本文選題：2型糖尿病 + 蒙特利爾認(rèn)知評估　； 參考：《山東大學(xué)》2012年碩士論文

【摘要】：目的：探討2型糖尿病認(rèn)知功能障礙的特點(diǎn)血清胰島素樣生長因子-1(insulin-like growth factor-1, IGF-1)水平與其之間的相關(guān)性,并進(jìn)一步分析影響認(rèn)知功能的其他因素如胰島素抵抗、血糖控制程度、血脂代謝和血壓等。 方法：選擇本院內(nèi)分泌科2011年12月-2012年3月份入院2型糖尿病病人78例,根據(jù)蒙特利爾認(rèn)知評估量表(MoCA)測評,將2型糖尿病患者分為糖尿病認(rèn)知障礙組(39例)、糖尿病非認(rèn)知障礙組(39例)。對所有入選患者收集臨床一般資料包括一般情況、既往病史、用藥情況及生活習(xí)慣等,采用酶聯(lián)免疫吸附法(enzyme-linked immunosorbent assay, ELISA)測定血清IGF-1水平,并山東省立醫(yī)院化驗(yàn)室統(tǒng)一測定空腹胰島素、C肽、空腹血糖、糖化血紅蛋白、血脂,同時(shí)記錄體重指數(shù)、血壓等指標(biāo),HOMA-IR模型計(jì)算胰島素抵抗指數(shù)。 對評定和記錄的結(jié)果進(jìn)行記錄整理,剔除不符合要求者或中途退出檢查者。所有數(shù)據(jù)SPSS18.0進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：2011年11月年至2012年3月共篩選出符合條件T2DM患者78例,其中糖尿病認(rèn)知障礙者39例、糖尿病非認(rèn)知障礙者39例,其中單純T2DM18例,T2DM僅合并高血壓者14例,T2DM僅合并血脂異常者20例；T2DM同時(shí)合并高血壓和血脂異常者26例。 1.2型糖尿病認(rèn)知障礙組與非認(rèn)知障礙組比較,體重指數(shù)、血壓、高密度脂蛋白、糖尿病病程以及空腹血糖和C肽、糖尿病并發(fā)癥累及系統(tǒng)數(shù)差異無統(tǒng)計(jì)學(xué)意義,教育程度、低密度脂蛋白、總膽固醇、甘油三酯、胰島素抵抗指數(shù)(HOMA-IR)、空腹胰島素、糖化血紅蛋白、血清IGF-1水平差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.糖尿病認(rèn)知障礙組血清IGF-1水平低于糖尿病非認(rèn)知障礙組(P0.05)。 3.2型糖尿病患者的MoCA評分與LDL、TC、TG、HbAlc、HOMA-IR、空腹胰島素呈負(fù)相關(guān)(r分別=-0.411、-0.498、-0.414、-0.452、-0.539、-0.449,P均0.05),與受教育年限、IGF-1呈正相關(guān)(r=0.579、0.491,P均0.05)。 4.兩組患者M(jìn)oCA量表中在視結(jié)構(gòu)空間與語言、抽象、延遲記憶、定向、總分等項(xiàng)檢查結(jié)果比較差異具有統(tǒng)計(jì)學(xué)意義(均P0.05),在命名、注意方面差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。 結(jié)論： 1.T2DM可導(dǎo)致中老年人群認(rèn)知功能損害,記憶、執(zhí)行功能和視空間結(jié)構(gòu)功能損害更加明顯。 2.教育程度低下、血糖控制不佳、胰島素抵抗及血脂代謝紊亂與2型糖尿病認(rèn)知障礙密切相關(guān)。 3.血清IGF-1水平下降是2型糖尿病患者認(rèn)知功能下降的一個(gè)危險(xiǎn)因素。
[Abstract]:Objective: to investigate the relationship between the level of serum insulin-like growth factor-1 (IGF-1) and cognitive impairment in type 2 diabetes mellitus, and to analyze other factors influencing cognitive function such as insulin resistance and blood glucose control. Metabolism of blood lipids and blood pressure. Methods: 78 patients with type 2 diabetes mellitus admitted to our hospital from December 2011 to March 2012 were assessed with the Montreal Cognitive Assessment scale (MoCA). Type 2 diabetic patients were divided into diabetic cognitive impairment group (39 cases) and diabetic non-cognitive disorder group (39 cases). General clinical data including general information, past medical history, drug use and living habits were collected from all patients. Serum IGF-1 levels were measured by enzyme-linked immunosorbent assay (Elisa). The fasting insulin C peptide, fasting blood glucose, glycosylated hemoglobin, blood lipids, body mass index and blood pressure were measured in laboratory of Shandong Provincial Hospital. HOMA-IR model was used to calculate insulin resistance index. Record the results of the evaluation and record, and eliminate those who do not meet the requirements or exit the check. All data were analyzed by SPSS 18.0. Results: from November 2011 to March 2012, 78 patients with T2DM were selected, including 39 patients with diabetic cognitive impairment and 39 patients with diabetes non-cognitive impairment. Among them, there were only 18 cases of T2DM with hypertension and 14 cases of T2DM with dyslipidemia. There were 20 cases of T2DM complicated with hypertension and 26 cases of dyslipidemia. The body mass index (BMI), blood pressure (BP) of type 1.2 diabetic cognitive impairment group were compared with those of non-cognitive disorder group. High density lipoprotein (HDL), course of diabetes, fasting blood glucose and C peptide, diabetic complications involved no significant difference in the number of system, education, low density lipoprotein, total cholesterol, triglyceride, There were significant differences in insulin resistance index (HOMA-IR), fasting insulin, glycosylated hemoglobin and serum IGF-1 levels (P0.05). The level of serum IGF-1 in diabetic cognitive impairment group was lower than that in diabetic non-cognitive impairment group (P0.05). The MoCA score of type 3.2 diabetic patients was negatively correlated with the level of HbAlcl HOMA-IRR and fasting insulin (r = -0.411 ~ -0.498U -0.445 ~ -0.452- 0.539- 0.449p 0.05), and positively correlated with the years of education and IGF-1 (r = 0.579n 0.491g, P < 0.05). There were significant differences in visual structure space and language, abstraction, delayed memory, orientation, total score between the two groups (P0.05), but there was no significant difference in naming and attention (P0.05). Conclusion: 1. T2DM can lead to cognitive impairment, memory, executive function and visual spatial structure impairment. 2. 2. Low level of education, poor control of blood glucose, insulin resistance and dyslipidemia were closely related to cognitive impairment of type 2 diabetes mellitus. The decrease of serum IGF-1 level is a risk factor for cognitive impairment in type 2 diabetes mellitus.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R587.1;R749.2

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