【摘要】：目的：通過(guò)對(duì)2型糖尿病(T2DM)患者的回顧性調(diào)查,了解控制血糖及其他相關(guān)危險(xiǎn)因素對(duì)認(rèn)知功能障礙(CI)的影響,探討早期防治糖尿病合并認(rèn)知功能障礙的方法。 方法：連續(xù)選取門(mén)診及體檢中心T2DM患者129例,根據(jù)其認(rèn)知功能評(píng)分(Mini. Mental State Examination, MMSE)分為3組：認(rèn)知功能正常組,輕度認(rèn)知功能障礙組(mild cognitive impairment,MCI)及癡呆組,將3組病例再根據(jù)糖化血紅蛋白數(shù)值各分為血糖控制滿意和控制不良組,對(duì)各組隨訪一年前后認(rèn)知功能程度的變化進(jìn)行比較。再將認(rèn)知功能正常組,輕度認(rèn)知功能障礙組(1nild cognitive impairment,MCI)及癡呆組3組病例根據(jù)高血壓的診斷標(biāo)準(zhǔn)各分為合并高血壓組與不合并高血壓組,對(duì)各組隨訪前后認(rèn)知功能程度的變化進(jìn)行比較。數(shù)據(jù)分析用SPSS11.5統(tǒng)計(jì)學(xué)軟件完成,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,兩組間均數(shù)比較采用t檢驗(yàn),計(jì)數(shù)資料比較采用x2檢驗(yàn),P0.05認(rèn)為差異有顯著性。 結(jié)果： 1.隨訪一年后,認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組與初診資料構(gòu)成比的比較,血糖控制組認(rèn)知功能障礙程度均好于控制不良組,采用x2檢驗(yàn),P0.05,差異有顯著性。 2.初診時(shí),認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組中血糖控制不良組較控制滿意組CMS水平低,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 隨訪1年后,三組中血糖控制不良組MMSE、CMS、指向記憶、聯(lián)想學(xué)習(xí)、圖象自由回憶、無(wú)意義圖形再認(rèn)、人像特點(diǎn)回憶水平均低于同期血糖控制滿意組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 隨訪1年后與初診資料的組間比較中,血糖控制組,只有人像特點(diǎn)回憶水平下降較一年前有所下降,,差異有統(tǒng)計(jì)學(xué)意義(P0.05)：而血糖控制不良組,MMSE、CMS、指向記憶、聯(lián)想學(xué)習(xí)、圖象自由回憶、無(wú)意義圖形再認(rèn)、人像特點(diǎn)回憶水平均低于一年前期血糖控制滿意組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 3.隨訪一年后,認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組與初診資料構(gòu)成比的比較,不合并高血壓組認(rèn)知功能障礙程度均好于合并高血壓組,采用x2檢驗(yàn),P0.05,差異有顯著性。 4.初診時(shí),認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組中合并高血壓組MMSE及MoCA評(píng)分均低于不合并高血壓組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 隨訪一年后,認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組中合并高血壓組MMSE及MoCA評(píng)分均低于同期不合并高血壓組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 隨訪一年后,認(rèn)知功能正常組,輕度認(rèn)知功能障礙組及癡呆組中相同血壓情況的隨訪病(?)MMSE及MoCA評(píng)分均低于初診病例,差異有統(tǒng)計(jì)學(xué)意義,(P0.05)。 結(jié)論： 1.血糖控制不良可增加糖尿病患者認(rèn)知功能障礙的進(jìn)展。 2.血糖控制不良可使記憶功能損傷的范圍明顯擴(kuò)大。 3.糖尿病合并高血壓,可進(jìn)一步促加重認(rèn)知功能障礙的進(jìn)展。 4.良好的血糖和血壓控制會(huì)有效的預(yù)防糖尿病合并認(rèn)知功能障礙的進(jìn)展。
[Abstract]:Objective: To investigate the effect of blood glucose control and other related risk factors on cognitive impairment (CI) in patients with type 2 diabetes mellitus (T2DM), and to explore the methods of early prevention and treatment of diabetes mellitus complicated with cognitive impairment.
Methods: A total of 129 T2DM patients in outpatient and physical examination centers were divided into three groups according to their cognitive function score (MMSE): normal cognitive function group, mild cognitive impairment (MCI) group and dementia group. The patients with normal cognitive function, mild cognitive impairment (MCI) and dementia were divided into hypertension group and non-hypertension group according to the diagnostic criteria of hypertension. The data analysis was performed by SPSS11.5 statistical software. The mean (+ standard deviation) was used to express the measurement data. The t test was used to compare the mean between the two groups. The x2 test was used to compare the counting data. P 0.05 showed that the difference was significant.
Result:
1. After a year of follow-up, the cognitive impairment of normal group, mild cognitive impairment group and dementia group was better than that of poor control group. The difference was significant by x2 test (P 0.05).
2. At the initial diagnosis, the CMS level in the normal cognitive function group, mild cognitive impairment group and dementia group was lower than that in the satisfactory control group (P 0.05).
After 1 year follow-up, MMSE, CMS, directional memory, associative learning, free recall of images, recognition of meaningless graphics, and recall of portrait characteristics in the three groups were significantly lower than those in the same period of glycemic control satisfaction group (P 0.05).
After 1 year of follow-up, compared with the first visit, the recall level of the blood glucose control group was lower than that of one year ago, and the difference was statistically significant (P 0.05). There was statistically significant difference in the pre - glucose control group (P0.05).
3. After a year of follow-up, the proportion of cognitive impairment in normal group, mild cognitive impairment group and dementia group was better than that in hypertension group. The difference was significant by x2 test (P 0.05).
4. At the initial diagnosis, MMSE and MoCA scores of normal cognitive function group, mild cognitive impairment group and dementia group with hypertension were lower than those of non-hypertension group (P 0.05).
After a year of follow-up, the scores of MMSE and MoCA in normal cognitive function group, mild cognitive impairment group and dementia group with hypertension were lower than those in non-hypertension group (P 0.05).
After one year of follow-up, the scores of MMSE and MoCA in the patients with normal cognitive function, mild cognitive impairment and dementia were lower than those in the patients with initial diagnosis (P 0.05).
Conclusion:
1. poor glycemic control can increase the progression of cognitive dysfunction in diabetic patients.
2. impaired glucose control can significantly increase the range of memory impairment.
3. diabetes and hypertension can further promote the progression of cognitive dysfunction.
4. good glycemic control and blood pressure control can effectively prevent the progression of diabetes combined with cognitive impairment.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R749.1

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