2型糖尿病患者合并脑白质病变的危险因素分析  

Analysis of risk factors of type 2 diabetes patients with leukoencephalopathy

作　　者：蔡月娣 梁碧 韩道宾 陈存伟 覃东红[1] 杨丹佳 刘丹 谭经 CAI Yuedi;LIANG Bi;HAN Daobin;CHEN Cunwei;QIN Donghong;YANG Danjia;LIU Dan;TAN Jing(Guangdong Agricultural Reclamation Central Hospital,Zhanjiang,Guangdong 524000,China;Zhanjiang Nanyue Rehabilitation Hospital,Zhanjiang,Guangdong 524000,China;The Second Hospital of Shandong University,Jinan,Shandong 250000,China)

机构地区：[1]广东省农垦中心医院,广东湛江524000 [2]湛江南粤康复医院,广东湛江524000 [3]山东大学第二医院,山东济南250000

出　　处：《国际检验医学杂志》2024年第S02期40-46,共7页International Journal of Laboratory Medicine

基　　金：广东省农垦中心医院科研基金项目(NKYY2021001);山东省自然科学基金青年项目(ZR2021QH055)。

摘　　要：目的探讨2型糖尿病(T2DM)患者合并脑白质病变的危险因素。方法纳入T2DM患者242例,根据脑白质病变评分分为无脑白质病变组(FA0)58例,轻度脑白质病变组(FA1)58例,中度脑白质病变组(FA2)79例,重度脑白质病变组(FA3)47例,方差分析脑白质病变与年龄、病程、体重指数(BMI)、受教育程度、血压、血糖、胰岛素、血脂及脑白质病变相关标志物等因素的关系,并采用Logistic回归分析影响脑白质病变的相关危险因素。结果方差分析显示,与无脑白质病变组比较,患者脑白质病变与年龄、病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)相关(P<0.05);与中度脑白质病变组比较,患者脑白质病变与餐后血糖(PBG)相关(P均<0.05);与重度脑白质病变组比较,患者脑白质病变与年龄、病程、FBG、PBG、HbA1c、空腹胰岛素(FINS)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、C反应蛋白(CRP)相关(P<0.05)。脑白质病变越严重的患者认知功能越差(P<0.05)。Logistic回归分析显示年龄、病程、胰岛素抵抗、FBG、HbA1c、PBG、HO-MA-IR、CRP、认知障碍为2型糖尿病患者合并脑白质病变的危险因素。结论病程长、血糖控制不佳、胰岛素抵抗明显、伴有炎症及认知障碍的糖尿病老年患者,脑白质病变越严重。有脑白质病变认知障碍基础的患者更容易发展为重度脑白质病变。Objective To explore the risk factors of type 2 diabetes mellitus(T2DM)patients with leu-koencephalopathy.Methods A total of 242 patients with T2DM were included,and according to cerebral white matter lesions score,they were divided into no cerebral white matter lesions group(FA0)(58 cases),mild cerebral white matter lesions group(FA1)(58 cases),moderate cerebral white matter lesions group(FA2)(79 cases),and severe cerebral white matter lesions group(FA3)(47 cases).The relationship between cerebral white matter lesions and age,course of disease,body mass index(BMI),education level,blood pres-sure,blood glucose,insulin,blood lipid and related markers of cerebral white matter lesions were analyzed by anova.Logistic regression was used to analyze the risk factors of cerebral white matter lesions.Results Anova showed that compared with the non-cerebral white matter lesions group,cerebral white matter lesions was correlated with age,course of disease,fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)(all P<0.05).Compared with moderate cerebral white matter lesions group,cerebral white matter lesions was correlated with postprandial blood glucose(PBG)(all P<0.05).Compared with severe cerebral white matter lesions group,cerebral white matter lesions was correlated with age,disease course,FBG,PBG,HbA1c,fasting insulin(FINS),insulin resistance index assessed by homeostasis model(HOMA-IR)and C-reactive protein(CRP)(all P<0.05).The more severe the white matter lesions,the worse the cognitive function(P<0.05).Logistic regression analysis showed that age,course of disease,insulin resistance,FBG,HbA1c,PBG,HOMA-IR,CRP and cognitive impairment were risk factors for leuconopathy in type 2 diabetes patients.Conclusion The older patients with diabetes who have a long course of disease,poor blood glucose control,obvious insulin resistance,inflammation and cognitive impairment,the more serious the white matter lesions.Patients with cognitive impairment based on white matter lesions are more likely to develop severe white ma

关 键 词：2型糖尿病 脑白质病变 血糖 胰岛素抵抗 炎症因子 认知障碍 

分 类 号：R587.1[医药卫生—内分泌]