GLP-1受体激动剂对2型糖尿病患者急性缺血性脑卒中后认知功能的影响

Effects of GLP-1 receptor agonists on cognitive function in patients with type 2 diabetes mellitus after acute ischemic stroke

目的研究胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonists,GLP-1 RA)对2型糖尿病(type 2 diabetes mellitus,T2DM)患者急性缺血性脑卒中后认知功能的影响。方法采用病例对照研究,将249例急性缺血性脑卒中合并T2DM患者根据既往是否规律使用GLP-1 RA(选取司美格鲁肽为代表)分为GLP-1 RA组和非GLP-1 RA组(胰岛素降糖治疗),记录基线状态下的人口学特征、生化检验结果以及在院期间血糖监测水平等,并使用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估认知功能,排除得分<26分的患者。两组患者的基线水平资料差异无统计学意义。筛选合格者219例,分别于卒中后3个月随访,再次使用MoCA评分评估认知功能,以得分<22分判定为发生卒中后认知障碍(post-stroke cognitive impairment,PSCI)。采用二元Logistic回归分析比较两组患者的评分情况,比较不同得分患者组间踝肱指数及衍生葡萄糖目标范围内时间(derived time in range,dTIR)的差异。结果研究结束时,GLP-1 RA组110例患者中有32例发生PSCI,PSCI发生率为29.09%;非GLP-1 RA组109例患者中有45例发生PSCI,PSCI发生率为41.28%。对两组患者进行认知功能评分,结果显示司美格鲁肽干预显著降低PSCI发生率。二元Logistic回归分析提示,司美格鲁肽干预的优势比为2.285,dTIR参数的优势比为0.985。结论GLP-1 RA降糖治疗能够减轻缺血性脑卒中合并T2DM患者的PSCI程度。

Objective To investigate the effects of glucagon-like peptide-1 receptor agonists(GLP-1 RA)on cognitive function in patients with type 2 diabetes mellitus(T2DM)after acute ischemic stroke.Methods A case-control study was conducted,involving 249 patients with acute ischemic stroke combined with T2DM.The patients were divided into two groups based on whether they had regularly used GLP-1 RA(with semaglutide as a representative)or not(insulin therapy).Baseline demographic characteristics,biochemical test results,and blood glucose monitoring levels during hospitalization were recorded.Cognitive function was assessed using the Montreal Cognitive Assessment(MoCA),and patients with a score below 26 were excluded.A total of 219 eligible patients were followed up 3 months after the stroke,and cognitive function was reassessed using the MoCA score,with a score below 22 indicating post-stroke cognitive impairment(PSCI).Binary Logistic regression analysis was used to compare the cognitive function scores between the two groups and to analyze the differences in ankle-brachial index and derived time in range(dTIR)between patients with different scores.Results By the end of the study,32 out of 110 patients in the GLP-1 RA group developed PSCI,with an incidence rate of 29.09%.In the non-GLP-1 RA group,45 out of 109 patients developed PSCI,with an incidence rate of 41.28%.Cognitive function scores showed that semaglutide intervention significantly reduced the incidence of PSCI.Binary Logistic regression analysis indicated that the odds ratio for semaglutide intervention was 2.285,while that for the dTIR parameter was 0.985.Conclusions GLP-1 RA therapy can reduce the severity of PSCI in patients with ischemic stroke combined with T2DM.