2型糖尿病认知功能损害研究进展

流行病学研究发现,2型糖尿病与认知功能损害有关,是Alzheimer病及血管性痴呆的独立危险因素。血糖控制不良,合并糖尿病并发症,病程长及应用胰岛素治疗等因素可能会加重患者的认知功能损害。心理及遗传因素对2型糖尿病患者的认知功能也具有一定的影响。     

高海拔地区中老年糖尿病患者认知功能损害的相关危险因素

目的观察高海拔地区糖尿病(DM)患者认知功能损害特点及相关危险因素。方法 3种病程DM患者194例行糖化血红蛋白(HbA1c)、甲状腺功能、同型半胱氨酸、认知功能评分[简易智力状况检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)]评估并观察低血糖情况。结果 DM病程越长,患者认知功能越差(P<0.05)。DM患者HbA1c水平与认知功能呈负相关。同型半胱氨酸是DM患者认知功能损害的危险因素。轻度甲状腺功能减退可加重DM患者认知功能损害(P<0.05)。低血糖加重DM患者认知功能损害(P<0.05)。结论影响高海拔地区中老年DM患者认知功能的主要危险因素是Hb A1c及同型半胱氨酸水平。     

2型糖尿病患者认知功能改变及其危险因素

目的了解2型糖尿病(T2DM)患者认知功能损害的情况及其危险因素。方法应用简易智能精神状态量表(MMSE)评估年龄、性别、文化程度和居住地相匹配的250例T2DM患者和250例对照者的认知功能,并将糖尿病组按年龄、病程、血糖控制水平、并发症与认知功能障碍进行单因素分析。结果糖尿病组MMSE总分,尤其是记忆、注意与计算力、语言能力、视空间、时间和地点定向得分显著低于对照组(P<0.05,P<0.01)。糖尿病组认知功能障碍与年龄、病程、血糖控制水平、合并高血压、高血脂、冠心病等因素均有统计学意义(P<0.05;P<0.01)。未发现糖尿病治疗方法与认知功能有明显的关系。结论认知功能减退与T2DM有关。严格控制血糖、血压,调整血脂等手段是改善认知功能的重要措施。     

2型糖尿病与认知功能障碍

1922年首次观察到糖尿病患者的认知功能障碍,在认知功能测试中,与正常对照组相比,糖尿病患者具有不同程度的记忆力以及注意力方面的损害。Petersen等首次提出了轻度认知功能障碍     

2型糖尿病患者认知功能影响因素分析

目的探讨2型糖尿病患者血糖水平对影响因素认知功能等。方法选取25例健康人作为对照组,将纳入的2型糖尿病患者100例作为观察组并进行正规降血糖治疗2年的影响,根据治疗前餐后2h血糖水平分为Ⅰ组（4．4〈血糖水平〈8mmol／L）、1I组（8≤血糖水平〈10mmol／L）、Ⅲ组（10≤血糖水平〈11．1mmol／L）和Ⅳ组（≥11．1mmol／L）,每组25例。对两组患者餐后2h血糖水平和认知功能评分进行检测对比分析。结果Ⅳ组患者在治疗2年后认知功能评分低于控制前（P均〈0．05）,认知功能评分依次为：Ⅱ组〉Ⅰ组〉Ⅲ组〉1V组,四组相互比较差异均有统计学意义（P均〈0．01）。多因素Logistic逐步回归分析结果显示,年龄、血糖水平和血糖下降幅度是认知功能评分下降的危险因素。结论高血糖水平会损害糖尿病患者的认知功能,有效控制血糖可保护患者的认知能力。     

