老年2型糖尿病患者认知功能障碍与平均血糖波动幅度的关系  

The relationship between mean amplitude of glycemic excursions and cognitive impairment in elderly patients with type 2 diabetes

作　　者：李新玲[1] 朱向阳[1] 黄怀宇[1] 徐峰[2] 

机构地区：[1]江苏南通大学第二附属医院神经内科,南通226001 [2]江苏南通大学第二附属医院内分泌科,226001

出　　处：《中华老年医学杂志》2012年第12期1066-1069,共4页Chinese Journal of Geriatrics

基　　金：南通市社会发展计划（S2009041）

摘　　要：目的探讨老年2型糖尿病患者认知功能障碍与平均血糖波动幅度（meanamplitudeofglycemicexcursions，MAGE）之间的关系，并评估其是否为独立影响认知功能的因素。方法选择60岁以上老年2型糖尿病患者80例，采用蒙特利尔认知评估量表（MontrealCognitiveAssessment，MoCA）进行认知功能测定，根据测定结果分为认知障碍组（31例）和非认知障碍组（49例）；所有患者均行72h连续皮下血糖监测，测定平均血糖（meanbloodglucose，MBG）、标准差（standarddeviation，SD）、日内MAGE及波动次数。结果认知障碍组与非认知障碍组比较，糖尿病病程、空腹血糖、餐后2h血糖、糖化血红蛋白、体质指数差异均有统计学意义（均P〈0．05）；MAGE[（5．89±2．17）mmol／L对（3．15±0．60）mmol／L，t=8．37，P=0．003、MBG[（11．85±3．45）mmol／L对（8．23±1．73）mmol／L，t=6．23，P=0．OO]、SD[（3．16±1．29）mmol／L对（1．26±0．42）mmol／L，产9．57，P=0．00；差异均有统计学意义。MAGE与MoCA评分呈负相关（r=-0．891，P〈0．01）；多元线性回归分析显示，糖尿病病程、餐后2h血糖、MAGE、SD与2型糖尿病患者认知功能障碍发病关系最为密切（β=-0．244、-0．375、-1．186、-1．455，均P〈0．05）。结论日内MAGE不依赖于空腹血糖、餐后血糖及糖化血红蛋白与认知功能障碍密切相关。Objective To investigate the relationship between mean amplitude of glycemic excursions （MAGE） and cognitive impairment in elderly patients with type 2 diabetes. Methods Totally 80 patients （aged 60 years） with type 2 diabetic were selected. According to the Montreal Cognitive Assessment （MoCA） score, the patients were divided into two groups., cognitive impairment group （31cases） and non-cognitive impairment group （49 cases）. Then all subjects were observed by continuous glucose monitoring for 3 days including the mean blood glucose （MBG） and its standard deviation （SD）, MAGE and numbers of glycemic excursion （NGE）. Results Compared with non- cognitive impairment group, diabetic course, fasting blood glucose, 2 h postprandial glycemia, glycosylated hemoglobin （HbAlc） and body mass index （BMI） were significantly different with the cognitive impairment group （P^0.05）. Furthermore, MAGE, MBG and SD were obviously higher than those in the non-cognitive impairment group[（5.89 ±2.17）mmol/L vs. （3.15 ± 0.60）mmol/L, t=8.37, P=0.00; （11.85±3.45）mmol/L vs. （8. 23±1.73）mmol/L, t=6.23, P=0.00; （3.16：i： 1.29）mmol/L vs. （1.26±0.42）retool/L, t=9.57, P：0.00]. MoCA scores of patients with type 2 diabetes were negatively correlated with MAGE （r =- 0. 891, P（0.01）. After multiple linear regression analysis, diabetic course, 2 h postprandial glycemia, MAGE and SD remained independently associated with cognitive impairment in type 2 diabetic patients （R2 =0. 835, P（0.05） Conclusions MAGE during a daily period is associated with cognitive impairment independent of fasting blood glucose, postprandial glycemia and HbAlc.

关 键 词：糖尿病 2型 认知障碍 葡萄糖代谢障碍 

分 类 号：R587.1[医药卫生—内分泌]