北京地区2型糖尿病患者发生认知功能障碍的危险因素研究

Risk factors associated with cognitive impairment in patients with type 2 diabetes mellitus in Beijing

目的分析2型糖尿病(diabetes mellitus type 2,T2DM)患者发生认知功能障碍的危险因素,为延缓T2DM脑小血管病变的进展、保护认知能力提供依据。方法以北京中医药大学东方医院内分泌科住院的30~85岁T2DM人群为研究对象,收集2019年4月—2021年6月住院的T2DM患者的社会人口学资料及临床客观指标。将165例患者根据蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表分值分为认知障碍组(T2DM-CI组)和认知正常组(T2DM-N组)。调查内容包括人口学特征、实验室血清学指标、并发症及服药情况等信息。运用logistic回归进行影响因素的分析。结果多因素logistic回归分析结果显示,年龄(OR=1.05,95%CI:1.02~1.08,P<0.01)、冠心病病史(OR=3.16,95%CI:1.40~7.14,P<0.01)、糖化血红蛋白(glycated hemoglobin,HbA1c)(OR=1.31,95%CI:1.02~1.52,P<0.05)是T2DM患者发生认知功能障碍的正影响因素;受教育年限(OR=0.82,95%CI:0.74,0.91,P<0.01)是T2DM患者发生认知功能障碍的负影响因素。结论T2DM合并发生认知功能障碍的危险因素包括高龄、合并冠心病、受教育程度低、高HbA1c,这提示临床治疗T2DM时,应积极控制血糖,预防冠心病的发生以及积极采用冠心病治疗手段,关注高龄T2DM患者和受教育程度低的患者。

Objective To explore the risk factors associated with cognitive impairment(CI)of patients with type 2 diabetes mellitus(T2DM),and to provide evidence for delaying the progression of cerebral small-vessel damage and protecting cognitive ability.Methods Patients aged 30-85 years with T2DM who were hospitalized in the Department of Endocrinology,Oriental Hospital of Beijing University of Traditional Chinese Medicine from April 2019 to June 2021 were enrolled and their socio-demographic data and clinical data were collected.The 165 patients were divided into T2DM-CI group(cognitive impairment group)and T2DM-N group(normal cognitive function group)based on the scores of Montreal cognitive Assessment(MoCA)scale.Logistic regression was used to analyze the influencing factors.Results Multivariate logistic regression analysis showed that age(OR=1.05,95%CI:1.02-1.08),history of coronary heart disease(OR=3.16,95%CI:1.40-7.14,P<0.01),glycated hemoglobin(HbA1 c)(OR=1.31,95%CI:1.02-1.52,P<0.05)were positive influencing factors for the occurrence of CI in patients with T2DM(P<0.05).While,years of education(OR=0.82,95%CI:0.74-0.91,P<0.01)was negative influencing factor for the occurrence of CI in patients with T2DM.Conclusions Older age,comorbidity with coronary heart disease,low education level and high Hb A1c are major risk factors for CI of patients with T2DM,suggesting that during the clinical treatment of patients with T2DM,we should control blood glucose,prevent and treat coronary heart disease especially for older patients and poor-educated patients.