糖化血红蛋白水平与帕金森病认知功能障碍的相关性

Relationship between glycosylated hemoglobin A1C levels and cognitive impairment in Parkinson's disease

目的探讨帕金森病(PD)患者糖化血红蛋白(HbA1c)水平与认知功能障碍的相关性及PD患者发生认知功能障碍的影响因素。方法选取2020年9月至2023年5月就诊于河南省人民医院的原发性PD患者81例,将患者分为糖尿病组(HbA1c≥6.5%或既往确诊为糖尿病,n=38)和对照组(HbA1c<6.5%,n=43)。采用统一帕金森病评定量表第三部分(UPDRSⅢ)评价运动症状,根据Hoehn-Yahr(H-Y)分期评价疾病严重程度,采用蒙特利尔认知量表(MoCA)评价患者认知功能。采用Spearman秩相关分析探讨PD患者MoCA评分与临床资料之间的相关性,采用单因素和多因素Logistic回归分析筛查PD患者发生认知功能障碍的影响因素。结果糖尿病组与对照组间年龄、起病年龄、高血压和冠心病比例、UPDRSⅢ评分、MoCA评分比较差异有统计学意义(P<0.05)。Spearman秩相关分析结果显示,PD患者MoCA评分与受教育年限呈正相关(r_(s)=0.345,P=0.002),与年龄、起病年龄、HbA1c水平呈负相关(r_(s)=-0.330,P=0.003;r_(s)=-0.332,P=0.002;r_(s)=-0.399,P=0.000)。HbA1c水平在认知功能障碍组高于认知功能正常组(Z=-2.828,P=0.005)。多因素Logistic回归分析结果显示,HbA1c是PD患者发生认知功能障碍的独立危险因素(OR=2.361,95%CI:1.248~4.465;P=0.008)。结论PD患者HbA1c水平越高,认知功能障碍越严重,HbA1c是PD患者发生认知功能障碍的独立危险因素。

Objective To explore the correlation between glycosylated hemoglobin A1C(HbA1c)levels and cognitive impairment in Parkinson's disease(PD)patients,and the related factors of cognitive impairment in PD patients.Methods A total of 81 patients with idiopathic PD admitted to Henan Provincial People's Hospital from September 2020 to May 2023 were enrolled.They were divided into diabetes mellitus group(HbA1c≥6.5%or previously diagnosed as diabetes,n=38)and control group(HbA1c<6.5%,n=43).The third part of the Unified Parkinson's Disease Rating Scale(UPDRSⅢ)was used to assess motor symptoms.The Hoehn-Yahr(H-Y)scale was used to assess the severity of PD.Cognitive function was evaluated by the Montreal cognitive assessment(MoCA).Spearman correlation analysis was used to explore the correlation between MoCA scores and clinical data in PD patients.Univariate and multivariate logistic regression analysis were used to explore the factors that influence cognitive impairment in PD patients.Results There were significant differences in terms of age,age of onset,incidence of hypertension and coronary heart disease,UPDRSⅢscores and MoCA scores between diabetes mellitus group and control group(all P<0.05).Spearman correlation analysis showed that MoCA scores were positively correlated with years of education(r_(s)=0.345,P=0.002),and negatively correlated with age,age of onset and HbA1c levels in PD patients(r_(s)=-0.330,P=0.003;r_(s)=-0.332,P=0.002;r_(s)=-0.399,P=0.000).There were significant differences in terms of HbA1c levels between cognitive impairment group and normal cognitive function group(Z=-2.828,P=0.005).Multivariate logistic regression analysis showed that HbA1c was an independent risk factor of cognitive impairment in PD patients(OR=2.361,95%CI:1.248-4.465,P=0.008).Conclusions The higher HbA1c levels are correlated with severe cognitive impairment in PD.HbA1c is an independent risk factor of cognitive impairment in PD patients.