老年2型糖尿病患者脑白质高信号和认知功能损伤危险因素随访研究

Follow-up study of risk factors of white matter hyperintensity and cognitive impairment in elderly patients with type 2 diabetes mellitus

目的随访老年2型糖尿病患者脑白质高信号(white matter hyperintensity,WMH)与认知功能损伤的进展情况,探讨影响老年2型糖尿病患者脑白质高信号进展的危险因素。方法对76例老年2型糖尿病患者进行2年随访,分别在基线期及2年后随访时收集受试者一般临床资料,完善颅脑MRI检查,采用Fazekas量表评估患者WMH严重程度,汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评估受试者的精神症状,并采用数字广度测验、词语即刻记忆与延迟记忆、Stroop色词干扰测验、言语流畅性测验、画钟测验对患者认知功能多个维度进行评估。结果基线期和2年后随访时比较,患者皮质下WMH评分[1.5(1,2)vs.2(1,3)]、WMH总分[3(2,4)vs.3(2,4)]、数字广度倒背(6.32±1.59 vs.5.37±1.43)、数字广度总分(14.71±2.61 vs.13.71±2.32)、词语延迟记忆(2.86±0.86 vs.2.14±0.99)、Stroop色词干扰测验颜色反应时间[0.58(0.43,0.72)vs.0.61(0.53,0.79)]、词汇反应时间[0.47(0.37,0.55)vs.0.51(0.42,0.65)]、色词反应时间[0.98(0.95,1.05)vs.1.01(0.97,1.13)]、画钟测验(8.09±1.48 vs.7.76±1.74)、言语流畅性(4.42±0.82 vs.4.29±0.75)差异有统计学意义(P<0.05)。logistic回归分析显示,年龄(OR=1.383,95%CI:1.094~1.748)、肌酐(OR=1.100,95%CI:1.004~1.205)与WMH进展关联有统计学意义(P<0.05)。结论经随访2年,老年2型糖尿病患者WMH、皮层下WMH有一定进展,注意力、延迟记忆、执行功能、视觉空间结构能力、认知灵活性有不同程度的受损,患者年龄、肌酐与WMH进展有明显相关性。

Objective To follow up the progression of white matter hyperintensity(WMH)and cognitive impairment in elderly patients with type 2 diabetes mellitus,and to investigate the risk factors affecting the progression of white matter hyperintensity(WMH)in elderly patients with type 2 diabetes mellitus.Methods Seventy-six elderly patients with type 2 diabetes were followed up for 2 years.General clinical data were collected at baseline and 2 years after follow-up,brain MRI was improved,WMH severity was assessed by Fazekas scale.The Hamilton anxiety scale(HAMA)and the Hamilton depression scale(HAMD)assessed the mental state of the subjects.A series of cognitive function tests were performed.The cognitive function assessment tools used included MMSE,number span test(attention),word immediate and delayed memory(memory),Stroop color word interference test(executive function inhibitory control),verbal fluency test(cognitive flexibility),and clock drawing test(visuospatial structure ability).Results At baseline and after 2 years of follow-up,subcortical WMH(SC-WMH)[1.5(1,2)vs.2(1,3)]and total WMH score[3(2,4)vs.3(2,4)],number span inversion(6.32±1.59 vs.5.37±1.43),total number span score(14.71±2.61 vs.13.71±2.32),word delay memory(2.86±0.86 vs.2.14±0.99),Stroop color word interference test color response time[0.58(0.43,0.72)vs.0.61(0.53,0.79)],word response time[0.47(0.37,0.55)vs.0.51(0.42,0.65)],color word response time[0.98(0.95,1.05)vs.1.01(0.97,1.13)],clock test(8.09±1.48 vs.7.76±1.74)and verbal fluency test(4.42±0.82 vs.4.29±0.75)were compared,and the difference was significant(P<0.05).Age(OR=1.383,95%CI:1.094~1.748)and creatinine(OR=1.100,95%CI:1.004~1.205)were significantly associated with WMH progression(P<0.05).Conclusions After 2 years of follow-up,WMH and SC WMH in the elderly patients with type 2 diabetes have exhibited certain progression.Attention,delayed memory,executive function,visuospatial structure,and cognitive flexibility are all impaired to varying degrees.Patients'age and creatinine are significantly correlated with the progression of WMH.