2型糖尿病认知功能障碍病人的影响因素及中医证候分布特点研究  

Study on the Influencing Factors and TCM Syndromes of Patients with Cognitive Impairment Caused by Type 2 Diabetes Mellitus

作　　者：杨静 张卓然 李静 田心 李玲 YANG Jing;ZHANG Zhuoran;LI Jing;TIAN Xin;LI Ling(Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi,China;Shaanxi Hospital of Traditional Chinese Medicine,Xi'an 710000,Shaanxi,China)

机构地区：[1]陕西省中医药大学,陕西咸阳712000 [2]陕西省中医医院,西安710000

出　　处：《中西医结合心脑血管病杂志》2021年第17期2917-2920,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家重点研发计划项目(No.2018YFC2002500)。

摘　　要：目的探讨住院2型糖尿病(T2DM)病人认知功能障碍的相关因素及中医证候分布特点。方法选取2017年6月—2019年6月在陕西省中医医院老年病科住院的T2DM病人共128例,根据蒙特利尔认知评估量表(MoCA)评分分为认知功能正常组(MoCA评分≥26分,26例)和认知功能障碍组(MoCA评分<26分,102例)。比较两组年龄、性别、受教育程度、糖尿病病史、糖化血红蛋白、血同型半胱氨酸(Hcy)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、24 h尿蛋白、颈动脉软斑检出率、糖尿病神经病变发生率、糖尿病视网膜病变发生率及低血糖发生率与认知功能的关系。再根据T2DM合并认知障碍证候分成实证组和虚证组,利用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分,比较虚证、实证中医证型病人认知功能的差异。结果认知功能障碍组年龄、糖尿病病史占比、糖化血红蛋白、LDL、Hcy、24 h尿蛋白、颈动脉软斑检出率、低血糖事件发生率均大于认知功能正常组(P<0.05),而受教育年限小于认知功能正常组(P<0.05);Logistic回归分析显示,糖化血红蛋白、LDL、Hcy、24 h尿蛋白为影响MoCA水平的独立影响因素。T2DM合并认知障碍病人实证组和虚证组MMSE量表评分比较,实证组计算和注意力及总分较虚证组高,MoCA量表评分比较,实证组总分、注意力和延迟回忆评分均明显高于虚证组,差异均有统计学意义(P<0.05)。结论T2DM病人糖化血红蛋白、LDL、Hcy、24 h尿蛋白是影响认知障碍的危险因素;T2DM合并认知障碍中医证型的区分,MoCA量表较MMSE量表更有优势。实证病人较虚证病人计算力、注意力和延迟回忆能力更差。Objective To explore the related factors of cognitive impairment in type 2 diabetes mellitus(T2DM)patients and the distribution characteristics of traditional Chinese medicine(TCM)syndrome.Methods From June 2017 to June 2019,one hundred and twenty-eight T2DM patients were selected.According to the Montreal Cognitive Assessment Scale(MoCA)score,the patients were divided into normal cognitive function group(≥26 points,n=26)and impaired cognitive function group(<26 points,n=102).Age,gender,education level,history of diabetes,HbA1c,homocysteine(Hcy),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),24-hour urine protein,the detection rate of arterial soft plaque,the incidence of diabetic neuropathy,the incidence of diabetic retinopathy,the incidence of hypoglycemia,and cognitive function were compared between the two groups.Then,the patients were divided into excess syndrome group and deficiency syndrome group.The cognitive function of patients with different TCM syndromes was compared by Mini-mental State Examination(MMSE)and MoCA.Results Age,diabetes history,HbA1c,LDL,Hcy,24-hour urine protein,carotid soft plaque detection rate,and hypoglycemia event incidence in impaired cognitive function group were than those in normal cognitive function group(P<0.05),while the education years in impaired cognitive function group were shorter than that in normal cognitive function group(P<0.05).Logistic regression analysis showed that HbA1c,LDL,Hcy,and 24-hour urine protein were independent factors affecting MoCA level.The computing power,thinking,and total score of MMSE in excess syndrome group were better than those in deficiency syndrome group.The total score,attention,and delayed recall score of MoCA in excess syndrome group were significantly higher than those in deficiency syndrome group(P<0.05).Conclusion HbA1c,LDL,Hcy,and 24-hour urinary protein are the risk factors of cognitive impairment in T2DM patients.MoCA is more advantageous than MMSE in the differentiation of TCM

关 键 词：2型糖尿病 认知功能障碍 危险因素 中医证候 糖化血红蛋白 同型半胱氨酸 

分 类 号：R74[医药卫生—神经病学与精神病学]