| 动脉硬化程度对糖尿病患者认知功能的影响研究 |
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| 引用本文： | 李晶,袁金环,王猛,张亚静,陈朔华,吴寿岭,吴云涛,高竞生,高碧霞,王晋伟. 动脉硬化程度对糖尿病患者认知功能的影响研究[J]. 中国全科医学, 2020, 23(19): 2417-2422. DOI: 10.12114/j.issn.1007-9572.2019.00.688 |
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| 作者姓名： | 李晶 袁金环 王猛 张亚静 陈朔华 吴寿岭 吴云涛 高竞生 高碧霞 王晋伟 |
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| 作者单位： | 1.063000河北省唐山市,华北理工大学研究生院 2.063000河北省唐山市,开滦总医院心内科 3.054000河北省邢台市,第三医院心内科 4.100034北京市,北京大学第一医院肾内科 5.100034北京市,北京大学肾脏疾病研究所*通信作者：高竞生,主任医师,教授;E-mail：gaojingsheng@kailuan.com.cn |
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| 基金项目： | 十三五国家重点研发计划项目(2016YFC1305400)——糖尿病肾病发生发展的危险因素及机制研究。 |
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| 摘 要： | 背景 已有研究表明高血压、血脂异常、动脉硬化等是认知功能障碍的危险因素,而糖尿病患者是高血压、血脂异常、动脉硬化等危险因素的聚集体。随着糖尿病认知功能障碍患病率逐年上升,明确动脉硬化是否对糖尿病认知功能有影响十分必要。目的 探究动脉硬化程度对糖尿病人群认知功能的影响。方法 选取2016年在开滦总医院及所属11家医院进行年度体检的开滦集团在职和离退休职工3 610例为研究对象。按照臂踝脉搏波传导速度（baPWV）三分位数将受检者分为3组,第1分位组baPWV19.30 m/s。观察各组基线资料、简易智力状态检查量表（MMSE）评分及认知功能障碍检出率。采用多因素Logistic回归分析动脉硬化水平对糖尿病人群认知功能的影响。结果 三组年龄、收缩压、舒张压、平均动脉压、baPWV、糖化血红蛋白、肾小球滤过率估计值（eGFR）及吸烟、文化程度为高中及以上、有高血压病史、服用降压药及服用降糖药占比比较,差异有统计学意义（P<0.05）。总人群平均MMSE评分为（27.01±3.29）分,认知功能障碍检出率为11.77%（425/3 610）。baPWV三分位组MMSE评分比较,差异有统计学意义（F=12.40,P<0.001）;进一步两两比较显示,第2、3分位组MMSE评分低于第1分位组,差异有统计学意义（P<0.05）。baPWV三分位组间认知功能障碍检出率比较,差异有统计学意义（χ2=17.89,P<0.001）;进一步两两比较显示,第2、3分位组认知功能障碍检出率高于第1分位组,差异有统计学意义（P<0.016 7）。校正年龄、性别、平均动脉压、BMI、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、三酰甘油、糖化血红蛋白、eGFR、饮酒、吸烟、体育锻炼变量后,多因素Logistic回归分析结果显示,与第1分位组相比,第2、3分位组均为认知功能障碍的危险因素,其OR（95%CI）分别为1.49（1.01,2.19）、1.52（1.02,2.28）。结论 高动脉硬化程度（baPWV≥16.11 m/s）是糖尿病人群发生认知障碍的危险因素。
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| 关 键 词： | 动脉硬化 糖尿病 认知障碍 臂踝脉搏波传导速度 |
Impact of Arterial Stiffness Level on Cognitive Function among Diabetic Patients |
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| LI Jing,YUAN Jinhuan,WANG Meng,ZHANG Yajing,CHEN Shuohua,WU Shouling,WU Yuntao,GAO Jingsheng,GAO Bixia,WANG Jinwei. Impact of Arterial Stiffness Level on Cognitive Function among Diabetic Patients[J]. Chinese General Practice, 2020, 23(19): 2417-2422. DOI: 10.12114/j.issn.1007-9572.2019.00.688 |
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| Authors: | LI Jing YUAN Jinhuan WANG Meng ZHANG Yajing CHEN Shuohua WU Shouling WU Yuntao GAO Jingsheng GAO Bixia WANG Jinwei |
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| Affiliation: | (Graduate School,North China University of Science and Technology,Tangshan 063000,China;Department of Cardiovascular Medicine,KaiLuan General Hospital,Tangshan 063000,China;Department of Cardiovascular Medicine,Xingtai Third Hospital,Xingtai 054000,China;Department of Nephrology,Peking University First Hospital,Beijing 100034,China;Peking University Institute of Nephrology,Beijing 100034,China) |
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| Abstract: | Background Previous studies have shown that hypertension,dyslipidemia and arterial stiffness are risk factors for cognitive dysfunction,while diabetes is an aggregation of the aforementioned three and other risk factors.As the incidence of diabetes-associated cognitive impairment is increasing annually,it is necessary to determine whether arterial stiffness has an effect on cognitive function in diabetic patients.Objective To explore the association between arterial stiffness and cognitive function among diabetic patients.Methods We enrolled 3610 employed and retired workers with diabetes of Kailuan(Group)Limited Liability Corporation who underwent annual physical examination in KaiLuan General Hospital and its affiliated 11 hospitals in 2016,and divided them into group 1(the first tertile:baPWV<16.11 m/s),group 2(the second tertile:baPWV 16.11-19.30 m/s),and group 3(the third tertile:baPWV>19.30 m/s)by the baPWV level.We collected their baseline data,Mini-Mental State Examination(MMSE)score and detection rate of cognitive impairment.We performed multivariate Logistic regression analysis to explore the influence of baPWV on cognitive function in diabetes population.Results There were significant differences in mean age,systolic blood pressure,diastolic blood pressure,mean arterial pressure,baPWV,glycosylated hemoglobin,and eGFR,prevalence of smoking,secondary and post-secondary education level,history of hypertension,treatment with antihypertensive drugs and hypoglycemic drugs among the three groups(P<0.05).The mean MMSE score,and the prevalence of cognitive impairment in all the participants were(27.01±3.29),11.77%(425/3610),respectively.The mean MMSE score differed significantly in baPWV tertile groups(F=12.40,P<0.001).Pairwise comparisons showed that group 1 had lower mean MMSE score than other two groups(P<0.05).The prevalence of cognitive impairment also differed significantly in baPWV tertile groups(χ2=17.89,P<0.001).In particular,group 1 had lower prevalence of cognitive impairment compared with other two groups(P<0.0167).Multivariate Logistic regression analysis showed that after adjusting for age,sex,mean arterial pressure,body mass index,low-and high-density lipoprotein,triglyceride,glycosylated hemoglobin,eGFR,alcohol consumption,smoking and physical exercise,the second tertile〔OR=1.49,95%CI(1.01,2.19)〕and third tertile〔OR=1.52,95%CI(1.02,2.28)〕of baPWV(higher baPWV)were associated with increased risk of cognitive impairment.Conclusion The degree of arterial stiffness(baPWV≥16.11 m/s)is an independent risk factor for cognitive impairment in diabetic patients. |
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| Keywords: | Arteriosclerosis Diabetes mellitus Cognition disorders Brachial ankle pulse wave velocity |
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