2型糖尿病患者轻度认知功能障碍的特点及其危险因素

目的 观察2型糖尿病患者轻度认知功能障碍特点及相关危险因素.方法 从无锡地区痴呆的流行病学调查对象中筛选出82例高血压患者,84例糖尿病患者,76例糖尿病合并高血压患者以及年龄、性别及文化程度相匹配的80名正常对照者,以上四组均进行认知功能筛查问卷调查,同时检测胆固醇、甘油三酯、血压.高血压和糖尿病患者进行空腹胰岛素测定,计算胰岛素抵抗指数.糖尿病人给予糖化血红蛋白测定,并对四组人群的认知功能和危险因素进行对照分析.结果 ①糖尿病组在时间定向,个人经历,近事记忆,做事质量,判断力人格变化上与正常老年组有统计学差异(P＜0.05).②糖尿病合并高血压组在近事记忆,语言问题,人格变化等方面与正常老年组有统计学差异(P＜0.05).③糖尿病合并高血压组较糖尿病组在个人经历上有统计学差异(P＜0.01).④糖尿病组较高血压组在语言问题,人格变化上有统计学差异(P＜0.05).⑤高血压组与正常组没有统计学差异(P＞0.05).⑥胰岛索抵抗指数与问卷得分呈负相关.结论 ①2型糖尿病患者较同龄正常老年人存在轻度认知功能障碍,合并高血压的糖尿病患者的认知功能损害更严重.②糖化血红蛋白与胰岛素抵抗是认知功能障碍的危险因素.③糖尿病患者在记忆力损害的同时还存在精神症状和人格变化.     

阿尔茨海默病与血管性痴呆的非认知功能损害

目的　观察阿尔茨海默病与血管性痴呆的患者除认知功能异常外 ,是否存在非认知功能的异常。方法　根据DSM -Ⅳ阿尔茨海默病及血管性痴呆的诊断标准以及CDR的临床痴呆分级标准 ,对神经内科老年记忆障碍专科病房的 2 1例轻中度阿尔茨海默病及 2 5例血管性痴呆患者的非认知功能损害的临床表现进行了观察 ,包括情感反应、行为异常、人格变化及知觉异常。结果　阿尔茨海默病患者的非认知功能损害在情感障碍 (16例 ,76 % )、人格异常 (10例 ,48% )及知觉异常 (6例 ,2 9% )方面 ,明显多于血管性痴呆组 (分别为 10例 ,40 % ;1例 ,4% ;1例 ,4% )。结论　痴呆患者不仅有认知功能的损害 ,还有非认知功能的损害。阿尔茨海默病的非认知功能损害重于血管性痴呆 ,可能与两种痴呆的发病机制不同有关。     

中老年2型糖尿病患者认知功能的影响因素分析

目的:评估中老年2型糖尿病患者的认知功能并了解其相关的影响因素。方法:选择中老年有2型糖尿病病史患者(年龄40~69岁)199例。调查患者既往病史、糖尿病病程、家族史,检测并比较所有入组患者的体质量指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂、血压及颈动脉彩色超声。选用蒙特利尔认知评估(MoCA)量表北京版进行认知功能的评估。结果:糖尿病病程5年以上的患者MoCA评分较5年以内者降低(P<0.05)。认知功能与受教育年限、高血压病史、WHR、FPG、HbA1c、颈动脉内膜中层厚度(IMT)、颈动脉阻力指数(RI)显著相关(P<0.05)。多元回归分析显示,受教育年限、高血压病史、颈动脉RI、HbA1c是影响糖尿病患者MoCA评分水平的关键因素。结论:中老年2型糖尿病患者的认知功能与其受教育程度、高血压病史、颈动脉血管阻力及血糖控制情况密切相关。     

老年患者认知功能和血糖血脂的相关性研究

目的研究老年患者认知功能损害的情况及其血糖血脂危险因素的相互关系。方法人组患者211例,根据标准分为糖尿病组97例,非糖尿病组114例;高脂血症组87例,非高脂血症组124例;糖尿病合并高脂血症组49例,非糖尿病非高脂血症组76例。人组患者应用神经心理学量表进行认知功能的评价,包括简易智能状态量表检查（MMSE）、蒙特利尔认知评估（北京版）量表（MOCA）、临床痴呆量表（CDR）和总体衰退量表（GDS）,并测定空腹血糖（FBG）、餐后2h血糖（2h-BG）、糖化血红蛋白（HbAlc）、血清总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—c）、脂蛋白（a）（Lpa）,对各组认知功能进行对比分析,以MMSE得分为因变量逐步回归分析。结果糖尿病组与非糖尿病组比、高脂血症组与非高脂血症组比、糖尿病合并高脂血症组与非糖尿病非高脂血症组比,MMSE、MOCA评分均明显降低（P〈0．01）。以MMSE为因变量,以年龄、受教育年限及以上生化指标为自变量,进行逐步回归分析,最终进入方程的是HDL-C（β=0．253,P〈0．001）,受教育年限（β=0．150,P=0．035）,TC（β=-0．161,P=0．011）,年龄（β=-0．165,P=0．023）和2hBG（β=-0．143,P=0．029）。结论糖尿病及高脂血症对老年患者认知功能有明显的损害,除年龄、受教育程度等因素外,血清总胆固醇及餐后2h血糖的水平可能是老年患者认知功能损伤的重要危险因素,而高密度脂蛋白胆固醇可能是其保护因素。     

