老年人低血糖症并发认知功能损害预测评分系统的建立

Establishment of a prodictive scoring system for cognitive impairment in elderly with hypoglycemia

目的回顾性研究老年低血糖患者并发认知功能障碍的临床特点,建立预测评分系统。方法纳入2012-01—2016-12在连云港市第二人民医院老年医学科就诊发生过低血糖的糖尿病患者401例,按低血糖后是否出现认知功能损害分为认知正常组和认知损害组;分析2组临床资料,筛选出危险因素并建立评分系统。结果 2组糖尿病程、家庭检测次数、发作次数、低血糖值、低血糖持续时间比较差异有统计学意义(P<0.05);认知损害组出汗、心慌、饥饿感占比较认知正常组低,反应迟钝、注意力不集中、精神错乱、昏迷占比较认知正常组高(P<0.05);非条件Logistic回归分析筛选出糖尿病程、发作次数、家庭检测次数、低血糖值、低血糖持续时间、使用胰岛素控制血糖、精神错乱、昏迷等危险因素,对危险因素赋值,建立评分系统,取评分≥4.5作为预测阈值,敏感度为83.1%,特异度为85.2%。结论老年人低血糖症并发认知功能损害评分系统具有较理想的敏感性和特异性,可用于指导临床预后,但仍需更大样本进一步完善。

Objective To retrospectively study the clinical characteristics of elderly patients with hypoglycemia complicated with cognitive impairment and establish a predictive scoring system. Methods A total of 401 diabetic patients with hypoglycemia who were admitted to the Department of Geriatrics in the Second People＇s Hospital of Lianyungang City from January 2012 to De cember 2016. They were divided into cognitive normal group and cognition impairment group according to whether there was cog nitive impairment after hypoglycemia. We analyzed the clinical data of two groups,screened out risk factors and established a sco ring system. Results There were significant differences in the duration of diabetes,family detection,number of episodes,hypogly cemia and duration of hypoglycemia in the two groups （P〈0.05）. The proportion of sweating,palpitation,and hunger was lower in the cognitive impairment group than in the normal cognitive group. The proportion of unresponsive,inattention,mental confu sion,and coma was higher in the cognitive impairment group than that in the cognitive normal group（P 〈0.05）. Unconditional Lo gistic regression analysis screened diabetes risk factors：number of episodes,number of home tests, hypoglycemia, hypoglycemia duration, use of insulin to control blood glucose, mental confusion, coma other risk factors. We assigned value to risk factors, estab lished a scoring system,and used a score of ≥4.5 as the prediction threshold. The sensitivity of the system was 83.1 %, and the specificity was 85.2%.Conclusion The elderly hypoglycemia complicated cognitive impairment score system established in this study has ideal sensitivity and specificity,which can be used to guide clinical prognosis, but still needs further samples to further improve.