血清Aβ1-42、GLP-1与2型糖尿病患者认知功能障碍的相关性及其危险因素分析

Correlation analysis between serum Aβ1-42,GLP-1 and cognitive dysfunction in type 2 diabetic patients and their risk factor analysis

目的探讨血清β-淀粉样蛋白1-42(Aβ1-42)、胰高血糖素样肽-1(GLP-1)与2型糖尿病患者认知功能障碍的相关性,并分析2型糖尿病患者认知功能障碍发生的危险因素。方法回顾性选取2020年6月至2023年6月青岛市胶州中心医院收治的80例2型糖尿病认知功能障碍患者作为研究对象,将其作为认知功能障碍组,另选取同期来本院体检的80例单纯2型糖尿病无认知功能障碍患者作为非认知功能障碍组。比较两组患者一般临床情况,并比较其Aβ1-42、GLP-1表达水平。采用Logistic回归分析分析2型糖尿病患者认知功能障碍发生的危险因素。采用简易智能精神状态检查量表(MMSE)评分将80例2型糖尿病认知功能障碍患者分为3个亚组,MMSE<10分为重度组(n=21),MMSE 10~20分为中度组(n=25),MMSE>20分为轻度组(n=34)。比较3组患者血清Aβ1-42、GLP-1表达水平。采用Spearman相关分析方法分析Aβ1-42、GLP-1与2型糖尿病认知功能障碍严重程度的相关性。结果认知功能障碍组患者年龄、糖尿病病程、合并高血脂患者比率、空腹血糖、糖化血红蛋白、餐后2 h血糖水平分别为(59.30±3.57)岁、(8.64±1.91)年、31.25%、(9.18±2.75)mmol/L、(11.91±0.72)%、(14.27±3.73)mmol/L,均高于非认知功能障碍组[(50.21±3.42)岁、(5.72±1.87)年、15.00%、(7.87±1.58)mmol/L、(8.73±0.57)%、(10.83±2.84)mmol/L],教育程度为(6.74±1.53)年,低于非认知功能障碍组[(8.35±2.63)年],差异均有统计学意义(P<0.05)。认知功能障碍组患者Aβ1-42水平为(566.28±113.19)pg/mL,高于非认知功能障碍组[(353.59±65.78)pg/mL],GLP-1水平为(19.85±4.25)pmol/L,低于非认知功能障碍组[(23.24±3.34)pmol/L],差异均有统计学意义(P<0.05)。Logistic回归分析结果表明:糖尿病病程、合并高血脂、糖化血红蛋白、Aβ1-42、GLP-1为2型糖尿病患者认知功能障碍发生的独立危险因素(P<0.05)。不同严重程度认知功能障碍患者Aβ1-42、GLP-1水平比较差异显著,重度组Aβ1-42水平高于轻度组和中度组,GLP-1水平低于轻度组和中度组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:Aβ1-42与认知功能障碍严重程度呈正相关(r=0.586,P<0.05),而GLP-1与知功能障碍严重程度呈负相关(r=-0.579,P<0.05)。结论糖尿病病程、合并高血脂、糖化血红蛋白、Aβ1-42、GLP-1水平可作为2型糖尿病患者认知功能障碍发生的中亚危险因素,且β1-42、GLP-1与认知功能障碍严重程度具有明显相关性。

Objective To explore the correlation between serumβ-amyloid 1-42(Aβ1-42),glucagon-like peptide-1(GLP-1)and cognitive dysfunction in patients with type 2 diabetes,and to analyze the risk factors of cognitive dysfunction in patients with type 2 diabetes.Methods Eighty patients with cognitive impairment of type 2 diabetes in Qingdao Jiaozhou Central Hospital from June 2020 to June 2023 were retrospectively selected as the research object,and they were divided into cognitive impairment group,and another 80 patients with simple type 2 diabetes without cognitive impairment who came to our hospital for physical examination in the same period were selected and divided into non cognitive impairment group.The general clinical conditions,the levels of Aβ1-42,GLP-1 of the two groups were compared.The risk factors of cognitive dysfunction in patients with type 2 diabetes was analyzed using Logistic regression analysis.Then 80 patients with cognitive impairment in patients with type 2 diabetes were assessed with the simplified intelligent mental state examination scale(MMSE)and divided into three subgroups,21 patients with MMSE<10 were divided into severe group,25 patients with MMSE 10~20 were divided into moderate group,and 34 patients with MMSE>20 were divided into mild group.The levels of serum Aβ1-42,GLP-1 in the three groups were compared.The correlation between Aβ1-42,GLP-1 and the severity of cognitive dysfunction in type 2 diabetes was analyzed using Spearman correlation analysis method.Results Age,duration of diabetes,ratio of patients with hyperlipidemia,fasting blood glucose,glycosylated hemoglobin,and postprandial blood glucose levels in the cognitive impairment group were(59.30±3.57)years,(8.64±1.91)years,31.25%,(9.18±2.75)mmol/L,(11.91±0.72)%,and(14.27±3.73)mmol/L,respectively,which were higher than those in the non cognitive impairment group[(50.21±3.42)years old,(5.72±1.87)years old,15.00%,(7.87±1.58)mmol/L,(8.73±0.57)%,(10.83±2.84)mmol/L],the education level was(6.74±1.53)years,which was lower than that in the non cognitive impairment group[(8.35±2.63)years],and the differences were statistically significant(P<0.05).The level of Aβ1-42 in the cognitive impairment group was(566.28±113.19)pg/mL,which was higher than that in the non cognitive impairment group[(353.59±65.78)pg/mL],and the level of GLP-1was(19.85±4.25)pmol/L,which was lower than that in the non cognitive impairment group[(23.24±3.34)pmol/L],the differences were statistically significant(P<0.05).The results of Logistic regression analysis showed that diabetes duration,hyperlipidemia,hemoglobin A1c,Aβ1-42,and GLP-1 were independent risk factors for the occurrence of cognitive dysfunction in type 2 diabetic patients(P<0.05).Aβ1-42 and GLP-1 levels in patients with different severity,Aβ1-42 was higher in severe than mild and moderate groups,and GLP-1 was lower than mild and moderate groups(P<0.05).Spearman correlation analysis showed that Aβ1-42 was positively associated with the severity of cognitive dysfunction(r=0.586,P<0.05),while GLP-1 was negatively correlated with the severity of known dysfunction(r=-0.579,P<0.05).Conclusion The course of diabetes,combined with hyperlipidemia,hemoglobin A1c,Aβ1-42 and GLP-1 levels can be used as subrisk factors for the occurrence of cognitive dysfunction in type 2 diabetic patients,andβ1-42 and GLP-1 have obvious correlation with the severity of cognitive dysfunction.