly patients with type 2 diabetes is relat-ed to serum visfatin and BDNF. Increased visfatin and BDNF may lead to cognitive dysfunction.
Objective To investigate the correlation of serum brain derived neurotrophic factor( BDNF),visceral adipose and cognitive dysfunction in elderly patients with type 2 diabetes. MethodsFrom July 2016 to August 2017,72 patients with type 2 diabetes in our department of inpatient were select-ed as subjects. According to whether there was cognitive dysfunction,they were divided into 2 groups,type2 diabetes mellitus combined with cognitive impairment group( A group) and simple type 2 diabetes group( B group). Another 40 healthy persons in the same period were selected as the control group. The indexesof glycolipid metabolism,visceral adipose and BDNF were measured in two groups. The logistic regressionanalysis was used to analyze the risk factors of cognitive dysfunction,and the relationship between visceraladipose,BDNF and cognitive function was analyzed by Pearson correlation. Results ⑴ The total choles-terol( TC),triglyceride( TG),low density lipoprotein cholesterol( LDL-C),fasting insulin( FINS),fast-ing blood glucose( FPG),glycosylated hemoglobin( Hb A1 c),fasting insulin( FINS),insulin resistanceindex( HOMA-IR),and visceral fat hormone level of the three groups were from high to low in A group >B group > C group( P < 0. 05); while the high density lipoprotein cholesterol( HDL-C),the expressionlevel of BDNF and Montreal Cognitive Assessment( MoCA) score of the three groups were from high to lowin C group > B group > A group( P < 0. 05); ⑵ The logistic regression analysis showed that visfatin,HO-MA-IR,BDNF for the risk of cognitive impairment factors in elderly patients with type 2 diabetes; ⑶ Corre-lation analysis showed that the score and visceral fat MoCA and HOMA-IR were negatively correlated withthe MoCA score was positively related to BDNF; HOMA-IR and visfatin was positively correlated,negativelycorrelated with BDNF. Conclusions The cognitive function of elderly patients with type 2 diabetes is relat-ed to serum visfatin and BDNF. Increased visfatin and BDNF may lead to cognitive dysfunction.
引文
[1]姚新丰. GDF-15在2型糖尿病肾病中的表达水平及临床意义[J].中国医师杂志,2017,19(3):418-420. DOI:10. 3760/cma.j. issn. 1008-1372. 2017. 03. 026.
[2] Yu Y,Mingjiao W,Yang X,et al. Association between DNAmethylation of SORL1 5'-flanking region and mild cognitive im-pairment in type 2 diabetes mellitus[J]. Ann Endocrinol(Par-is),2016,77(6):625-632. DOI:10. 1016/j. ando. 2016. 02.008.
[3]爦ahin TD,Karson A,BalcF,et al. TNF-alpha inhibition pre-vents cognitive decline and maintains hippocampal BDNF levels inthe unpredictable chronic mild stress rat model of depression[J].Behav Brain Res,2015,292:233-240. DOI:10. 1016/j. bbr.2015. 05. 062.
[4] Pek SL,Sum CF,Lin MX,et al. Circulating and visceral adiposemiR-100 is down-regulated in patients with obesity and Type 2 dia-betes[J]. Mol Cell Endocrinol,2016,427:112-123. DOI:10.1016/j. mce. 2016. 03. 010.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42. DOI:10.3760/cma. j. issn. 1674-5809. 2014. 07. 00.
[6] Speding RA,Aisen PS,Beckett LA,等.美国国立老化研究所与阿尔茨海默病协会诊断指南写作组:阿尔茨海默病临床前阶段的定义[J].中华神经科杂志,2012,45(5):336-344.DOI:10. 3760/cma. j. issn. 1006-7876. 2012. 05. 011.
[7]孙长忠,朱平.脑源性神经营养因子对大鼠颅脑损伤后继发氧化应激及细胞凋亡的影响[J].中国医师杂志,2016,18(2):240-244. DOI:10. 3760/cma. j. issn. 1008-1372. 2016. 02. 021.
