老年2型糖尿病患者认知障碍与抑郁的相关性研究  

Correlation between cognitive impairment and depression in elderly patients with type 2 diabetes mellitus

作　　者：詹媛媛 许馨月 逯博文 张慕新 陈芳博 冯洁 潘清蓉[1] 陈哲[1] Zhan Yuanyuan;Xu Xinyue;Lu Bowen;Zhang Muxin;Chen Fangbo;Feng Jie;Pan Qingrong;Chen Zhe(Department of Endocrinology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院内分泌科,100020 [2]首都医科大学附属北京朝阳医院全科医学,100020 [3]首都医科大学附属北京朝阳医院教育处,100020

出　　处：《中华老年心脑血管病杂志》2025年第4期426-430,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都卫生发展全科医学与社区卫生科研专项(2024-1Y-002,2023-2Y-007);首都医科大学教育教学改革研究课题(2024JYY171);首都医科大学本科生科研创新项目(XSKY2024330)。

摘　　要：目的本研究旨在探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者认知障碍与抑郁的相关性。方法采用中国健康与养老追踪调查2011年数据,共纳入老年T2DM患者521例,根据简易智能状态检查量表(mini-mental state examination,MMSE)评分及受教育程度分为认知障碍组437例和认知正常组84例。采用完整简版流调中心抑郁自评量表评分评估抑郁症状,分析认知障碍与抑郁的相关性。结果认知障碍组年龄、抑郁、C反应蛋白水平显著高于认知正常组[(71.98±5.29)岁vs(69.42±3.98)岁,P=0.000;60.6%vs 35.7%,P=0.000;(5.09±12.80)mg/L vs(2.25±2.43)mg/L,P=0.000],已婚、心血管疾病、估算的肾小球滤过率水平显著低于认知正常组[72.1%vs 86.9%,P=0.001;20.1%vs 32.1%,P=0.010;(77.15±15.88)ml/(min·1.73 m^(2))vs(81.91±13.55)ml/(min·1.73 m^(2)),P=0.001],差异有统计学意义。多因素logistic回归分析显示,老年T2DM患者认知障碍是抑郁发生的独立危险因素(OR=3.44,95%CI:1.89~6.27,P<0.01)。ROC曲线分析显示,MMSE评分对老年T2DM患者抑郁发生的曲线下面积为0.669(95%CI:0.626~0.709,P<0.01)。老年T2DM患者认知障碍的直接效应和孤独对抑郁的中介效应分别占总效应的72.22%和27.78%。结论老年T2DM患者认知障碍与抑郁相关,孤独感在其中起一定介导作用。Objective To investigate the correlation between cognitive impairment and depression in elderly patients with type 2 diabetes mellitus(T2DM).Methods Based on China Health and Retirement Longitudinal Study in 2011,totally 521 elderly T2DM patients were enrolled,and according to the results of minimum mental state examination(MMSE)and their education levels,they were divided into a cognitively impaired group(437 cases)and a cognitively normal group(84 cases).Center for ED Epidemiological Survey Depression Scale was used to assess the depression symptoms.The correlation between cognitive impairment and depression was analyzed.Results Compared with the cognitively normal group,the cognitively impaired group had significantly advanced age(71.98±5.29 year vs 69.42±3.98 year,P=0.000),larger proportion of depression(60.6%vs 35.7%,P=0.000),and higher C-reactive protein level(5.09±12.80 mg/L vs 2.25±2.43 mg/L,P=0.000),and obviously lower ratios of being married(72.1%vs 86.9%,P=0.001)and having cardiovascular disease(20.1%vs 32.1%,P=0.010),and decreased estimated glomerular filtration rate[77.15±15.88 ml/(min·1.73 m^(2))vs 81.91±13.55 ml/(min·1.73 m^(2)),P=0.001].Multivariate logistic regression analysis showed that cognitive impairment was an independent risk factor for the development of depression in elderly T2DM patients(OR=3.44,95%CI:1.89-6.27,P<0.01).ROC curve analysis indicated that the AUC value of MMSE score in predicting depression in elderly T2DM patients was 0.669(95%CI:0.626-0.709,P<0.01).The direct effect of cognitive impairment and the mediating effect of loneliness on depression in elderly T2DM patients accounted for 72.22%and 27.78%of the total effect,respectively.Conclusion Cognitive impairment is associated with the presence of depression in elderly T2DM patients,and loneliness plays a mediating role.

关 键 词：糖尿病 2型 抑郁 认知障碍 孤独 

分 类 号：R58[医药卫生—内分泌]