糖尿病对脑白质病变伴轻度认知功能障碍患者认知功能的影响

Effect of diabetes on cognitive function in patients with white matter lesions and mild cognitive impairment

目的：探讨糖尿病与脑白质病变（WML）伴轻度认知功能障碍（MCI）患者认知功能减退的关系。方法2012年1—12月在大坪医院神经内科住院病人中选择257例 WML 伴 MCI 患者进行前瞻性研究,随访时间为1年。收集患者血管危险因素（VRFs）及颅脑 MRI 检查结果,同时行神经心理学测试了解认知功能状态；根据1年内简易精神状态检查量表（MMSE）减少值分为认知功能下降组（≥3分）及无认知功能下降组（≤2分）,并比较两组各种危险因素的差异。结果257例中有246例（95.7%）患者完成了1年的观察随访过程,11例删失者中8例死亡、3例退出观察。246例中,认知功能下降组154例（62.6%）,无认知功能下降组92例（37.4%）；其中36例在观察期间发生卒中,余210例患者纳入线性回归分析。除受教育水平及血脂异常外,年龄、性别、高血压、糖尿病、短暂性脑缺血发作等各危险因素两组比较差异均有统计学意义（P 值均〈0.05）。糖尿病、基线 WML 程度及随访期间 WML 程度的加重与1年内 MMSE 减少值呈显著的线性关系,且对认知功能减退的影响由大至小依次为基线 WML 程度（βj′=0.570）、随访期间 WML 加重程度（βj′=0.244）、糖尿病（βj′=0.171）。结论糖尿病可使 WML 伴 MCI 患者认知功能进一步减退。重度 WML 伴 MCI 的糖尿病患者应作为痴呆的高危人群进行早期干预。

Objective To study the relationship between cognitive decline with diabetes in patients with white matter lesions （ WML） and mild cognitive impairment （ MCI）. Methods From January to December 2012, 257 patients with WML and MCI were selected from the inpatients in the Department of Neurology of Daping Hospital in the city of Chongqing. This is a prospective study, the patients enrolled into the present study accepted follow-up for 1 year. The demographic data, vascular risk factors, MRI and neuropsychological tests were collected . All patients were divided into cognitive decline group and non-cognitive decline group according to the reduction value of mini-mental state examination（ MMSE） within 1 year. The differences between 2 groups were compared. Results A total of 246 patients completed the follow-up, 8 patients died and 3 patients quitted. There were 154 patients in cognitive decline group, and 92 patients in non-cognitive decline group. Among of them, 210 patients were regression analyzed, but 36 patients were rejected duo to stroke attacked during the watch. In addition to the education level and hyperlipidemia, the other risk factors such as age, gender gap, hypertension, diabetes and transient ischemic attack were statistically different between two groups（all P values 〈 0. 05）. According to regression analysis, the decrease of MMSE scores over the 1-year study period was mainly attributed to diabetes, WML severity and deterioration of WML severity. In addition, the impact on cognitive decline from big to small in turn was baseline WML degree （βj′ = 0. 570）, deterioration of WML severity（βj′ = 0. 244） and diabetes （βj ′ = 0. 171）. Conclusions The occurrence of diabetes can lead to significant cognitive decline in patients with WML and MCI. Thus we should take the MCI patients with diabetes and severe WML as a high risk group of dementia, and give intervention timely.