[8] Lee SJ,Baek JH,Kim YH. Brain-derived Neurotrophic Factor IsAssociated with Cognitive Impairment in Elderly Korean Individu-als[J]. Clin Psychopharmacol Neurosci,2015,13(3):283-287.DOI:10. 9758/cpn. 2015. 13. 3. 283.
[9] Ko YH,Kwon SH,Lee SY,et al. Liquiritigenin ameliorates memoryand cognitive impairment through cholinergic and BDNF pathwaysin the mouse hippocampus[J]. Arch Pharm Res,2017,40(10):1209-1217. DOI:10. 1007/s12272-017-0954-6.
[10] Zhen YF,Liu XY,Zhou DH,et al. Cognition,serum BDNF lev-els,and BDNF Val66Met polymorphism in type 2 diabetes patientsand healthy controls[J]. Oncotarget,2018,9(3):3653-3662.DOI:10. 18632/oncotarget. 23342.
[11] Hughes CG,Patel MB,Jackson JC,et al. Surgery and AnesthesiaExposure Is Not a Risk Factor for Cognitive Impairment After MajorNoncardiac Surgery and Critical Illness[J]. Ann Surg,2017,265(6):1126-1133. DOI:10. 1097/SLA. 0000000000001885.
[12] Xiao K,Zou WH,Yang Z,et al. The role of visfatin on the regu-lation of inflammation and apoptosis in the spleen of LPS-treatedrats[J]. Cell Tissue Res,2015,359(2):605-618. DOI:10.1007/s00441-014-1997-3.
[13] Nourbakhsh M,Nourbakhsh M,Gholinejad Z,et al. Visfatin inobese children and adolescents and its association with insulin re-sistance and metabolic syndrome[J]. Scand J Clin Lab Invest,2015,75(2):183-188. DOI:10. 3109/00365513. 2014.1003594.
[14] Shiraki A,Saito F,Akane H,et al. Gene expression profiling ofthe hippocampal dentate gyrus in an adult toxicity study captures avariety of neurodevelopmental dysfunctions in rat models of hypot-hyroidism[J]. J Appl Toxicol,2016,36(1):24-34. DOI:10.1002/jat. 3140.
[15] Yang S,Ryu JH,Oh H,et al. NAMPT(visfatin),a direct targetof hypoxia-inducible factor-2α,is an essential catabolic regulatorof osteoarthritis[J]. Ann Rheum Dis,2015,74(3):595-602.DOI:10. 1136/annrheumdis-2013-204355.
[16] Seidel M,King JA,Ritschel F,et al. Serum visfatin concentra-tion in acutely ill and weight-recovered patients with anorexia ner-vosa[J]. Psychoneuroendocrinology,2015,53:127-135. DOI:10. 1016/j. psyneuen. 2014. 12. 010.
[17] Han J,Kim SH,Suh YJ,et al. Serum Chemerin Levels Are Asso-ciated with Abdominal Visceral Fat in Type 2 Diabetes[J]. J Ko-rean Med Sci,2016,31(6):924-931. DOI:10. 3346/jkms.2016. 31. 6. 924.
[2] Yu Y,Mingjiao W,Yang X,et al. Association between DNAmethylation of SORL1 5'-flanking region and mild cognitive im-pairment in type 2 diabetes mellitus[J]. Ann Endocrinol(Par-is),2016,77(6):625-632. DOI:10. 1016/j. ando. 2016. 02.008.
[3]爦ahin TD,Karson A,BalcF,et al. TNF-alpha inhibition pre-vents cognitive decline and maintains hippocampal BDNF levels inthe unpredictable chronic mild stress rat model of depression[J].Behav Brain Res,2015,292:233-240. DOI:10. 1016/j. bbr.2015. 05. 062.
