【摘要】：目的： 通過研究中醫(yī)脾虛證及TOMM40基因(translocase of outer mitochondrial membrane40homolog)rs10524523位點(diǎn)的多態(tài)性與2型糖尿病輕度認(rèn)知功能障礙(mild cognitive impairment, MCI)的關(guān)系,進(jìn)一步明確2型糖尿病MCI的危險(xiǎn)因素和發(fā)病機(jī)理,為中西醫(yī)結(jié)合在2型糖尿病MCI的治療思路上提供循證依據(jù)。 對(duì)象與方法： 176例2型糖尿病患者,進(jìn)行蒙特利爾認(rèn)知評(píng)估表(Montreal Cognitive Assessment, MoCA)、工具性日常生活工具量表(Instrumental Activities of Daily Living, IADL)簡(jiǎn)易精神狀態(tài)量表(Mini-mental state examination, MMSE)等量表的評(píng)測(cè)。同時(shí),檢測(cè)其TOMM40基因rs10524523的多態(tài)性及紅細(xì)胞、血紅蛋白、白蛋白等血生化指標(biāo)。參照歐洲阿爾茨海默病協(xié)會(huì)制定的標(biāo)準(zhǔn)(2006)將研究對(duì)象分為2型糖尿病MCI組104例和2型糖尿病非MCI組(對(duì)照組)72例,2型糖尿病MCI組又根據(jù)中醫(yī)辨證分為脾虛證組56例及非脾虛證組48例,比較各組的基因頻率及各項(xiàng)臨床數(shù)據(jù)。 結(jié)果： (1)2型糖尿病MCI組和2型糖尿病非MCI組相比較,其糖尿病病程長(zhǎng),HbAlC、CRP、 TG、LDL升高明顯,MoCA評(píng)分等方面均有顯著統(tǒng)計(jì)學(xué)差異(P0.01)；CHOL水平及T0MM40基因rs10524523缺失基因型分布差異具有統(tǒng)計(jì)學(xué)意義(x2=4.252P0.05)；在性別、年齡、BMI、HDL、腹圍、有無高血壓病病史、吸煙史、家族史等方面差異無統(tǒng)計(jì)學(xué)意義。 (2)2型糖尿病MCI脾虛證組與非脾虛證組相比較,其紅細(xì)胞、血紅蛋白、血清白蛋白等血生化指標(biāo)均有差異,且有統(tǒng)計(jì)學(xué)意義(P0.05)；TOMM基因rs10524523缺失基因型的分布差異也具有統(tǒng)計(jì)學(xué)意義(x2=4.148P0.05)。而在年齡、性別、糖尿病病程、HbAlC、CRP、血脂水平等方面均無統(tǒng)計(jì)學(xué)差異。 結(jié)論： (1)MCI與2型糖尿病患者的病程長(zhǎng)短、血脂水平、血糖控制情況與有關(guān)。 (2)脾虛是2型糖尿病MCI的發(fā)病機(jī)制中很重要的一方面。從脾論治、健脾益氣是中醫(yī)治療2型糖尿病MCI很重要的一方面。 (3)檢測(cè)TOMM4G基因rs10524523的多態(tài)性可以在一定程度上提示2型糖尿病患者認(rèn)知功能障礙風(fēng)險(xiǎn)。 (4)從脾論治、健脾益氣的中醫(yī)辨證論治法則與西醫(yī)基因檢測(cè)方法互補(bǔ)在診斷治療2型糖尿病MCI方面更能發(fā)揮巨大作用。
[Abstract]:Objective: to study the relationship between the polymorphism of rs10524523 locus of spleen deficiency syndrome and TOMM40 gene (translocase of outer mitochondrial membrane40homolog and (mild cognitive impairment, MCI) in type 2 diabetes mellitus. To further clarify the risk factors and pathogenesis of type 2 diabetes mellitus (MCI), to provide evidence-based basis for the treatment of type 2 diabetes mellitus MCI with the combination of traditional Chinese and western medicine. Participants and methods: 176 patients with type 2 diabetes mellitus received Montreal Cognitive Assessment form (Montreal Cognitive Assessment, MoCA),) instrumental Daily living tool scale (Instrumental Activities of Daily Living, IADL), simple Mental State scale (Mini-mental state examination,). MMSE) and other scales. At the same time, the polymorphism of TOMM40 gene rs10524523 and blood biochemical indexes such as erythrocyte, hemoglobin and albumin were detected. According to the European Alzheimer's Association criteria (2006), the subjects were divided into two groups: type 2 diabetes mellitus (MCI) group (104 cases) and type 2 diabetes (non-MCI group) (control group) (72 cases). Type 2 diabetes mellitus MCI group was divided into spleen deficiency syndrome group (56 cases) and non-spleen deficiency syndrome group (48 cases) according to TCM syndrome differentiation. The gene frequency and clinical data of each group were compared. Results: (1) the duration of diabetes was longer, the HbAlC,CRP, TG,LDL was significantly increased and the MoCA score was significantly higher in type 2 diabetes mellitus than that in type 2 diabetes non-MCI group (P0.01). The CHOL level and the genotype distribution of T0MM40 rs10524523 deletion were statistically significant (x2=4.252P0.05), but there were no significant differences in sex, age, BMI,HDL, abdominal circumference, hypertension history, smoking history, family history and so on. (2) compared with non-spleen deficiency syndrome group and type 2 diabetes mellitus MCI spleen deficiency group, the blood biochemical indexes such as erythrocyte, hemoglobin and serum albumin were significantly different (P0.05); The distribution of rs10524523 deletion genotype of TOMM gene was also significantly different (x2=4.148P0.05). However, there were no significant differences in age, sex, course of diabetes, HbAlC,CRP, level of blood lipid and so on. Conclusion: (1) the duration of MCI and type 2 diabetes mellitus, blood lipid level and blood glucose control were related. (2) spleen deficiency is an important aspect in the pathogenesis of type 2 diabetes mellitus (MCI). From the point of view of spleen treatment, invigorating spleen and supplementing qi is one of the important aspects of TCM treatment of type 2 diabetes mellitus (MCI). (3) Detection of TOMM4G gene rs10524523 polymorphism may suggest the risk of cognitive dysfunction in type 2 diabetes mellitus. (4) the rule of TCM differentiation and treatment of invigorating spleen and invigorating qi and the method of gene detection of western medicine can play a more important role in the diagnosis and treatment of type 2 diabetes mellitus (MCI).
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.16

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