糖尿病合并肾功能障碍对卒中后认知功能的影响  

The impact of the combination of diabetes and renal dysfunction on cognitive function after stroke

作　　者：耿介立[1] 曹雯炜[1] 支楠[1] 陈刚[1] 管阳太[1] GENG Jie-li;CAO Wen-wei;ZHI Nan;CHEN gang;GUAN yang-tai(Department of Neurology,Shanghai Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院神经内科,上海200000

出　　处：《阿尔茨海默病及相关病杂志》2021年第1期46-50,共5页Chinese Journal of Alzheimer's Disease and Related Disorders

基　　金：2019年国自然院内种子基金,项目批号RJZZ19-05。项目名称:内皮祖细胞来源外泌体介导缺血性卒中后血脑屏障保护的作用及机制。

摘　　要：目的:已知糖尿病是认知障碍的危险因素。但糖尿病对卒中后认知障碍的影响尚不清楚。严重肾功能障碍与认知功能障碍有关。本文研究糖尿病患者合并肾功能障碍对卒中后认知功能的影响。方法:本院收治入院的急性腔隙性梗死患者,发病1个月后进行认知功能测评和血生化检测。根据既往病史和空腹血糖,糖化血红蛋白检测结果定义糖尿病。肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)<90 mL/min/1.73 m^(2)定义为肾功能障碍。根据蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)和简明精神状态检查(mini-mental state examination,MMSE)得分定义卒中后认知障碍。结果:92例腔隙性梗死患者纳入统计学分析。其中糖尿病31例(33.7%),糖尿病伴肾功能障碍者13例(14.1%),除外1例患者的eGFR值为58 mL/min/1.73 m^(2),其余均大于60 mL/min/1.73 m^(2)。使用MoCA评分定义认知功能受损。多因素分析显示轻度肾功能障碍的糖尿病患者发生认知障碍的风险是肾功能正常的非糖尿病患者的近20倍(P=0.002)。结论:糖尿病与卒中后认知功能表现的关联在一定程度上取决于肾功能损害的存在。Background:Diabetes is known to be a risk factor for cognitive impairment.However,the impact of diabetes on cognitive impairment after stroke is unclear.Severe renal dysfunction is related to cognitive dysfunction.The goal of this study was to investigate the impact of the combination of diabetes and renal dysfunction on cognitive function after stroke.Methods:Patients with acute lacunar infarction were admitted to this hospital,cognitive function assessment and blood biochemical testing were performed one month after discharge from hospital.Renal dysfunction was defined as eGFR<90 mL/min/1.73m^(2).The post-stroke cognitive impairment was defined based on Montreal Cognitive Assessment(MoCA)or Mental State Examination(MMSE)scores.Results:Of the 92 patients with lacunar infarction included for the statistical analysis,31 cases(33.7%)had diabetes mellitus and 13 cases(14.1%)had diabetes with renal dysfunction.Except for one patient with the eGFR of 58 mL/min/1.73m^(2),the rest of patients were greater than 60 mL/min/1.73m^(2).Multivariate analysis showed that the risk of cognitive impairment in diabetic patients with mild renal dysfunction was nearly 20 times that of non-diabetic patients with normal renal function(p=0.002)using the MoCA score to define cognitive dysfunction.Conclusion:The relationship between diabetes and cognitive impairment after stroke partially depends on the renal dysfunction.

关 键 词：卒中后认知障碍 糖尿病 肾功能障碍 

分 类 号：R741[医药卫生—神经病学与精神病学]