老年2型糖尿病认知功能障碍患者血清炎症因子与脑影像学病理改变的相关性研究

Analysis on the inflammatory factors and metabolism of brian in elderly type 2 diabetic dysfunction

目的观察2型糖尿病认知功能障碍患者血清炎症因子、叶酸、同型半胱氨酸(HCY)水平与脑影像学病理改变的相关性。方法搜集2013年12月至2014年12月南京鼓楼医院老年科住院的60岁以上患者,分为2型糖尿病痴呆组66例和单纯痴呆组43例。行神经心理量表评估,检测血清炎症因子、HCY、叶酸及基因水平;经磁共振海马薄层平扫及波普观察患者海马高度、脉络膜裂大小、胶质细胞增生及神经元退变。结果与单纯痴呆组相比,糖尿病痴呆组患者的蒙特利尔认知评估(MoCA)评分下降;血清白细胞介素(IL)-1β、IL-6及HCY水平上升,叶酸水平降低,叶酸基因分布不同;海马高度、NAA/Cr减少,脉络膜裂、MI/Cr增加。IL-1β、HCY、脉络膜裂是糖尿病痴呆组的独立危险因素。结论老年2型糖尿病痴呆患者的海马体积萎缩,神经元退变及胶质细胞增生,其认知功能与血清IL-1β、HCY水平及脉络膜裂大小密切相关。

Objective To evaluate the relationship of serum inflammation factors,homocysteine and brain metabolism of elderly patients with type 2 diabetes in the pathogenesis of cognitive dysfunctio.Methods Collecting from December 2013 to December 2014 Nanjing Drum Tower Hospital Geriatric inpatients aged over 60,with reference to the diagnostic criteria for diabetes and cognitive impairment in type 2 diabetes patients were divided into 66 groups dementia and dementia alone group 43.Observation：In general,inflammatory markers（IL-6,IL-1β,CRP）,homocysteine,serum folate gene;Neuropsychological Assessment Scale（including：MMSE,MoCA,ADL,HAMD）;hippocampal MRI measurement（hippocampus height,fissure size,NAA/Cr,MI/Cr）.Results Compared with the pure dementia group,diabetes dementia group of patients with MoCA score decreased;serum IL-1,IL-6 and beta HCY level increased,decreased levels of folic acid,folic acid of different gene distribution;hippocampus height,NAA/Cr decreased,MI/Cr increased,the choroidal fissure.IL-1 beta,HCY and choroidal fissure were independent risk factors for diabetic dementia.Conclusion Compared with pure dementia patients,the cognitive function in elderly dementia patients with type 2 diabetes decreased hippocampus volume atrophy,neuronal degeneration（NAA/Cr decrease）and gliosis（MI/Cr increase）,which may be associated with inflammation and hyperhomocysteinemia.