2型糖尿病合并认知功能障碍的危险因素

目的 探讨T2DM与认知功能障碍的相关性.方法 选取2015年1月至2019年8月南京医科大学附属脑科医院收治的T2DM合并认知功能障碍的住院病人50例,另外选取同期无认知功能障碍的T2DM病人50例,年龄均≥65岁.收集2组的一般资料及疾病信息,检测血脂、HbA1c、空腹胰岛素(FINS)、肌酐(Cr)、Hcy、血清...     

糖尿病患者勃起功能障碍的相关因素分析

调查了226例男性2型糖尿病患者（T2DM），分析了年龄、病程、HbA1c、血压、吸烟、饮酒等因素对发生勃起功能障碍的影响。糖尿病患者勃起功能障碍（DED）患病率为67．7％，病程每增加5年、年龄每增加10岁、HbA1c每增加2％、收缩压每增加30mmHg、吸烟史、饮酒史OR分别为1．9617、1．2519、2．3207、1．1219、1．6745（P均〈0．05）、4．3671（P均〈0．01）。     

Analysis of cognitive dysfunction and its risk factors in patients with hypertension

To observe whether obstructive sleep apnea syndrome (OSAS) can aggravate the cognitive dysfunction of patients with hypertension (HTN), and to explore other risk factors.One hundred one hypertensive patients were selected for information collection. After the polysomnography test, they were divided into HTN-obstructive sleep apnea (OSA) and HTN groups. The Montreal cognitive assessment and the mini-mental state examination scales were used to appraise the patients’ cognitive function. Logistic regressive analysis was used to determine the risk factors of cognitive dysfunction in patients with HTN.Compared with the HTN patients, HTN-OSA patients performed worse in mini-mental state examination (25.5 ± 2.9 vs 23.5 ± 3.2; P = .01) and Montreal cognitive assessment (28 ± 1.58 vs 21.2 ± 3.96; P = .003), and patients in the HTN-OSA group seemed more likely to suffer from dementia (31% vs 66%; P < .01). The apnea-hypopnea index (AHI) in the HTN group was lower than HTN-OSA group. Through multivariate logistic regression analysis, we can found that alcohol drinking, body mass index, long-term medication, diabetes, hypercholesterolemia, coronary heart disease, and OSAS were the independent risk factors of cognitive dysfunction in patients with HTN.OSAS can aggravate the cognitive dysfunction of hypertensive patients, besides, drinking, high-body mass index, long-term medication, diabetes, hypercholesterolemia, and coronary heart disease were also the risk factors of cognitive dysfunction in patients with hypertension. The cognitive dysfunction of patients with HTN can benefit from sleep apnea treatment.     

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery: A retrospective analysis

Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management.Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. Logistic regression was used to analyze the potential influencing factors.A total of 572 patients with laparoscopic surgery were included. The incidence of POCD was 11.89%. There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO₂ during anesthesia induction, PaCO₂ after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO₂ during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13–0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery.For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.     

糖尿病足溃疡危险因素分析

观察23例糖尿病足溃疡患者的年龄、糖尿病病程、空腹血糖、血清总蛋白、血清白蛋白、血清肌酐、血清尿素氮及溃疡发生的位置,并与20例无溃疡糖尿病患者进行对比分析。结果显示：两组患者糖尿病病程、空腹血糖、血清总蛋白、血清白蛋白有显著性差异,年龄,血清肌酐、尿素氮、无显著性差异,糖尿病足溃疡患者右足溃疡发生率（86％）显著高于左足（39％）,双母趾溃疡发生率（65％）高于部位（35％）,但无显著性差异,结果提示：糖尿病程、高血糖、低蛋白血症及足部受力过多和压迫是糖尿病足溃疡发生的危险因素。     

Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients.

