病程对老年2型糖尿病患者认知功能及相关危险因素的影响  

Effect of diabetes mellitus duration on cognition and its related risk factors in elderly type 2 diabetes mellitus patients

作　　者：苏琳[1] 张庆文[1] 李卫[1] 宝辉[1] 康丽萍[1] 周全[1] 杨素敏[1] 郭远[1] 

机构地区：[1]北京大学人民医院老年科,100044

出　　处：《中华老年心脑血管病杂志》2015年第10期1071-1075,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察病程对老年2型糖尿病患者认知功能及相关危险因素的影响。方法选择2型糖尿病患者172例,按病程分为3组：糖尿病A组（病程〈10年）60例,糖尿病B组（病程10~19年）67例,糖尿病C组（病程≥20年）45例,同期入选的糖耐量异常组（空腹血糖受损及糖耐量减低）41例,对照组68例。均行头颅CT和颈动脉超声检查。结果糖尿病C组颈动脉不稳定性斑块（64.4%vs 36.8%,P〈0.01;64.4%vs 36.6%,P〈0.01）、腔隙性脑梗死（84.4%vs 61.8%,P〈0.01;84.4%vs 65.9%,P〈0.05）和脑白质病变比例（62.2%vs 35.3%,P〈0.05;62.2%vs 36.6%,P〈0.05）明显高于对照组和糖耐量异常组。糖尿病C组胰岛素或其类似物治疗比例明显高于糖尿病A组（42.2%vs 15.0%,P〈0.05）。糖尿病C组他汀类物治疗、轻度认知功能障碍和痴呆比例明显高于对照组（77.8%vs 54.4%,20.0%vs 2.9%,8.9%vs 0%,P〈0.05）。logistic回归分析显示,糖尿病病程≥20年、颈动脉狭窄和胰岛素或其类似物治疗预示患者轻度认知功能障碍和痴呆的可能（P〈0.05,P〈0.01）。结论糖尿病病程≥20年的患者更易出现轻度认知功能障碍、痴呆,同时并发腔隙性脑梗死、脑白质病变和颈动脉不稳定性斑块比例增高。Objective To study the effect of type 2diabetes mellitus（T2DM）duration on cognition and its related risk factors in the elderly T2 DM patients.Methods One hundred and seventy-two elderly T2 DM patients were divided into group A with the duration 10years（n=60）,group B with the duration being 10-19years（n=67）and group C with the duration≥20years（n=45）.Forthermore,41 subjects with impaired glucose tolerance（IGT）served as an IGT group and 68 subjects served as a control group.The subjects underwent brain CT and carotid artery ultrasonography.Results The incidence of unstable carotid plaques,lacunar infaction and white matter lesions was significantly higher in group C than in control group and IGT group（P〈0.05,P〈0.01）.The percentage of patients who were treated with insulin or its analogues was significantly higher in group C than in group A（P〈0.05）.The percentage of patients who were treated with statins and the incidence of mild cognition impairment and dementia were significantly higher in group C than in control group（P〈0.05）.Multivariate logistic regression analysis showed that T2 DM duration ≥20years,carotid stenosis,use of insulin or its analogues were the predictors of mild cognition impairment and dementia.Conclusion Mild cognition impairment,dementia,lacunar infaction,white matter lesion and unstable carotid plaques are common in DM patients with its duration ≥20years.

关 键 词：糖尿病 2型 认知障碍 痴呆 脑梗死 颈动脉狭窄 危险因素 

分 类 号：R587.1[医药卫生—内分泌]