轻度认知功能障碍与2型糖尿病胰岛素抵抗指数的关系  

Relationship between mild cognitive impairment and insulin resistance indicators in type 2 diabetes mellitus

作　　者：邓超维 王舒艺[2] 孙明谨[1] Deng Chaowei;Wang Shuyi;Sun Mingjin(Department of Endocrinology,Suizhou Central Hospital,Hubei University of Medicine,Suizhou 441300,China;Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]湖北医药学院附属随州中心医院内分泌科,441300 [2]武汉大学中南医院胃肠外科,430071

出　　处：《中华实验外科杂志》2022年第10期1998-2001,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨2型糖尿病(T2DM)患者简化胰岛素抵抗指数与轻度认知功能障碍(MCI)的关系,比较不同指数对T2DM患者MCI的预测价值。方法将湖北医药学院附属随州中心医院住院的397例T2DM患者作为研究对象,对其行简易智能评估量表(MMSE)检测,排除痴呆患者后再进行蒙特利尔认知评估量表(MoCA)评价,根据MoCA评分将其分为MCI组164例,正常组233例。收集其临床资料和血生化指标,计算简化胰岛素抵抗指数,包括胰岛素抵抗稳态模型评估(HOMA-IR)、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)、甘油三酯葡萄糖(TyG)、TyG-体重指数(TyG-BMI)、TyG-腰高比(TyG-WHtR)。分析各项指标与MCI的相关性,探讨认知功能的影响因素,绘制受试者工作特征(ROC)曲线评估简化胰岛素抵抗指数对MCI的预测价值。结果与认知正常组比较,MCI组年龄较大,糖尿病病程长,BMI、糖化血红蛋白(HbA1c)、血尿酸水平较高,MoCA评分和教育水平较低(P均<0.05)。调整混杂因素后,TyG[比值比(OR)=3.83,95%可信区间(CI)=1.99~7.38,P<0.01]、TyG-BMI(OR=1.03,95%CI=1.01~1.04,P<0.01)、TyG-WHtR(OR=9.37,95%CI=3.97~22.11,P<0.01)、VAI(OR=1.53,95%CI=1.23~1.91,P<0.01)、LAP(OR=1.04,95%CI=1.02~1.05,P<0.01)、HOMA-IR(OR=3.21,95%CI=2.08~4.96,P<0.01)均与MCI明显相关。TyG指数的ROC曲线下面积(AUC)最大(AUC为0.818;95%CI:0.776~0.861)。结论在简化胰岛素抵抗指数中TyG对T2DM患者MCI预测效果最好,并且优于HOMA-IR。Objective To investigate the relationship between simplified insulin resistance indicators and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM),and to compare the predictive value of different indexes for MCI in T2DM patients.Methods A total of 397 patients with T2DM hospitalized in Suizhou Central Hospital,Hubei University of Medicine were selected as the research objects.They were tested by mini mental states examination(MMSE),and then evaluated by Montreal Cognitive Assessment(MoCA)after excluding dementia patients.According to the MoCA score,they were divided into MCI group(164 cases)and normal group(233 cases).The clinical data and blood biochemical indexes were collected,and the simplified insulin resistance indicators was calculated,including homeostasis model assessment-insulin resistance(HOMA-IR),lipid accumulation product(LAP),visceral adiposity index(VAI),triglyceride-glucose(TyG),TyG-body mass index(BMI),and TyG-waist height ratio(TyG-WHtR).The correlation between each indicator and MCI was analyzed,and the influencing factors of cognitive function were explored.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of simplified insulin resistance indicators on MCI.Results Compared with the cognitive normal group,the MCI group had older age,longer duration of diabetes,higher BMI,glycosylated hemoglobin A1c(HbA1c),serum uric acid level,and lower MoCA score and education level(all P<0.05).After adjusting for confounding factors,TyG[odds ratio(OR)=3.83,95%confidence interval(CI)=1.99-7.38,P<0.01],TyG-BMI(OR=1.03,95%CI=1.01-1.04,P<0.01),TyG-WHtR(OR=9.37,95%CI=3.97-22.11,P<0.01),VAI(OR=1.53,95%CI=1.23-1.91,P<0.01),LAP(OR=1.04,95%CI=1.02-1.05,P<0.01),HOMA-IR(OR=3.21,95%CI=2.08-4.96,P<0.01)were significantly related with MCI.The area under the ROC curve of TyG index(AUC,0.818;95%CI0.776-0.861)was the largest.Conclusion TyG was the best predictor of MCI in T2DM patients in the simplified IR indcators and was superior to HOMA-IR.

关 键 词：2型糖尿病 甘油三酯-葡萄糖指数 胰岛素抵抗 轻度认知功能障碍 

分 类 号：R749.1[医药卫生—神经病学与精神病学] R587.2[医药卫生—临床医学]