糖尿病前期对皮质下缺血性血管性认知障碍的影响  

The effect of prediabetes on subcortical ischemic vascular cognitive impairment

作　　者：李美锡[1,2] 成斯琪 谢小华 牛小莉[2] 牛亚丽 王天俊[2] 吕佩源[2] LI Meixi;CHENG Siqi;XIE Xiaohua;NIU Xiaoli;NIU Yali;WANG Tianjun;LV Peiyuan(不详;Department of Neurology,Hebei Key Laboratory of Cerebral Network and Cognitive Disorders,Hebei General Hospital,Shijiazhuang Hebei 050051,China)

机构地区：[1]河北省人民医院博士后创新实践基地、河北师范大学,050051 [2]河北省人民医院神经内科、河北省脑网络与认知障碍疾病重点实验室 [3]首都医科大学,100069 [4]河北省人民医院影像科,050051

出　　处：《中国神经免疫学和神经病学杂志》2024年第4期277-282,294,共7页Chinese Journal of Neuroimmunology and Neurology

基　　金：河北省高端人才资助项目(6833452、83587216);河北省政府资助临床医学优秀人才培养项目(冀财社:2019-139-5);河北省科技创新团队资助项目(冀政2020-9号5-2);河北省引智项目(冀科专函:2020-19-2);河北省医学科学研究重点课题资助项目(青年科技课题20230378)。

摘　　要：目的探讨糖尿病前期对皮质下缺血性血管性认知障碍(SIVCI)的影响。方法回顾性分析2017年4月至2022年7月于作者医院就诊的皮质下缺血性脑血管病(SIVD)患者242例。依据认知功能分为血管性痴呆组(VaD),轻度认知障碍组(vMCI)以及无认知障碍组(NoCI),记录并应用单因素分析比较各组一般临床资料以及空腹血糖、糖化血红蛋白等生化指标,以及颅内脑白质病变(WMLs)的Fazekas评分、腔隙性脑梗死评级等影像学指标的差异,并将组间差异有统计学意义(P<0.05)的指标纳入有序Logistic回归方程,分析SIVD发生SIVCI的危险因素。结果VaD组及vMCI组的受教育程度低于NoCI组,高血压、糖代谢异常的患者比例高于NoCI组,而VaD组糖尿病患者比例高于vMCI组(均P<0.05),VaD组与vMCI组的受教育程度、高血压、糖尿病前期患者比例差异无统计学意义(P>0.05);VaD组的MMSE评分低于vMCI组及NoCI组,重度WMLs患者比例高于vMCI组及NoCI组,vMCI组MMSE评分低于NoCI组(均P<0.05),vMCI组与NoCI组的重度WMLs比例差异无统计学意义(P>0.05)。有序Logistic回归分析提示糖尿病〔OR(95%CI)=2.921(1.636~5.215),P=0.001〕及糖尿病前期〔OR(95%CI)=2.743(1.461~5.150),P=0.002〕均是SIVD患者发生SIVCI的危险因素。受教育程度低〔OR(95%CI)=0.861(0.811~0.914),P=0.001〕、有高血压史〔OR(95%CI)=1.867(1.089~3.201),P=0.023〕、重度WMLs〔OR(95%CI)=2.227(1.344~3.690),P=0.002〕也是发生SIVCI的危险因素。结论除了受教育程度低、高血压史以及重度WMLs以外,糖尿病前期及糖尿病也是SIVD患者发生认知障碍的危险因素。对SIVD患者早期进行糖代谢筛查,在糖尿病前期进行血糖干预有助于预防SIVCI发生。Objective To investigate the effect of prediabetes on subcortical ischemic vascular cognitive impairment(SIVCI).Methods A retrospective analysis was performed on 242 patients with subcortical ischemic vascular disease(SIVD)who were admitted to the authors’hospital from April 2017 to July 2022.They were divided into vascular dementia(VaD)group,mild cognitive impairment(vMCI)group and no cognitive impairment(NoCI)group based on their cognitive function.Data of general clinical features,biochemical indexes,including fasting blood glucose and glycated hemoglobin,imaging indicators including the Fazekas score of white matter lesions(WMLs)and the degree of lacunar cerebral infarction were collected.Differences were compared by one-way analysis among three groups.The indicators with statistical significance(P<0.05)among groups were included in the ordered Logistic regression equation to analyze the risk factors of SIVCI.Results The education level in VaD group and vMCI group was lower than that in NoCI group(P<0.05),but the prevalence of hypertension and abnormal glucose regulation was higher than that in NoCI group(P<0.05).There was no significant difference between VaD group and vMCI group in education level,prevalence of hypertension and prediabetes(P>0.05),but the prevalence of diabetes in VaD group was higher than that in vMCI group(P<0.05).The MMSE score in VaD group was lower than that in vMCI group and NoCI group(P<0.05).The prevalence of severe WMLs in VaD group was higher than that in vMCI group and NoCI group(P<0.05).The MMSE score in vMCI group was lower than that in NoCI group(P<0.05),but there was no significant difference in the prevalence of severe WMLs between vMCI group and NoCI group(P>0.05).Ordered Logistic regression analysis suggested diabetes[OR(95%CI)=2.921(1.636-5.215),P=0.001],prediabetes[OR(95%CI)=2.743(1.461-5.150],low education level[OR(95%CI)=0.861(0.811-0.914),P=0.001],history of hypertension[OR(95%CI)=1.867(1.089-3.201),P=0.023],and severe WMLs[OR(95%CI)=2.227(1.344-3.690),P=0.002]were

关 键 词：糖尿病前期 皮质下缺血性血管性认知障碍 皮质下缺血性脑血管病 

分 类 号：R741.041[医药卫生—神经病学与精神病学]