帕金森病患者轻度认知损害与胰岛素抵抗的相关性

The Relationship between Mild Cognitive Impairment and Insulin Resistance in Parkinson's Disease

目的研究胰岛素抵抗与帕金森患者轻度认知功能障碍(PD-MCI)的关系,以期早期发现帕金森病患者的认知损害并进行干预.方法入选2013年8月至2015年2月昆明医科大学第二附属医院住院的94例帕金森病患者,经HOMA稳态模型评估分为胰岛素抵抗组43例与非胰岛素抵抗组51例.胰岛素敏感指数测定胰岛素抵抗程度.蒙特利尔认知评价量表(Mo CA)评估患者认知功能,Zung氏抑郁自评量表(SDS)评估患者抑郁情况.结果胰岛素抵抗组PD-MCI的发生(61.5%)显著高于非胰岛素抵抗组(29.6%);PD-MCI患者中有72.2%存在胰岛素抵抗,明显高于PD-NCI患者(29.3%);轻度胰岛素抵抗组PD-MCI发生率(55.2%)明显低于重度胰岛素抵抗组(81.5%);与非胰岛素抵抗组相比,胰岛素抵抗组Mo CA评分显著减少,SDS评分显著增加,尤以重度胰岛素抵抗组明显.Logistic分析显示胰岛素抵抗是PD-MCI的独立影响因素之一.结论胰岛素抵抗可能是帕金森病患者发生轻度认知损害的危险因素,改善胰岛素抵抗情况可能有助于降低患者认知功能损害及抑郁的发生.

Objective To study the relationship between mild cognitive impairment and insulin resistance （IR） in Parkinson＇s disease （PD-MCI） , and to provide a new way to diagnose and treat PD-MCI in the early stage. Methods 94 patients with Parkinson＇s disease in our hospital were included from August 2013 to February 2015. All the patients were divided into insulin resistance group （43 cases） and non-insulin resistance group （5l cases） by homeostasis model assessment. Insulin sensitivity index, Montreal Cognitive Assessment （MoCA） and Self-rating Depression Scale （SDS） were used to estimate the severity of IR, patients＇ cognitive function and depression degree, respectively. Results The incidence of PD-MCI in IR group （61.5%） was significantly higher than that in non-IR group （29.6%） . There was 72.2% of patients with PD-MCI suffered IR and the rate was much higher than that of patients with non PD-MCI （29.3%） . The incidence of PD-MC[ in mild IR group （55.2%） was significantly lower than that in severe IR group （81.5%） . Compared with the non-IR group, the score of MoCA in IR group was much lower, and the score of SDS was higher, especially in severe IR group. Logistic analysis showed that IR was one of the independent risk factor for PD-MCI. Conclusion IR may be the risk factor for PD-MCI. The improvement of the degree of IR may help to decrease the development of cognitive impairment and depression.