本文選題：胱抑素C + 頸動(dòng)脈硬化�。� 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:研究血清胱抑素C(Cystatin C)、頸動(dòng)脈硬化在評(píng)估老年2型糖尿病(Type 2 diabetes mellitus,T2DM)患者認(rèn)知功能損害方面的臨床價(jià)值,并分析三者之間的相關(guān)性及對(duì)認(rèn)知功能損害不同區(qū)域的差異。方法:選取蘭州大學(xué)第二醫(yī)院內(nèi)分泌代謝二科診治的老年2型糖尿病住院患者169例,其中男性106例,女性63例,均符合WHO(1999)糖尿病診斷標(biāo)準(zhǔn);以簡(jiǎn)易智力精神狀態(tài)量表(Mini-mental state examination,MMSE)作為診斷T2DM認(rèn)知損害的測(cè)評(píng)工具,診斷標(biāo)準(zhǔn)以MMSE總分≥27分為糖尿病認(rèn)知功能正常組,27分為認(rèn)知功能障礙組,為排除文化程度對(duì)認(rèn)知的影響,受教育年限≤12年,得分再加1分。其中糖尿病認(rèn)知功能正常組69例,糖尿病認(rèn)知障礙組100例,對(duì)兩組的性別、年齡進(jìn)行匹配,比較兩組間的MMSE總得分、各分項(xiàng)分值及一般臨床資料分析,同時(shí)進(jìn)行多因素非條件Logistic回歸分析,比較血清Cystatin C、頸動(dòng)脈硬化在老年T2DM認(rèn)知障礙方面的診斷價(jià)值,同時(shí)探討老年T2DM發(fā)生認(rèn)知功能障礙的其他影響因素;頸動(dòng)脈硬化以頸動(dòng)脈內(nèi)中膜厚度(Intima-media thickness,IMT)為診斷標(biāo)準(zhǔn),將IMT≤1.0mm為無頸動(dòng)脈內(nèi)膜增厚,N=103例,IMT1.0mm為頸動(dòng)脈硬化,N=66例,比較不同頸動(dòng)脈硬化程度的患者與MMSE總分及各分項(xiàng)分值的相關(guān)性。結(jié)果:1兩組間一般資料分析顯示,年齡、性別、體重指數(shù)、不同降糖方案均無統(tǒng)計(jì)學(xué)意義(P0.05),說明各因素在兩組間分配良好,而兩組患高血壓情況有顯著統(tǒng)計(jì)學(xué)意義(P0.001),T2DM認(rèn)知障礙組合并高血壓人數(shù)明顯升高。2老年T2DM認(rèn)知功能正常組Cys-C水平1.04±0.49mg/L,頸動(dòng)脈IMT0.96±0.18mm;老年T2DM認(rèn)知障礙組Cys-C水平1.32±0.48mg/L,頸動(dòng)脈IMT1.1±0.24mm,兩組間數(shù)據(jù)比較,Cys-C及IMT在T2DM認(rèn)知障礙組水平較高,分布差異有統(tǒng)計(jì)學(xué)意義(P0.001);T2DM認(rèn)知功能正常組MMSE總評(píng)分28.19±0.98,T2DM認(rèn)知障礙組22.49±4.01,差別有顯著統(tǒng)計(jì)學(xué)意義(P0.001),此外,甘油三酯、高密度脂蛋白在兩組間差別亦有統(tǒng)計(jì)學(xué)意義(P0.05),而總膽固醇、低密度脂蛋白、肌酐、尿酸的差別無統(tǒng)計(jì)學(xué)意義;兩組間合并糖尿病情況分析,其中糖尿病病程、糖化血紅蛋白、空腹血糖、胰島素抵抗指數(shù)均有統(tǒng)計(jì)學(xué)意義(P0.05),糖化血紅蛋白處于統(tǒng)計(jì)學(xué)意義的邊緣(P=0.049),而餐后2小時(shí)血糖在兩組間差別無統(tǒng)計(jì)學(xué)意義(P0.05)。3以頸動(dòng)脈IMT 1.0mm為界,比較不同程度頸動(dòng)脈硬化在MMSE總分及各分項(xiàng)分值的差異,在頸動(dòng)脈IMT≤1.0mm組,MMSE總分為25.11±3.78,IMT1.0mm組,MMSE總分22.06±3.77,頸動(dòng)脈IMT小的MMSE分值大,MMSE在兩組間差別有統(tǒng)計(jì)學(xué)意義(P0.001),同時(shí)MMSE各分項(xiàng)包括注意力、回憶力、語(yǔ)言力、定向力、記憶力在兩組間差別亦有統(tǒng)計(jì)學(xué)意義(P0.05);Cys-C與MMSE總分及各分項(xiàng)得分均呈負(fù)相關(guān),其中Cys-C與MMSE總分r=-0.455,定向力r=-0.423,注意力r=-0.383,語(yǔ)言力r=-0.411均呈負(fù)相關(guān)(r0 P0.05),而與記憶力r=-0.142,回憶力r=-0.146的負(fù)相關(guān)處于統(tǒng)計(jì)學(xué)邊緣(P=0.066、P=0.058);而Cys-C與IMT呈正相關(guān)(r=0.178 P=0.02)。4在0.05檢驗(yàn)水準(zhǔn)下,多因素非條件Logistic回歸分析提示共6個(gè)變量進(jìn)入方程:糖尿病病程、糖尿血紅蛋白、Cys-C、IMT、合并高血壓情況、使用的降糖方案,糖尿病病程(OR:0.291,95%CI:0.167-0.510,P0.001),Cys-C(OR:0.450,95%CI:0.242-0.836,P=0.012),IMT(OR:0.495,95%CI:0.264-0.925,P=0.028),糖化血紅蛋白(OR:0.549,95%CI:0.361-0.834,P=0.005))與T2DM認(rèn)知功能障礙危險(xiǎn)性的關(guān)聯(lián)有統(tǒng)計(jì)學(xué)意義。結(jié)論:T2DM認(rèn)知功能損害的危險(xiǎn)因素包括Cys-C、頸動(dòng)脈IMT、高血壓、糖尿病病程和糖化血紅蛋白,Cys-C可能與頸動(dòng)脈硬化共同作用,參與了T2DM認(rèn)知障礙的發(fā)生發(fā)展。
[Abstract]:Objective: To study the clinical value of serum cystatin C (Cystatin C) and carotid arteriosclerosis in assessing cognitive impairment in elderly patients with type 2 diabetes mellitus (Type 2 diabetes mellitus, T2DM), and to analyze the correlation between the three and the differences in different areas of cognitive impairment. Methods: two families of Endocrinology and metabolism in Second Hospital Affiliated to Lanzhou University were selected. 169 cases of hospitalized elderly patients with type 2 diabetes were treated, of which 106 were male and 63 were female, all in accordance with WHO (1999) diabetes diagnostic criteria; the simple mental state scale (Mini-mental state examination, MMSE) was used as an assessment tool for the diagnosis of T2DM cognitive impairment, and the diagnostic standard was divided into the normal group of diabetes cognitive function with the total score of MMSE score more than 27, 2 7 were divided into cognitive impairment group, in order to exclude the influence of cultural degree on cognition, the number of years of education was less than 12 years, and the score was 1 points. Among them, 69 cases of diabetic cognitive function group and 100 diabetic cognitive impairment group were matched to the sex and age of the two groups, the total score of MMSE among the two groups was compared, the scores of each sub item and general clinical data were analyzed. Multifactor unconditional Logistic regression analysis was