多梗死性痴呆与代谢综合征关系的临床研究

Clinical research of relationship between multi-infarct dementia and metabolic syndrome

目的评估多梗死性痴呆(MID)患者与代谢综合征(Mets)之间的关系。方法 85例神经内科住院治疗的反复发生2次以上脑梗死患者,将所有患者分为伴代谢综合征组(Mets组,39例)与不伴代谢综合征组(NMets组,46例)。所有患者均于入院时、第1个月及第6个月进行痴呆及神经功能缺损评分,并在空腹状态测量所有研究对象的腰围、血压,静脉血检测血脂相关指标、空腹血糖(FPG)、餐后2 h血糖、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS),采用稳态模型(HOMA)方法评估胰岛素抵抗(IR)=FINS×FPG/22.5,必要时行口服葡萄糖耐量试验(OGTT)。结果 Mets组入院时、第1个月、第6个月多梗死痴呆发生率分别为59.0%、64.1%、61.5%,NMets组分别为32.6%、34.8%、34.8%。两组患者在入院时、第1个月、第6个月出现多梗死痴呆情况比较差异具有统计学意义(P<0.05);Mets组发生痴呆的严重程度较NMets组明显增加,其中,在发病的第1个月内,发生血管性痴呆的风险明显增高(P<0.05)。结论代谢综合征使多发脑梗死患者发生多梗死性痴呆的风险明显增高;对于伴有代谢综合征的多发脑梗死患者,发病第1个月发生血管性痴呆的风险最高;对于早期出现血管性痴呆患者,合并代谢综合征的患者其痴呆的恶化进程较不合并代谢综合征者明显加快。

Objective To evaluate relationship between multi-infarct dementia （MID） and metabolic syndrome （Mets） in patients. Methods A total of 85 hospitalized patients with more than 2 recurrent cerebral infarction were randomly divided into complicated metabolic syndrome group （Mets group, 39 cases） and noncomplicated metabolic syndrome group （NMets group, 46 cases）. Dementia score and neurological functional deficit score in all patients were made at admission, and in 1 and 6 months of treatment. Waistline and blood pressure were measured in fasting state. Venous blood of patients were taken into detection of blood lipid related indexes, fasting plasma glucose （FPG）, 2 h postprandial blood glucose, glycosylated hemoglobin （HbAlc）, and fasting insulin （FINS）. Homeostasis model assessment （HOMA） was applied to evaluated insulin resistance （IR）=FINS × FPG/22.5, and oral glucose tolerance test （OGTT） was taken when necessary. Results Mets group had incidence of multi-infarct dementia at admission, and in 1 and 6 months of treatment respectively as 59.0%, 64.1% and 61.5%, which were respectively 32.6%, 34.8% and 34.8% in NMets group, and their difference of occurred multi-infarct dementia at admission, and in 1 and 6 months of treatment had statistical significance （P〈0.05）. Mets group had obviously increasing severity of dementia than NMets group, and it had obvious rise in risk of vascular dementia within 1 month of morbidity （P〈0.05）. Conclusion Metabolic syndrome leads to increasing risk of multi-infarct dementia in patients with multiple cerebral infarction. The highest risk of vascular dementia occurs within 1 month of morbidity in patients with multiple cerebral infarction and complicated metabolic syndrome. Patients with early vascular dementia and complicated metabolic syndrome shows obviously quicker exacerbation process than those without complicated metabolic syndrome.