2型糖尿病患者轻度认知功能障碍的筛查及相关危险因素的分析

Assessment implement and its related factors in type 2 diabetic patients with mild cognitive impairment

目的探讨2型糖尿病患者轻度认知功能障碍（mild cognitive impairment，MCI）的筛查及相关危险因素的分析。方法选用蒙特利尔认知评估（Montreal Cognitive Assessment，MoCA）北京版量表作为认知功能的测评工具，选择2型糖尿病轻度认知功能障碍患者58例为研究对象，2型糖尿病无认知功能障碍30例为对照。检测入选病例的HbA1c血脂、肝肾功能和尿微量白蛋白水平。结果与对照组比较，MCI组HbA1c[（10．48±2．38对9．28±2．19）％，P〈0．05]、总胆固醇[（4．87±1．18对4．18±1．04）mmoL／L，P〈0．01]、低密度脂蛋白胆固醇[LDL-C，（2．97±0．87对2．37±0．61）mmol／L，P〈0．01]水平明显升高，高密度脂蛋白胆固醇水平降低[（1．08±0．34对1．25±0．33）mmol／L，P〈0．05]，甘油三酯、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酐、尿微量白蛋白差异无统计学意义。两组糖尿病病程、糖尿病视网膜病变、体重指数、腹围差异具有统计学意义（均P〈0．05）。MCI组MoCA评分与HbA1c（r=-0．396，P=0．002）和LDL—C（r=-0．275，P=0．036）呈负相关。多因素回归分析显示，HbA1c是影响MoCA评分最为显著的因素。结论2型糖尿病病程、肥胖、合并糖尿病并发症、血糖控制不良和血脂紊乱等因素与认知功能障碍相关。提示控制血糖、血脂，减轻体重，减少并发症有助于改善认知功能。

Objective To study the assessment implement and its related factors in type 2 diabetic patients with mild cognitive impairment（MCI）. Methods Montreal Cognitive Assessment （MoCA） （Beijing Version）was chosen as cognition assessment implement. 58 type 2 diabetic patients with MCI were enrolled as the research group and 30 type 2 diabetic patients with normal cognitive function as control. HbA1c, blood lipid, urine microalbumin, liver and renal functions were measured in all subjects. Results Compared with control group, the blood levels of HbA1c[ （ 10.48±2.38 vs 9.28±2.19）% ,P〈0.05 ] ,total cholesterol[ （4.87±1.18 vs 4.18±1.04） mmol/L,P〈 0.01 ] ,and low-density lipoprotein-cholesterol[ LDL-C, （2.97±0.87 vs 2.37±0.61 ） mmol/L,P〈0.01 ] increased, and high-density lipoprotein-cholesterol decreased [ （ 1.08 ±0.34 vs 1.25 ±0.33 ） mmol/L, P〈0.05 ] in MCI group. There were significant differences in the duration of diabetes mellitus, diabetic retinopathy, body mass index, and abdominal circumference between MCI group and control group（ all P〈0.05 ）. There were no significant differences in blood triglycerides, alanine aminotransferase （ ALT ）, aspartate aminotransferase （ AST）, creatinine, and urine microalbumin between the two groups. MoCA scores were negatively correlated with HbAlc（ r=-0. 396,P=0.002） and LDL-C （ r = - 0. 275, P = 0. 036 ） in MCI group. Multiple regression analysis showed that HbA,c was a significantly independent determinant for the MoCA scores. Conclusion The risk factors such as longer duration of diabetes mellitus, more diabetes mellitus complications, obesity, dyslipidemia, and inefficient control of blood glucose all contribute to the development and aggravation of cognitive impairment. Therefore, good control of blood glucose and lipids, and reduction of complication and body weight may help to improve the cognitive function.