2型糖尿病肾脏微血管病变与脑白质高信号及认知域损害的相关性研究  

Correlation between nephropathy and white matter hyperintensities and cognitive impairment in type 2 diabetic patients

作　　者：马楼艳 李雷 郭亚刚 屈秋民[4] MA Louyan;LI Lei;GUO Yagang;QU Qiumin(不详;Department of Neurology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an Shaanxi 710061,China)

机构地区：[1]西安市第九医院老年病二科,710054 [2]西安市第九医院影像科,710054 [3]西安市第九医院检验科,710054 [4]西安交通大学第一附属医院神经内科,710061

出　　处：《中国神经免疫学和神经病学杂志》2022年第2期102-107,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金项目(81700736);陕西省社会发展项目计划(2020SF-160);西安市卫生科研教育项目(2013021)。

摘　　要：目的通过观察不同严重程度2型糖尿病肾病患者认知功能及脑白质高信号(WMH)的体积,探讨糖尿病肾脏微血管病变与糖尿病认知功能障碍的相关性。方法选取作者医院内分泌科、老年病科住院的2型糖尿病患者178例,根据胱抑素C(Cys C)水平分为糖尿病非肾病组(DM组;Cys C<1.05 mg/L)、糖尿病早期肾功能损害组(DM-Ⅰ组;2.00 mg/L>Cys C≥1.05 mg/L)及糖尿病临床期肾功能损害组(DM-Ⅱ组;Cys C≥2.00 mg/L),年龄、性别、文化程度相匹配的其他患者30例为对照组。比较各组受试者Cys C、肌酐、24 h尿蛋白及糖化血红蛋白水平;以简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)测试各组受试者认知水平,以头颅MRI平扫检查对WMH进行评分,并分析各组受试者认知功能与WMH体积的差异以及两者的相关性。结果与对照组比较,DM-Ⅰ组和DM-Ⅱ组MoCA评分均下降(P<0.0.5),尤其是在视空间和执行功能、语言、延迟回忆、注意和抽象等方面出现损害(P<0.05);与DM组比较,DM-Ⅰ组和DM-Ⅱ组MoCA评分差异无统计学意义(P>0.05),但DM-Ⅱ组在视空间与执行功能、注意、语言、延迟回忆方面评分较DM组下降(P<0.05)。DM-Ⅱ组MoCA评分与24 h尿蛋白水平(r=-0.486,P=0.002)及Cys C水平(r=-0.315,P=0.048)呈负相关。与对照组比较,DM-Ⅰ组、DM-Ⅱ组WMH体积明显增大(P<0.05);与DM组比较,DM-Ⅱ组WMH体积增大(P=0.002)。DM-Ⅱ组WMH体积与Cys C(ρ=0.421,P=0.004)和24 h尿蛋白水平呈正相关(ρ=0.344,P=0.030)。多因素Logistic回归分析结果显示,文化程度(χ^(2)=22.005,P=0.034)、24 h尿蛋白水平(χ^(2)=12.437,P=0.014)和Cys C水平(χ^(2)=17.737,P=0.023)是影响2型糖尿病患者认知功能的因素。结论伴有肾功能损害的2型糖尿病患者在视空间和执行功能、注意、语言和延迟回忆方面出现损害。且随着肾功能损害的加重,2型糖尿病患者的认知功能障碍逐渐加重,这可能与脑内WMH的体积�Objective To investigate the cognitive function and the volume of white matter hyperintensities(WMH)in patients with type 2 diabetic nephropathy,and to analyze the relationship between diabetic renal microangiopathy and diabetic cognitive dysfunction.Methods A total of 178 patients with type 2 diabetes mellitus in the department of endocrinology and geratology were collected.All patients were divided into diabetic non-nephropathy group(Cys C<1.05 mg/L,DM group),diabetic early-stage nephropathy group(2 mg/L>Cys C≥1.05 mg/L,DM-Ⅰgroup),and diabetic late-stage renal dysfunction group(Cys C≥2 mg/L,DM-Ⅱgroup,according to Cystatin C(Cys C)level.Other thirty patients matched on age,gender and education level were also enrolled(control group).Differences in the levels of Cys C,creatinine,urinary microalbumin,and glycosylated hemoglobin of the subjects in each group were compared.Cognitive function was assessed by mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA).The WMH volume was also calculated based on brain MRI.We compared the differences in the cognigitve function and the volume of WMH between these groups.Correlations between diabetic nephropathy and cognitive function as well as WMH volume were also detected.Results Compared with the control group,the MoCA scores of the DM-Ⅰand DM-Ⅱgroups were both decreased(P<0.05),especially in visuospatial and executive function,language,delayed recall,attention and abstration.There were no significant differences in MoCA score between DM-Ⅰand DM group,and between DM-Ⅱand DM group(P>0.05).However the scores of executive function,attention,language,and delayed recall in DM-Ⅱgroup were lower than those in the DM group(P<0.05).A negative correlation was found between the MoCA score and 24 hours urinary microalbumin(r=-0.486,P=0.002)as well as Cys C level(r=-0.315,P=0.048).Compared with the control group,the WMH volume of DM-Ⅰand DM-Ⅱgroup increased significantly(P<0.05).The WMH volume of the DM-Ⅱgroup also increased related to DM gro

关 键 词：2型糖尿病 糖尿病肾病 认知功能障碍 脑白质高信号 

分 类 号：R743.9[医药卫生—神经病学与精神病学]