嗅觉障碍是2型糖尿病合并轻度认知功能障碍的危险因素  

Olfactory dysfunction is a risk factor for the comorbidity of mild cognitive impairment and Type 2 diabetes mellitus

作　　者：龚丽娜[1] 谢建飞[2] 刘佳[3] 汤观秀[4] 林婉丽[1] 张忱[1] GONG Lina;XIE Jianfei;LIU Jia;TANG Guanxiu;LIN Wanli;ZHANG Zhen(Intensive Care Unit,Department of Neurology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Nursing,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Transplantation,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Gerontology,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院神经内科重症监护室,长沙410013 [2]中南大学湘雅三医院护理部,长沙410013 [3]中南大学湘雅三医院移植科,长沙410013 [4]中南大学湘雅三医院老年科,长沙410013

出　　处：《中南大学学报（医学版）》2021年第8期831-837,共7页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2019JJ50929)。

摘　　要：目的:糖尿病可加快认知功能损害的进展速度,从而影响患者的预后,而嗅觉功能评估为早期识别认知功能障碍提供了可能。本研究拟探讨嗅觉功能对2型糖尿病(Type 2 diabetes mellitus,T2DM)患者合并轻度认知功能障碍(mild cognitive impairment,MCI)的影响。方法:选择2018年6月至2019年6月在长沙市某三甲医院住院治疗的472例T2DM患者作为研究对象。分别采用异丙醇吸入试验、蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估患者的嗅觉功能和认知功能。根据MoCA评估结果将研究对象分为T2DM合并MCI组和T2DM不合并MCI组。收集研究对象的一般资料并进行实验室检查。采用两独立样本t检验比较两组嗅觉功能评分的差异。采用χ^(2)检验比较两组出现嗅觉障碍所占比例的差异,采用多因素logistic回归分析T2DM合并MCI的影响因素。结果:162名研究对象合并MCI,合并率为34.3%。T2DM合并MCI组和T2DM不合并MCI组的嗅觉功能评估值分别为(9.15±3.22)cm和(21.03±4.36)cm,两组差异有统计学意义(P<0.05)。合并MCI组120例出现嗅觉障碍,不合并MCI组50例出现嗅觉障碍,差异具有统计学意义(P<0.05)。在调整年龄、受教育程度、糖尿病病程、空腹胰岛素及糖化血红蛋白后,多因素logistic回归分析显示年龄较大(OR=1.14,95%CI:1.09~1.20)、糖尿病病程较长(OR=1.21,95%CI:1.12~1.31)以及出现嗅觉障碍(OR=4.61,95%CI:3.04~6.18)是T2DM合并MCI的独立危险因素,受教育程度高(OR=0.26,95%CI:0.15~0.38)是T2DM合并MCI的独立保护因素。结论:嗅觉障碍是T2DM合并MCI的危险因素,在对T2DM患者实施促进认知功能的干预措施时应重点关注已出现嗅觉障碍的个体。Objective:Diabetes can accelerate cognitive decline and hence affect the prognosis of patients with Type 2 diabetes mellitus(T2DM).Olfactory assessment can facilitate the early identification of cognitive impairment among T2DM patients.This study aims to evaluate the effects of olfactory function on mild cognitive impairment(MCI)in patients with T2DM.Methods:A total of 472 T2DM patients who were hospitalized in a first-class hospital in Changsha City from June 2018 to June 2019 were enrolled for this study.Olfactory function and cognitive function were assessed by the alcohol sniff test and the Montreal Cognitive Assessment(MoCA)scale,respectively.Participants were categorized into a comorbidity of MCI and T2DM group and a T2DM group.General information was collected and some biochemical indices were tested.Difference in the alcohol sniff test score between the 2 groups was assessed by 2-sample t-test.Difference in the presence of olfactory dysfunction between the 2 groups was assessed byχ^(2) test,and multivariable logistic regression was used to determine the relevant factors contributing to the comorbidity of MCI and T2DM.Results:Of the 472 participants,162 were identified with MCI,making the comorbidity rate at 34.3%.Values of isopropyl alcohol sniff test were significantly different between the 2 groups[(9.15±3.22)cm vs(21.03±4.36)cm,P<0.05].The number of patients with olfactory dysfunction also differed significantly between the 2 groups(120 vs 50).After adjustment for age,educational level,T2DM duration,fasting insulin,and glycosylated hemoglobin(HbA1c),multivariate logistic regression analysis showed older age(OR=1.14,95%CI 1.09 to 1.20),longer course of diabetes(OR=1.21,95%CI 1.12 to 1.31),and olfactory-impaired(OR=4.61,95%CI 3.04 to 6.18)were independent risk factors for T2DM combined with MCI,and the high education level(OR=0.26,95%CI 0.15 to 0.38)was an independent protective factor for T2DM combined with MCI.Conclusion:Olfactory dysfunction is an independent risk factor for the comorbidity of MCI

关 键 词：2型糖尿病 嗅觉障碍 轻度认知功能障碍 

分 类 号：R587.2[医药卫生—内分泌] R749.1[医药卫生—内科学] R765.63[医药卫生—临床医学]