used to compare the diagnostic value of serum Cystatin C and carotid atherosclerosis in the elderly with cognitive impairment of T2DM, and to explore the other influencing factors of cognitive impairment in elderly T2DM; carotid arteriosclerosis was diagnosed as the carotid artery middle membrane thickness (Intima-media thickness, IMT) as the diagnostic criterion, and IMT < 1. Mm had no carotid intima intima thickening, N=103 cases, IMT1.0mm as carotid arteriosclerosis, N=66 cases, and compared the correlation between the total scores of different carotid atherosclerosis and the total score of MMSE. Results: 1 the general data analysis between the two groups showed that age, sex, body mass index, and different hypoglycemic schemes were not statistically significant (P0.05), indicating that the factors were two The group distribution was good, but the two groups of hypertension had significant statistical significance (P0.001), the combination of T2DM cognitive impairment and the number of hypertension increased significantly in the normal group of.2 aged T2DM cognitive function, Cys-C level was 1.04 + 0.49mg/L, the carotid IMT0.96 + 0.18mm, the Cys-C level of the elderly T2DM cognitive impairment group was 1.32 + 0.48mg/L, the carotid IMT1.1 = two groups were between the two groups. The level of Cys-C and IMT in T2DM cognitive impairment group was higher, and the distribution difference was statistically significant (P0.001), the total MMSE score of T2DM cognitive function group was 28.19 + 0.98, T2DM cognitive impairment group was 22.49 + 4.01, and the difference was statistically significant (P0.001), in addition, the difference of glycerol three ester and high density lipoprotein in the two groups was also statistically significant (P0.) 05), there was no significant difference in total cholesterol, low density lipoprotein, creatinine and uric acid. The analysis of diabetes in the two groups was statistically significant (P0.05) in the course of diabetes, glycated hemoglobin, fasting blood glucose, and insulin resistance index (P=0.049), and 2 hours postprandial blood. The difference between the two groups was not statistically significant (P0.05).3 with the IMT 1.0mm of the carotid artery as the boundary. The difference in the total MMSE score and the score of different degrees of carotid atherosclerosis was compared. In the IMT < 1.0mm group, the total score of MMSE was 25.11 + 3.78, IMT1.0mm group, MMSE total score of 22.06 + 3.77, and the IMT fraction of the carotid artery was large. There was a statistical difference between the two groups. Learning significance (P0.001), at the same time, each sub item of MMSE includes attention, memory, language force, orientation and memory, and there are also significant differences between the two groups (P0.05); Cys-C has a negative correlation with the total score of MMSE and the scores of each sub item, of which Cys-C and MMSE total score r=-0.455, directional force r=-0.423, attention r=-0.383, and linguistic force r=-0.411 are negatively correlated (R0) 05), and the negative correlation between memory r=-0.142 and memory r=-0.146 was on the edge of Statistics (P=0.066, P=0.058); while Cys-C and IMT were positively correlated (r=0.178 P=0.02).4 at 0.05 test levels, multiple factor non conditional Logistic regression analysis suggested that 6 variables entered the equation: diabetes course, diabetic hemoglobin, Cys-C, IMT, combined with hypertension There was a statistically significant correlation between the glucose lowering program (OR:0.291,95%CI:0.167-0.510, P0.001), Cys-C (OR:0.450,95%CI:0.242-0.836, P=0.012), IMT (OR:0.495,95%CI:0.264-0.925, P=0.028), glycosylated hemoglobin (OR:0.549,95%CI:0.361-0.834, P=0.005)) and the risk of T2DM cognitive dysfunction. The risk factors include Cys-C, carotid IMT, hypertension, the course of diabetes and glycosylated hemoglobin, and Cys-C may be associated with carotid atherosclerosis and participate in the development of T2DM cognitive impairment.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2

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