代谢综合征与轻度认知功能障碍的相关性

Correlations among metabolic syndrome and mild cognitive impairment

目的 探讨代谢综合征（MS）及其组分与轻度认知功能障碍（MCI）的相关性.方法 选择来自广州军区总医院内六科2009年6月至2010年6月住院的168例代谢综合征患者及80名健康人,记录入选对象的性别、年龄、文化程度、身高、体重、腰围及血压,登记既往冠心病、脑卒中、糖尿病、高血压病、高脂血症病史等,吸烟、饮酒等个人史,次日完成血脂、空腹血糖、空腹胰岛素、糖化血红蛋白等实验室检查,并行蒙特利尔认知评估量表（MoCA）、临床记忆量表（CMS）、日常生活能力评定（ADL）、汉密尔顿抑郁量表（HAMD）等量表评定.结果（1）MS组认知功能障碍发生率（24.4％）高于对照组（11.2％）；（2）MS组的MoCA总分及各项分测验评分（总分26.8±0.5,EF4.4±0.04,NA M2.60±0.06,MEM3.60±0.20,ATT5.60±0.09,LANG2.60±0.08,ABS1.50±0.10,ORT 5.40±0.13）均低于对照组（总分27.6±0.4,EF4.50±0.05,NAM2.70±0.08,MEM4.20t±0.11,ATr5.70±0.08,LANG2.60±0.09,ABS1.60±0.07,ORT 5.40±0.10）.记忆（MEM）及抽象概括（ABS）评分差异有统计学意义（P＜0.05）,MoCA总分及其他各分项评分差异无统计学意义（P＞0.05）；MS组CMS总量表分及各分量表评分（总量表分72±8,指向记忆14±2,联想学习14 ＋3,图像自由回忆14±4,无意义图形再认16±3,人像特点回忆14±3）均低于对照组（总量表分85±7,指向记忆16±2,联想学习16±3,图像自由回忆17±3,无意义图形再认18±3,人像特点回忆17±3）,差异均有统计学意义（均P＜0.05）；（3）文化程度高是MCI的保护因素（OR=0.512,P=0.011）,糖尿病、胰岛素抵抗、代谢综合征是MCI的独立危险因素（OR1 =4.240,P1=0.014.OR2=7.230,P2 =0.023.OR3 =8.620,P3 =0.001）.结论 糖尿病、代谢综合征是MCI的独立危险因素.

Objective To determine the correlations between metabolic syndrome（MS）,its individual components and mild cognitive impairment（MCI）.Methods We selected 168 MS patients and 150 healthy control subjects from our hospital from June 2009 to June 2010.Socio-demographic characteristic data including gender,age,education level,height,weight waist circumference and blood pressure,past history of coronary heart disease,stroke,diabetes mellitus,hypertension,hyperlipoidemia and unhealthy habit of smoking and drinking,were investigated.The patient levels of fasting plasma glucose,fast insulin glycated,hemoglobin and blood lipids were measured on the next day.All subjects were evaluated with regards to the scores of Montreal cognitive assessment（MoCA）,clinical memory scale（CMS）,daily living skills assessment（ADL）and Hamilton depression scale（HAMD）.Result（1）MCI was more frequently detected in MS subjects than that in the healthy controls（24.4% vs 1.2%）;（2）the scores of general MoCA and several parts of MoCA were lower in the MS subjects（scores of general 26.8 ± 0.5,EF4.40 ± 0.04,NAM2.60 ＋0.06,MEM3.60 ＋0.20,ATT5.60 ±0.09,LANG2.60 ＋0.08,ABSI.50 ±0.10,ORT5.40 ±0.13）than those of the controls（scores of general 27.6 ± 0.4,EF4.50 ± 0.05,NAM2.70 ＋0.08,MEM4.20＋0.11,ATT5.70 ±0.08,LANG2.60 ＋0.09,ABS1.60±0.07,ORT5.40 ＋0.10）.No statistically significant differences existed in the scores of general MoCA and several parts except for memory and abstract（P 〉 0.05）.The scores of general CMS and several parts of CMS were lower in the MS subjects （scores of general 72 ＋ 8,memory function reflected in memory 14 ± 2,associating study 14 ± 3,free image memory 14 ±4,recognition of meaningless figure 16 ±3,recollection ability of human figure 14 ±3）than those in the controls（scores of general 85 ±7,memory function reflected in memory 16 ±2,associating study 16 ±3,free image memory 17 ± 3,recognition of meaningless figure 18 ± 3,recollection ability of human figure 17 ±3）.And the differences had statistical significance（P 〈0.05）;（3）a high degree of education was a protective factor of MCI（OR =0.512,P =0.011）while diabetes,insulin resistance and metabolic syndrome were the independent risk factors of MCI（OR1 =4.240,P1 =0.014; OR2 =7.230,P2 =0.023 ;OR3 =8.620,P3 =0.001）.Conclusion Diabetes mellitus and metabolic syndrome are the independent risk factors of MCI.