【摘要】：目的:本研究通過檢測(cè)2型糖尿病(Type 2 diabetes mellitus,T2DM)患者及健康對(duì)照組人群血清s Fas(soluble fas)、s Fasl(soluble fas ligand)水平,同時(shí)使用可重復(fù)的成套神經(jīng)心理狀態(tài)測(cè)量量表(Repeatable battery for the assessment of neuropsychological status,RBANS量表)對(duì)病例組2型糖尿病患者及健康對(duì)照組人群進(jìn)行認(rèn)知功能評(píng)定,使用抑郁自評(píng)量表(Self-Rating Depression Scale,SDS量表)對(duì)入組2型糖尿病患者及健康對(duì)照組人群進(jìn)行抑郁狀態(tài)評(píng)定,并通過檢測(cè)病例組2型糖尿病患者一般資料及生化指標(biāo),進(jìn)行統(tǒng)計(jì)學(xué)分析,來探討2型糖尿病患者血清s Fas、s Fasl水平變化及其認(rèn)知功能、抑郁狀態(tài)情況,并進(jìn)一步探討血清s Fas、s Fasl水平與2型糖尿病患者認(rèn)知功能及抑郁狀態(tài)的相關(guān)性及其可能機(jī)制。方法:選取2013年3月~2014年3月期間,河北省唐山市唐山工人醫(yī)院內(nèi)分泌二科住院的2型糖尿病患者63例設(shè)為病例組,健康體檢中心選取68例血糖值及糖化血紅蛋白值正常者設(shè)為健康對(duì)照組。收集兩組對(duì)象年齡(age)、性別(sex)、學(xué)歷(education)、病程(course)、體重指數(shù)(Body Mass Index,BMI)等一般資料及空腹血糖(Fasting plasma glucose,FPG)、糖化血紅蛋白(Hb A1c)、總膽固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High-density lipoprotein,HDL-C)、低密度脂蛋白(Low-density lipoprotein,LDL-C)等生化指標(biāo)。病例組另外進(jìn)行空腹胰島素(Fasting insulin,FINS)測(cè)定,用于計(jì)算胰島素抵抗指數(shù)(Homeostasis model assessment of insulin resistance,HOMA-IR)。同時(shí)測(cè)定研究對(duì)象血清s Fas、s Fasl水平并進(jìn)行統(tǒng)計(jì)分析比較。根據(jù)RBANS量表評(píng)分評(píng)定兩組研究對(duì)象認(rèn)知功能,根據(jù)抑郁自評(píng)量表(SDS)評(píng)分比較兩組研究對(duì)象抑郁狀態(tài)。并進(jìn)行病例組血清s Fas、s Fasl水平與其余各項(xiàng)指標(biāo)的單因素相關(guān)性分析及多元逐步回歸分析。結(jié)果:1病例組與健康對(duì)照組比較結(jié)果①兩組一般資料與臨床生化指標(biāo)比較結(jié)果:病例組較健康對(duì)照組FPG、Hb A1C、TC、TG水平升高,HDL水平降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(見Table 1,Fig.1-Fig.5)②兩組血清s Fas和s Fasl水平比較結(jié)果:病例組血清s Fas水平較健康對(duì)照組水平升高,血清s Fasl水平較健康對(duì)照組水平下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(見Table 2,Fig.6-Fig.7)③兩組認(rèn)知功能比較結(jié)果:病例組即時(shí)記憶、視覺空間、延時(shí)記憶和RBANS總分較健康對(duì)照組評(píng)分低,差異具有統(tǒng)計(jì)學(xué)差異(P0.05),而言語功能、注意力則無統(tǒng)計(jì)學(xué)差異(P0.05)。(見Table 3,Fig.8-Fig.11)④兩組抑郁量表評(píng)分比較結(jié)果:病例組抑郁評(píng)分較健康對(duì)照組評(píng)分高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(見Table 4,Fig.12)2病例組各指標(biāo)相關(guān)分析及多元逐步回歸分析結(jié)果:①病例組血清s Fas和s Fasl水平與臨床生化指標(biāo)的相關(guān)性分析:血清s Fas水平與FINS、HOMA-IR、Hb A1c呈正相關(guān)(P0.05)。血清s Fasl水平與FPG、FINS、HOMA-IR呈負(fù)相關(guān)(P0.05)。(見Table 5)多元逐步回歸分析結(jié)果進(jìn)一步顯示:校正了混雜因素影響后,s Fas仍與HOMI-IR呈正相關(guān)(t=3.249,P=0.002)。s Fasl仍與HOMA-IR呈負(fù)相關(guān)(t=-2.299,P=0.025)。(見Table 8-Table 9,Fig.13-Fig.14)②病例組血清s Fas、s Fasl水平與其認(rèn)知功能的相關(guān)性分析:血清s Fas水平與RBANS量表中的子項(xiàng)目視覺空間及RBANS量表總分呈負(fù)相關(guān)(P0.05)。血清s Fasl水平與RBANS量表總分呈正相關(guān)(P0.05)。(見Table 6)進(jìn)一步行認(rèn)知功能總分、各子項(xiàng)目與其余各指標(biāo)的多元逐步回歸分析結(jié)果顯示:校正了混雜因素影響后(1)RBANS量表總分與HOMA-IR(t=-3.61,P=0.001)、Age(t=-2.65,P=0.010)、s Fas(t=-2.309,P=0.024)呈負(fù)相關(guān)。(見Table 10,Fig.15-Fig.16)(2)即時(shí)記憶與年齡(t=-3.312,P=0.002)、HOMA-IR(-3.007,P=0.004)呈負(fù)相關(guān)。(3)視覺空間與s Fas(t=-2.537,P=0.014)呈負(fù)相關(guān)。(4)言語功能與HOMA-IR(t=-2.905,P=0.005)呈負(fù)相關(guān)。(5)注意力與HOMA-IR(t=-3.534,P=0.001)呈負(fù)相關(guān),與教育(t=2.321,P=0.024)呈正相關(guān)。