本文關(guān)鍵詞： 2型糖尿病 輕度認(rèn)知障礙 糖尿病血管并發(fā)癥　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景伴隨經(jīng)濟(jì)社會(huì)的發(fā)展,2型糖尿病(T2DM)和癡呆(dementia)的發(fā)病率均明顯升高,成為全球性的重要公共衛(wèi)生問(wèn)題,輕度認(rèn)知功能障礙(mild cognitive impairment, MCI)是介于正常老齡化和癡呆之間的過(guò)渡狀態(tài),是發(fā)展成癡呆的重要“前驅(qū)信號(hào)”。盡管大量研究表明T2DM與MCI密切相關(guān),但MCI與糖尿病血糖控制及血管并發(fā)癥的關(guān)系在不同研究人群中得出的結(jié)論并不完全一致。研究目的分析合并MCI的T2DM患者及認(rèn)知功能正常的T2DM患者各項(xiàng)代謝指標(biāo)的差異,探討T2DM患者患MCI的危險(xiǎn)因素以及MCI與T2DM患者血糖控制情況和糖尿病血管并發(fā)癥的相關(guān)性。研究方法對(duì)2014年1月——2014年10月期間于威海市立醫(yī)院內(nèi)分泌科住院40歲以上的T2DM患者根據(jù)蒙特利爾認(rèn)知評(píng)估量表(MoCA)進(jìn)行認(rèn)知功能評(píng)分,以26分作為MCI的標(biāo)準(zhǔn),分為MCI組和對(duì)照組,每組患者各200例。比較兩組間空腹血糖(FBG)、餐后2小時(shí)血糖(2hPG)、空腹胰島素(FINS).糖化血紅蛋白(HbAlc)、頸動(dòng)脈內(nèi)中膜厚度(IMT)、同型半胱氨酸(Hcy)、尿微量白蛋白(Alb)以及吸煙、飲酒等指標(biāo)的差異,分析MoCA評(píng)分的影響因素以及MCI發(fā)生的危險(xiǎn)因素。以7%為臨界值將所有研究對(duì)象分為血糖控制達(dá)標(biāo)組(HbAlc≤7)和血糖控制不良組(HbAlc7),分析兩組間各種代謝指標(biāo)和MoCA評(píng)分的差異,探討MCI在血糖控制中的作用。以尿微量蛋白≥30mg/L為臨界值將所有研究對(duì)象分為糖尿病腎病組(DN組)和對(duì)照組,分析兩組間各項(xiàng)指標(biāo)的差異,探討MCI在DN發(fā)生中的作用。根據(jù)是否患糖尿病視網(wǎng)膜病變(DR),將研究對(duì)象分為DR組和對(duì)照組,對(duì)比兩組間的差異并分析MCI在DR發(fā)生中的作用。根據(jù)IMT≥1mm為臨界值,將研究對(duì)象分為IMT增厚組和對(duì)照組,對(duì)比兩組間的差異并分析MCI在IMT增厚中的作用。結(jié)果1.MCI組HbAlc、Hcy、總膽固醇(TC)、非高密度脂蛋白(non-HDL-C)、低密度脂蛋白膽固醇(LDL-C)、尿Alb、胱抑素C(Cyc)、IMT, DN及DR患病率、吸煙率均較對(duì)照組顯著升高,高密度脂蛋白膽固醇(HDL-C)較對(duì)照組顯著降低(所有P0.05)。2.多元線性逐步回歸分析示HbAlc、Hcy、non-HDL-C、IMT、TG、尿Alb均與MoCA呈負(fù)相關(guān),是MoCA評(píng)分的危險(xiǎn)因素(所有P0.05)。二元logistic回歸分析示HbAlc、Hcy、non-HDL-C、尿Alb、DR、IMT、吸煙是T2DM患者發(fā)生MCI的危險(xiǎn)因素(OR=I.396、1.134、1.690、1.003、2.239、1.253、1.670)。3. HbAlc7組Hcy、尿Alb、 MCI及DN患病率均較HbAlc≤7組明顯升高(P0.05), MoCA評(píng)分較HbAlc≤7組明顯降低(P0.05); Logistic回歸分析示,在校正了BMI、Hcy、non-HDL-C、胰島素抵抗、吸煙等因素后,MCI(OR=I.370,P=0.008)仍是HbAlc7的危險(xiǎn)因素。4.DN組的MoCA評(píng)分較對(duì)照組明顯降低,Hcy、Cr、尿Alb、Cyc、 HbAlc、MCI患病率、吸煙率、IMT均較對(duì)照組明顯升高(P0.05)；Logistic回歸分析示,在校正了糖尿病病程、HbAlc、Hey、吸煙、IMT等因素后,MCI (OR=1.534,P=0.019)仍是DN的危險(xiǎn)因素。5.DR組MoCA評(píng)分及FINS低于非DR組,MCI患病率高于非DR組(P0.05)；Logistic回歸分析示在校正了糖尿病病程、尿Alb、FINS、吸煙、IMT等因素后,MCI (OR=1.206,P=0.038仍是DR的危險(xiǎn)因素。6.Logistic回歸分析示在校正了糖尿病病程、HbAlc、Hcy、吸煙、TG、LDL等因素后,MCI (OR=1.632, P=0.028)仍是IMT增厚的危險(xiǎn)因素。結(jié)論1.T2DM伴MCI患者代謝紊亂情況較單純T2DM者更加嚴(yán)重,HbAlc、Hey、 non-HDL-C、吸煙及IMT增厚可能是T2DM患者伴發(fā)MCI的危險(xiǎn)因素。2.在中老年T2DM人群中,合并MCI的患者可能更容易發(fā)生血糖控制不良、DR及IMT增厚(動(dòng)脈粥樣硬化)。
[Abstract]:Background with the development of economy and society, type 2 diabetes mellitus (T2DM) and Alzheimer's disease (dementia) incidence increased significantly, has become an important global public health problem, mild cognitive impairment (mild cognitive, impairment, MCI) between normal aging and dementia between the transition state, is an important precursor signal "development dementia. Although a large number of studies show that T2DM and MCI are closely related, but the relationship between MCI and blood glucose control and vascular complications of diabetes in different research groups in the conclusion is not entirely consistent. The purpose of the study is to analysis differences of metabolism indexes in patients with T2DM T2DM patients with normal cognitive function and combined with MCI, to investigate the risk of MCI patients T2DM factors and MCI and blood glucose control in patients with T2DM and diabetic vascular complications. The correlation research methods on January 2014, October 2014 in Weihai City Hospital Department of Endocrinology hospital over 40 T2DM patients according to Montreal cognitive assessment scale (MoCA) were scored with 26 points as the standard of MCI, divided into MCI group and control group, there were 200 cases in each group. The comparison between two groups of fasting blood glucose (FBG), 2 hour postprandial blood glucose (2hPG) fasting insulin, glycosylated hemoglobin (FINS). (HbAlc), carotid artery intima-media thickness (IMT), homocysteine (Hcy), urinary albumin (Alb), smoking, drinking and other indicators of differences, risk factors and MCI. The effect of MoCA score. 7% of the critical value all subjects were divided into control group (HbAlc = 7) blood glucose control and poor glycemic control group (HbAlc7), analysis of differences between the two groups of various metabolic indicators and scores of MoCA, to explore the role of MCI in glucose control. The urine protein is more than 30mg/L critical value of all the research objects were divided into sugar 灝跨梾鑲劇梾緇，

本文編號(hào)：1484774