血浆骨桥蛋白水平与2型糖尿病患者合并轻度认知功能障碍的相关性研究  

Association between plasma osteopontin level and mild cognitive impairment in patients with type 2 diabetes mellitus

作　　者：于丹丹 周学玲 牛叠静 王少华[1] Yu Dandan;Zhou Xueling;Niu Diejing;Wang Shaohua(Department of Endocrinology,Zhongda Hospital Southeast University,Nanjing 210000,China)

机构地区：[1]东南大学附属中大医院内分泌科,南京210000

出　　处：《中华医学杂志》2024年第38期3593-3599,共7页National Medical Journal of China

摘　　要：目的分析2型糖尿病(T2DM)患者合并轻度认知功能障碍(MCI)的影响因素,探讨血浆骨桥蛋白(OPN)水平与MCI的相关性。方法回顾性分析2021年10月至2023年5月东南大学附属中大医院收治的254例T2DM患者的临床资料,依据是否患有MCI将患者分为MCI组(n=106)和认知功能正常对照组(n=148)。收集临床资料,使用神经学量表评估认知功能并采用酶联免疫吸附法检测血浆OPN水平。分析各指标与T2DM患者发生MCI的相关性。应用多因素logistic回归模型分析T2DM患者MCI患病的影响因素,建立性别、年龄、体质指数(BMI)与OPN的交互项,验证其显著性水平。绘制受试者工作特征(ROC)曲线评估OPN对T2DM患者合并MCI的预测价值。以空腹血糖(FPG)为中介变量构建OPN-FPG-蒙特利尔认知评分(MoCA)中介模型,对中介效应进行检验,并计算中介效应占比。结果共纳入254例患者,男162例,女92例,年龄(61.5±7.5)岁。与对照组比较,MCI组患者年龄更大[63.0(59.0,69.0)岁比60.0(54.2,66.8)岁],女性比例更大[43.4%(46/106)比31.1%(46/148)],受教育年限更短[12(9,12)年比12(9,15)年],糖尿病病程更长[15.0(8.0,20.0)年比10.0(5.0,15.0)年],FPG[7.78(6.07,10.23)mmol/L比6.86(5.36,8.59)mmol/L]、胰岛素抵抗指数[2.93(2.47,3.98)比2.79(2.27,3.25)]、糖化血红蛋白(HbA1c)[9.24%(7.89%,10.96%)比7.97%(7.00%,9.45%)]、总胆固醇(TC)[(4.51±1.17)mmol/L比(4.19±0.99)mmol/L]、OPN[11.30(8.68,12.84)ng/ml比9.69(7.82,11.74)ng/ml]水平均更高(均P<0.05)。MCI患者的各项神经心理学测试得分均低于认知正常的对照组(均P<0.05)。Spearman相关分析显示,年龄(r=-0.212)、糖尿病病程(r=-0.156)、高血压病程(r=-0.132)、FPG(r=-0.207)、胰岛素抵抗指数(r=-0.171)、HbA1c(r=-0.271)、OPN(r=-0.238)、总胆固醇(r=-0.125)与MoCA得分呈负相关,而受教育年限(r=0.285)与MoCA评分呈正相关(均P<0.05)。多因素logistic回归分析显示,年龄、受教育年限、糖尿病病程、HbA1c、TC及OPN为T2DObjective To analyze the influencing factors of type 2 diabetes mellitus(T2DM)patients with mild cognitive impairment(MCI),and to explore the association between plasma osteopontin(OPN)levels and MCI.MethodsA retrospective analysis was conducted on the clinical data of 254 patients with T2DM admitted to Zhongda Hospital Affiliated to Southeast University from October 2021 to May 2023.The patients were divided into MCI group(n=106)and normal cognitive function control group(n=148)according to whether they had MCI.Clinical data were collected,cognitive function was assessed using neurological scales and plasma OPN levels were measured by enzyme linked immunosorbent assay.A multivariate logistic regression model was applied to analyze the influencing factors of MCI in T2DM patients.Interaction terms between gender,age,body mass index(BMI),and OPN were established to verify their significance levels.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of OPN for MCI in T2DM patients.The mediation model of OPN-FPG-montreal cognitive assessment(MoCA)was constructed with fasting plasma glucose(FPG)as the mediating variable to test the mediating effect,and the mediating effect percentage was calculated.ResultsA total of 254 patients were included,including 162 males and 92 females,with an average age of(61.5±7.5)years old.Compared with the control group,the patients in MCI group were older[63.0(59.0,69.0)years vs 60.0(54.2,66.8)years],had a greater proportion of females[43.4%(46/106)vs 31.1%(46/148)],shorter years of education[12(9,12)years vs 12(9,15)years],longer duration of diabetes[15.0(8.0,20.0)years vs 10.0(5.0,15.0)years],and higher levels of FPG[7.78(6.07,10.23)mmol/L vs 6.86(5.36,8.59)mmol/L],insulin resistance index[2.93(2.47,3.98)vs 2.79(2.27,3.25)],glycated hemoglobin(HbA1c)[9.24%(7.89%,10.96%)vs 7.97%(7.00%,9.45%)],total cholesterol(TC)[(4.51±1.17)mmol/L vs(4.19±0.99)mmol/L],and OPN[11.30(8.68,12.84)ng/ml vs 9.69(7.82,11.74)ng/ml](all P<0.05).The scores of various neu

关 键 词：糖尿病 2型 轻度认知功能障碍 骨桥蛋白 横断面研究 

分 类 号：R587.2[医药卫生—内分泌] R749.1[医药卫生—内科学]