(6)延時(shí)記憶與HOMA-IR(t=-5.145,P0.001)、年齡(t=-2.589,P=0.012)呈負(fù)相關(guān)。③病例組血清s Fas、s Fasl水平與其SDS評(píng)分的相關(guān)性分析:血清s Fas水平與SDS評(píng)分呈正相關(guān)(P0.05)。(見Table 7)多元逐步回歸分析結(jié)果顯示:校正了混雜因素影響后,SDS評(píng)分仍與HOMA-IR(t=2.538,P=0.014)、Age(t=2.759,P=0.008)、s Fas(t=3.062,P=0.003)呈正相關(guān)。(見Table 11,Fig.17-Fig.18)結(jié)論:1 2型糖尿病患者血清s Fas水平升高,s Fasl水平降低,表明2型糖尿病患者s Fas/s Fasl系統(tǒng)存在異常改變。2 2型糖尿病患者存在認(rèn)知功能損傷,易伴發(fā)抑郁狀態(tài)。3 2型糖尿病患者血清s Fas水平與認(rèn)知功能障礙及抑郁的發(fā)生密切相關(guān)。
[Abstract]:AIM: To investigate the serum levels of s Fas (soluble fas), s Fasl (soluble Fas ligand) in type 2 diabetes mellitus (T2DM) patients and healthy controls, and to use a repeatable Repeatable battery for the assessment of neuropsychological status (RBANS). Cognitive function of type 2 diabetes mellitus patients and healthy control group was assessed. Self-Rating Depression Scale (SDS) was used to assess depressive status of type 2 diabetes mellitus patients and healthy control group. The general data and biochemical indexes of type 2 diabetes mellitus patients were tested. Statistical analysis was conducted to investigate the changes of serum s Fas and s Fasl levels and their cognitive function, depression status in patients with type 2 diabetes mellitus, and to further explore the correlation between serum s Fas and s Fasl levels and cognitive function and depression status in patients with type 2 diabetes mellitus. Sixty-three patients with type 2 diabetes mellitus hospitalized in the Department of Endocrinology of Shandong Workers Hospital were divided into the case group and 68 patients with normal blood glucose and glycosylated hemoglobin were selected as the healthy control group. Fasting plasma glucose (FPG), glycosylated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and other biochemical indicators. The case group was also fasting insulin (Fasting insulin, LDL-C). In, FINS was used to calculate the Homeostasis model assessment of insulin resistance (HOMA-IR). Serum levels of s Fas and s Fasl were measured and compared statistically. The cognitive function of the two groups was assessed according to the RBANS scale, and the self-rating depression scale (SDS) was used to compare the two groups. Result: 1. Comparison between case group and healthy control group. Results: The general data of two groups and clinical biochemical indexes were compared. Results: The levels of FPG, Hb A1C, TC, TG in case group were higher than those in healthy control group, HDL was higher. The level of serum s Fas and s Fasl in the case group was higher than that in the healthy control group, and the level of serum s Fasl was lower than that in the healthy control group, the difference was statistically significant (P 0.05). (See Table 2, Fig.6-Fig.7) Results: The scores of immediate memory, visual space, delayed memory and RBANS in the case group were lower than those in the healthy control group (P 0.05), but there was no significant