中老年2型糖尿病患者血清胱抑素C水平与糖尿病相关认知功能障碍的关系

Relation of serum cystatin C level with diabetes-associated cognitive dysfunction in middle-aged and elderly patients with diabetes mellitus

目的探讨中老年2型糖尿病(T2DM)患者血清胱抑素C水平与糖尿病相关认知功能障碍(DACD)的关系。方法选取130例中老年T2DM患者作为研究对象,应用中文版蒙特利尔认知评估基础量表将其分为认知功能正常组62例与DACD组68例。比较两组患者的一般资料、肾功能指标(包括血清胱抑素C、尿素、肌酐水平和肾小球滤过率、尿微量白蛋白/尿肌酐比值),采用非条件Logistic回归模型分析中老年T2DM患者发生DACD的危险因素,采用受试者工作特征(ROC)曲线评估血清胱抑素C水平对中老年T2DM患者发生DACD的诊断价值。结果两组患者的年龄、糖尿病病程、血清胱抑素C水平、血清肌酐水平、血清尿素水平、肾小球滤过率、尿微量白蛋白/尿肌酐比值比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,年龄、血清胱抑素C水平是中老年T2DM患者发生DACD的危险因素(均P<0.05)。ROC曲线分析结果显示,血清胱抑素C水平诊断中老年T2DM患者发生DACD的曲线下面积为0.654(P<0.05),血清胱抑素C水平的最佳截断值为1.05 mg/L,此时其敏感度为48.5%,特异度为85.5%,阳性预测值为78.6%,阴性预测值为60.2%,准确率为66.2%。结论血清胱抑素C水平是中老年T2DM患者发生DACD的危险因素之一,对早期DACD具有一定的诊断价值。

Objective To explore the relation of serum cystatin C level with diabetes-associated cognitive dysfunction(DACD)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 130 middle-aged and elderly patients with T2DM were selected as the research subjects,and they were assigned to normal cognitive function group(62 cases)or DACD group(68 cases)by using Chinese Montreal Cognitive Assessment-Basic.The general data,indices of renal function(levels of serum cystatin C,urea,creatinine,and glomerular filtration rate,urinary microalbumin-to-creatinine ratio)were compared between the two groups.The risk factors for the occurrence of DACD in middle-aged and elderly patients with T2DM were analyzed by the unconditioned Logistic regression model.The diagnostic value of serum cystatin C level on the occurrence of DACD in middle-aged and elderly patients with T2DM was evaluated by the receiver operating characteristic(ROC)curve.Results There were statistically significant differences in age,length of diabetic disease course,serum cystatin C level,serum creatinine level,serum urea level,and glomerular filtration rate,and urinary microalbumin-to-creatinine ratio of patients between the two groups(all P<0.05).The results of Logistic regression analysis revealed that age,serum cystatin C level were the risk factors for the occurrence of DACD in middle-aged and elderly patients with T2DM(all P<0.05).The results of ROC curve analysis presented that the area under the curve of serum cystatin C level for diagnosing the occurrence of DACD in middle-aged and elderly patients with T2DM was 0.654(P<0.05),and the optimal cut-off value of serum cystatin C level was 1.05 mg/L,the sensitivity was 48.5%by this moment,the specificity was 85.5%,the positive predictive value was 78.6%,the negative predictive value was 60.2%,and the accuracy was 66.2%.Conclusion Serum cystatin C level is one of the risk factors for the occurrence of DACD in middle-aged and elderly patients with T2DM,exerting a diagnostic value on early DACD to a certain extent.