鼻内滴入胰岛素对阿尔茨海默病患者认知功能的影响

The effect of intranasal instillation of insulin on cognitive function in patients with Alzheimer disease

目的 探讨鼻内滴入不同剂量胰岛素对阿尔茨海默病（AD）患者认知功能障碍的影响.方法 将63例AD患者按照就诊顺序分为三组：胰岛素1组（21例）、胰岛素2组（21例）和安慰剂组（21例）,胰岛素1组给予每次鼻内滴入20U胰岛素,每日2次;胰岛素2组给予每次鼻内滴入40U胰岛素,每日2次;安慰剂组给予鼻内滴入0.9％氯化钠,每日2次.使用简易精神状态评价量表（MMSE）及Rivermead记忆测验第2版（RBMTⅡ）评价鼻内滴入不同剂量胰岛素后3个月及6个月患者认知功能的改善程度.结果 治疗后3个月,胰岛素1组和胰岛素2组MMSE评分和RBMTⅡ评分得到明显改善[MMSE评分：（21.8±3.2）分比（20.2±2.3）分,（21.6±3.5）分比（20.7±2.8）分;RBMTⅡ评分：（19.2±2.0）分比（17.2±1.9）分,（18.1±2.0）分比（16.5±1.9）分],差异有统计学意义（P＜ 0.05或＜0.01）,安慰剂组MMSE评分和RBMTⅡ评分明显恶化[（18.9±3.8）分比（20.9±2.5）分;（15.2±2.1）分比（16.1±2.0）分],差异有统计学意义（P＜0.05）.治疗后6个月,胰岛素1组和胰岛素2组MMSE评分和RBMTⅡ评分明显优于安慰剂组[MMSE评分：（22.5±3.3）,（22.7±3.1）分比（17.9±4.5）分;RBMTⅡ评分：（20.5±2.0）,（19.8±1.9）分比（14.7±2.0）分],差异有统计学意义（P＜0.01）.结论 鼻内滴入胰岛素可以改善AD患者的认知功能.

Objective To investigate the effect of intranasal instillation of insulin with different doses on cognitive function in patients with Alzheimer disease （AD）.Methods Sixty-three AD patients were collectcd.According to the order of doctor＆#39;s office visiting,they were divided into insulin 1 group （21 cases,intranasal instillation of insulin 20 U,2 times per day）,insulin 2 group （21 cases,intranasal instillation of insulin 40 U,2 times per day） and placebo group （21 cases,intranasal instillation of physiological saline,2 times per day）.Mini-mental state examination scale （MMSE） and Rivermead behavioural memory test second edition （RBMT Ⅱ） were used to evaluate the improvement of cognitive function after 3 months and 6 months.Results Before treatment,the scores of MMSE and RBMT Ⅱ in insulin 1 group were （20.2 ± 2.3） and （17.2 ± 1.9） scores,in insulin 2 group were （20.7 ± 2.8） and （16.5 ± 1.9） scores.After treatment for 3 months,the scores of MMSE and RBMT Ⅱ in insulin 1 group were （21.8 ± 3.2） and （19.2 ± 2.0） scores,in insulin 2 group were （21.6 ± 3.5） and （18.1 ± 2.0） scores.The scores of MMSE and RBMT Ⅱ in insulin 1 group and insulin 2 group significantly improved compared with those before treatment （P 〈 0.05 or 〈 0.01）.But the scores of MMSE and RBMT Ⅱ in placebo group were significantly aggravated,（18.9 ± 3.8） scores vs.（20.9 ± 2.5） scores,（15.2 ± 2.1） scores vs.（16.1 ± 2.0） scores,P 〈 0.05.After treatment for 6 months,the scores of MMSE and RBMT Ⅱ in insulin 1 group were （22.5 ± 3.3） and （20.5 ± 2.0） scores,in insulin 2 group were （22.7 ± 3.1） and（19.8 ± 1.9） scores,and in placebo group were （17.9 ± 4.5） and（14.7 ± 2.0） scores.The scores of MMSE and RBMT Ⅱ in insulin 1 group and insulin 2 group were significantly better than those in placebo group （P 〈 0.01）.Conclusion Intranasal instillation of insulin can improve cognitive disorders in patients with AD.