老年糖尿病患者轻度认知功能障碍与内脏脂肪素的相关性研究

Study on the correlation between visfatin and mild cognitive impairment in elderly patients with diabetes

目的探讨血清内脏脂肪素与2型糖尿病（T2DM）患者轻度认知功能障碍（MCI）的相关性。方法前瞻性研究，筛选我科住院的T2DM患者75例为病例组，应用蒙特利尔认知评估（MoCA）量表筛选T2DM患者合并MCI患者（MCI组）35例，T2DM患者非MCI患者（NMCI组）40例，同期健康体检者30例为对照组。测定人选者空腹血糖（FPG）、空腹胰岛素（FINS）、血脂、糖化血红蛋白（HbAlc）、内脏脂肪素及计算稳态胰岛素评价指数（HOMA-IR）。结果MCI组血清内脏脂肪素水平为（28．81±3．32）μg／L，高于NMCI组（20．69±3．40）μg／L及对照组（19．06±2．35）μg／L（F=96．491，P〈0．01）。血清内脏脂肪素水平与MoCA评分呈负相关（r=-0．646，P〈0．01）。内脏脂肪素水平与病程、腰臀比、FPG、HbAlc、FINS、HOMA-IR、三酰甘油呈正相关（r值分别为0．282、0．276、0．318、0．496、0．339、0．433、0．309，P〈0．05或P〈0．01）；MoCA与病程、HbAlc、HOMA-IR、三酰甘油、总胆固醇、低密度脂蛋白胆固醇呈负相关（r值分别为-0．582、-0．365、-0．234、-0．330、-0．277、-0．238，P〈0．05或P〈0．01）；MoCA与高密度脂蛋白胆固醇呈正相关（r=0．290，P〈0．05）。多因素Logistic回归分析结果显示，内脏脂肪素（OR=3．246，P〈0．01）、HbAlc（OR=2．308，P〈O．01）及病程（OR=1．634，P〈0．05）是影响MCI的危险因素。结论内脏脂肪素升高可能是T2DM患者MCI的危险因素。

Objective To explore the relationship between visfatin and mild cognitive impairment（MCI）in patients with type 2 diabetes mellitus（T2DM）. Methods A perspective study involving 75 hospitalized T2DM patients were divided into groups with（MCI, n = 35）and without （NMCI,n= 40）mild cognitive impairment. Another 30 non-diabetic patients were chosen as normal control（NC）. Fasting plasma levels of glucose （FPG）, insulin （FINS）, lipid, glycosylated hemoglobin （HbAlc）,HOMA IR and visfatin were measured and calculated. Results The serum visfatin level was higher in MCI（28.81±3.32）μg/L than in NMCI（20.69±3.40）μg/L and NC（19.06±2.35）μg/L （F = 96. 491, P 〈 0.01）. Visfatin was negatively correlated with Montreal Cognitive Assessment （MoCA） total score （MoCA-TS） （ r = -0. 646, P 〈 0.01 ）, but positively correlated with course of disease, waist hip ratio, FPG, HbAlc, FINS, HOMA-IR and triglyceride （r = 0. 282,0. 276,0. 318, 0. 496,0. 339,0. 433,0. 309,P〈0.05 or P〈0.01）. MoCA-TS was negatively correlated with course of disease, HbA1c, HOMA-IR, triglyceride, total cholesterol, low density lipoprotein cholesterol （r=-0.582,-0.365,-0.234,-0.330, -0.277,-0.238, P〈0.05 or P〈0.01）,but positively correlated with high density lipoprotein cholesterol（r= 0. 290, P%0.05）. Higher values of visfatin（OR =3. 246,P〈0.01）,HbAlc（OR=2. 308,P〈0.01）and course of disease（OR= 1. 634,P〈0.05）were the risk factors for MCI. Conclusions The elevated visfatin level might be a risk factor for MCI in T2DM patients.