老年2型糖尿病认知功能障碍患者血清胃促生长素和血管内皮生长因子水平变化及临床意义

Changes and clinical significances of serum ghrelin and vascular endothelial growth factor levels in elderly patients with cognitive impairment and type 2 diabetes mellitus

目的探讨血清胃促生长素(ghrelin)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平在老年2型糖尿病认知功能障碍(cognitive impairment,CI)患者中的变化及意义。方法老年2型糖尿病患者196例,体检健康者60例(对照组)。采用蒙特利尔认知评估量表(Montreal Cognitive Assessment Scale,MoCA)和简明精神状态量表(Mini-Mental State Examination Scale,MMSE)评定入选者认知功能,并将老年2型糖尿病患者分为CI组81例和非CI(non-CI,NCI)组115例。收集各组基本资料,并采用ELISA法检测血清ghrelin和VEGF水平;采用Pearson相关分析血清ghrelin、VEGF水平与CI的相关性,采用多因素logistic回归分析老年2型糖尿病患者发生CI的影响因素。结果对照组和NCI组受教育时间、MoCA评分和MMSE评分均高于CI组(P<0.05),对照组与NCI组比较差异无统计学意义(P>0.05);NCI组和对照组血清ghrelin[(246.20±58.72)、(301.84±42.93)ng/L]和VEGF[(220.46±59.68)、(255.23±73.37)ng/L]水平高于CI组[(185.19±48.80)、(185.62±54.76)ng/L](P<0.05),对照组高于NCI组(P<0.05);血清ghrelin和VEGF水平与MoCA评分(r=0.503,P=0.006;r=0.463,P=0.023)、MMSE评分(r=0.486,P<0.001;r=0.437,P=0.012)均呈正相关;受教育时间(OR=0.65,95%CI:0.51~0.82,P<0.001)、糖化血红蛋白(OR=1.47,95%CI:1.09~1.98,P=0.011)、ghrelin(OR=0.90,95%CI:0.88~0.93,P<0.001)和VEGF(OR=0.48,95%CI:0.29~0.80,P=0.005)是老年2型糖尿病患者发生CI的影响因素。结论老年2型糖尿病伴CI患者血清ghrelin、VEGF水平降低,且与认知功能评分存在一定相关性,ghrelin、VEGF可能参与老年2型糖尿病患者CI的发生、发展过程。

Objective To investigate the changes and clinical significances of serum ghrelin and vascular endothelial growth factor(VEGF)levels in elderly patients with cognitive impairment(CI)and type 2diabetes mellitus(T2DM).Methods Totally 196elderly patients with T2DM and 60healthy volunteers(control group)were examined by Montreal Cognitive Assessment Scale(MoCA)and Mini-Mental State Examination(MMSE)to assess the cognitive function.Observation group was divided into CI group(n=81)and non-CI group(n=115).The clinical data were collected and the serum ghrelin and VEGF levels were measured by ELISA technique.Pearson correlation analysis was used to analyze the correlation of serum ghrelin and VEGF levels with CI,and multivariate logistic regression was used to analyze the influencing factors for CI in elderly patients with T2DM.Results The level of education,MoCA and MMSE scores were significantly higher in control group and non-CI group than those in CI group(P<0.05),and showed no significant differences between control group and NCI group(P>0.05).The levels of serum ghrelin((246.20±58.72),(301.84±42.93)ng/L)and VEGF((220.46±59.68),(255.23±73.37)ng/L)in non-CI group and control group were higher than those in CI group((185.19±48.80),(185.62±54.76)ng/L)(P<0.05),and higher in control group than those in non-CI group(P<0.05).The serum ghrelin and VEGF levels were positively correlated with MoCA scores(r=0.503,P=0.006;r=0.463,P=0.023)and MMSE scores(r=0.486,P<0.001;r=0.437,P=0.012).The multivariate logistic regression analysis showed that the level of education(OR=0.65,95%CI:0.51-0.82,P<0.001),glycosylated hemoglobin(OR=1.47,95%CI:1.09-1.98,P=0.011),ghrelin(OR=0.90,95%CI:0.88-0.93,P=0.011)and VEGF(OR=0.48,95%CI:0.29-0.80,P=0.005)were the influencing factors for CI in elderly patients with T2DM.Conclusion The serum levels of ghrelin and VEGF in elderly patients with T2DM and CI decrease,and are correlated with cognitive function score.Ghrelin and VEGF might be involved in the occurrence and development of CI in elderly patients with T2DM.