[4] Pek SL,Sum CF,Lin MX,et al. Circulating and visceral adiposemiR-100 is down-regulated in patients with obesity and Type 2 dia-betes[J]. Mol Cell Endocrinol,2016,427:112-123. DOI:10.1016/j. mce. 2016. 03. 010.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42. DOI:10.3760/cma. j. issn. 1674-5809. 2014. 07. 00.
[6] Speding RA,Aisen PS,Beckett LA,等.美国国立老化研究所与阿尔茨海默病协会诊断指南写作组:阿尔茨海默病临床前阶段的定义[J].中华神经科杂志,2012,45(5):336-344.DOI:10. 3760/cma. j. issn. 1006-7876. 2012. 05. 011.
[7]孙长忠,朱平.脑源性神经营养因子对大鼠颅脑损伤后继发氧化应激及细胞凋亡的影响[J].中国医师杂志,2016,18(2):240-244. DOI:10. 3760/cma. j. issn. 1008-1372. 2016. 02. 021.
[8] Lee SJ,Baek JH,Kim YH. Brain-derived Neurotrophic Factor IsAssociated with Cognitive Impairment in Elderly Korean Individu-als[J]. Clin Psychopharmacol Neurosci,2015,13(3):283-287.DOI:10. 9758/cpn. 2015. 13. 3. 283.
[9] Ko YH,Kwon SH,Lee SY,et al. Liquiritigenin ameliorates memoryand cognitive impairment through cholinergic and BDNF pathwaysin the mouse hippocampus[J]. Arch Pharm Res,2017,40(10):1209-1217. DOI:10. 1007/s12272-017-0954-6.
[10] Zhen YF,Liu XY,Zhou DH,et al. Cognition,serum BDNF lev-els,and BDNF Val66Met polymorphism in type 2 diabetes patientsand healthy controls[J]. Oncotarget,2018,9(3):3653-3662.DOI:10. 18632/oncotarget. 23342.
[11] Hughes CG,Patel MB,Jackson JC,et al. Surgery and AnesthesiaExposure Is Not a Risk Factor for Cognitive Impairment After MajorNoncardiac Surgery and Critical Illness[J]. Ann Surg,2017,265(6):1126-1133. DOI:10. 1097/SLA. 0000000000001885.
[12] Xiao K,Zou WH,Yang Z,et al. The role of visfatin on the regu-lation of inflammation and apoptosis in the spleen of LPS-treatedrats[J]. Cell Tissue Res,2015,359(2):605-618. DOI:10.1007/s00441-014-1997-3.
[13] Nourbakhsh M,Nourbakhsh M,Gholinejad Z,et al. Visfatin inobese children and adolescents and its association with insulin re-sistance and metabolic syndrome[J]. Scand J Clin Lab Invest,2015,75(2):183-188. DOI:10. 3109/00365513. 2014.1003594.
[14] Shiraki A,Saito F,Akane H,et al. Gene expression profiling ofthe hippocampal dentate gyrus in an adult toxicity study captures avariety of neurodevelopmental dysfunctions in rat models of hypot-hyroidism[J]. J Appl Toxicol,2016,36(1):24-34. DOI:10.1002/jat. 3140.
[15] Yang S,Ryu JH,Oh H,et al. NAMPT(visfatin),a direct targetof hypoxia-inducible factor-2α,is an essential catabolic regulatorof osteoarthritis[J]. Ann Rheum Dis,2015,74(3):595-602.DOI:10. 1136/annrheumdis-2013-204355.
[16] Seidel M,King JA,Ritschel F,et al. Serum visfatin concentra-tion in acutely ill and weight-recovered patients with anorexia ner-vosa[J]. Psychoneuroendocrinology,2015,53:127-135. DOI:10. 1016/j. psyneuen. 2014. 12. 010.
[17] Han J,Kim SH,Suh YJ,et al. Serum Chemerin Levels Are Asso-ciated with Abdominal Visceral Fat in Type 2 Diabetes[J]. J Ko-rean Med Sci,2016,31(6):924-931. DOI:10. 3346/jkms.2016. 31. 6. 924.