difference in speech function and attention (P 0.05). (See Table 3, Fig.8-Fig.11) The results of correlation analysis and multiple stepwise regression analysis showed that: (1) The correlation analysis of serum s Fas and s Fasl levels with clinical biochemical indicators in case group: Serum s Fas levels were positively correlated with FINS, HOMA-IR, Hb A1c (P 0.05). Serum s Fasl levels were positively correlated with FPG, FI. NS, HOMA-IR was negatively correlated (P 0.05). (See Table 5) Multivariate stepwise regression analysis further showed that after correction for confounding factors, s Fasl was still positively correlated with HOMI-IR (t = 3.249, P = 0.002). s Fasl was negatively correlated with HOMA-IR (t = - 2.299, P = 0.025). (See Table 8-Table 9, Fig. 13-Fig. 14) Correlation analysis: Serum s Fasl level was negatively correlated with the sub-item visual space and the total score of the RBANS scale (P 0.05). Serum s Fasl level was positively correlated with the total score of the RBANS scale (P 0.05). (See Table 6). Further, the total score of cognitive function was calculated, and the results of multiple stepwise regression analysis showed that the sub-items and the other indicators were correlated. (1) The total score of RBANS was negatively correlated with HOMA-IR (t = - 3.61, P = 0.001), Age (t = - 2.65, P = 0.010), Fas s (t = - 2.309, P = 0.024). (see Table 10, Fig. 15-Fig. 16) (2) Immediatmemory and age (t = - 3.312, P = 0.312, P = 0.002), HOMA-IR (- 3.007, P = 0.007, P = 0.004) Ag (t = - 2.65, P = 0.010 0 0 0 0 0 0 0 0 0 0), Fas (t = - 2.309, P = 0.309, P = 0.024) Fas (see Table 10, Fig. 15 537, P = 0.014) was negatively correlated. Language function was negatively correlated with HOMA-IR (t =-2.905, P = 0.005). (5) Attention was negatively correlated with HOMA-IR (t =-3.534, P = 0.001), and was positively correlated with education (t = 2.321, P = 0.024). (6) Delayed memory was negatively correlated with HOMA-IR (t =-5.145, P = 0.001), age (t =-2.589, P = 0.012). 3. Fas s and Fas s levels were negatively correlated with serum SDS scores. Fas levels were positively correlated with SDS scores (P 0.05). (See Table 7) Multivariate stepwise regression analysis showed that SDS scores were positively correlated with HOMA-IR (t = 2.538, P = 0.014), Age (t = 2.759, P = 0.008), and s Fas (t = 3.062, P = 0.003). (See Table 11, Fig. 17-Fig. 18) Conclusion: Serum s Fas levels in type 2 diabetes mellitus were elevated and s Fas levels were positively correlated. The decrease of Fasl level indicates that there are abnormal changes in the s Fas/s Fasl system in type 2 diabetes mellitus. 2 Type 2 diabetes mellitus patients have cognitive impairment and are prone to depression. 3 Type 2 diabetes mellitus patients'serum s Fas level is closely related to cognitive impairment and depression.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1

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