AIM: To estimate the prevalence of erectile dysfunction (ED) in Chinese diabetic men and to identify its risk factors, we carried out a cross-sectional survey of 500 Chinese diabetic men attending a community hospital diabetic clinic in Hong Kong. METHODS: Patients were interviewed and asked to report on their experience of ED as defined in the National Institutes of Health Consensus Conference 1993. Diabetic complications and patient clinical data were obtained from patients' medical records. RESULTS: Of the 486 patients studied, the prevalence of ED was 63.6% (95% confidence interval 59.3-67.9%). The prevalence of ED increased with age, from 33.3% to 73.8% for diabetic men aged between 21 and 80 years (P = 0.001). Severity of ED also increased with age. Among diabetic men with ED, there was no report of complete ED for diabetic men aged 40 years and below, whereas the proportion of patients with complete ED increased from 7.4% to 71.1% between the ages of 41 and 80 years. ED occurred early in the course of the disease, with a prevalence increasing from 56.0% in men with diabetes mellitus (DM) for < 5 years to 72.0% in those with DM for > 20 years (P = 0.038). Duration of DM was also associated with severity; the proportion of patients with complete ED increased from 30.8% for those with DM for < 5 years to 72.2% for those with DM for > or = 20 years (P < 0.001). Using logistic regression analysis, DM duration, diabetic complications including retinopathy, abnormal albuminuria and sensory neuropathy, and higher level of education were associated with a higher risk of ED. By polychotomous logistic regression, age was the only factor found to be associated with the severity of ED, after adjusting for other variables. CONCLUSIONS: Chinese diabetic patients have a prevalence of self-reported ED that appears to be higher than that of Western populations. This may be due to cultural differences and the association of abnormal albuminuria and hypertension.     

老年2型糖尿病患者糖尿病肾病危险因素分析

糖尿病肾病（DN）可进展为终末期肾病（ESRD）。在所有老年ESRD患者中41％为DN所致，75岁以上者比例更高。本文对60岁以上568例2型糖尿病患者的临床资料及生化指标进行了分析，探讨DN的危险因素。     

Advanced endothelial dysfunction in diabetic patients with multiple risk factors; importance of insulin resistance

AIM: Endothelial dysfunction is considered an early event in the development of atherosclerosis. The present study was undertaken to determine whether the accumulation of cardiovascular risk factors and insulin resistance are associated with endothelial function in diabetic patients.METHODS: 101 patients with type 2 diabetes without macroangiopathy stratified by the number of cardiovascular risk factors (dyslipidemia, hypertension, obesity) and 9 normal control subjects were studied for vascular endothelial functions by measuring flow-mediated vasodilation (FMD) using a high-resolution ultrasound method, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT), and the ankle-brachial index (ABI).RESULTS: FMD negatively correlated with baPWV and carotid IMT, and positively correlated with ABI. FMD was significantly lower in diabetic patients associated with 3 other risk factors than in those with diabetes alone. In subjects with fasting plasma glucose < or = 140mg/dL, FMD showed significant negative correlations with fasting insulin levels and homeostasis model assessment (HOMA)-R. Multivariate analysis revealed that insulin resistance as represented by HOMA-R and systolic blood pressure showed a significant association with impaired FMD.CONCLUSION: The present results suggest that the accumulation of cardiovascular risk factors is associated with endothelial dysfunction in diabetic patients, and that insulin resistance as well as high blood pressure could play a pathogenic role in the development of endothelial dysfunction.     

老年认知功能障碍可控危险因素的研究进展

随着全球人口老龄化的日趋严重,老年认知功能障碍患者人数也在迅速增长。认知功能障碍相关疾病成为继肿瘤、心脑血管病及糖尿病之后,严重影响老年人生活质量,给家庭和社会带来沉重负担的一组重要疾病。强有力的证据支持改变潜在危险因素对老年认知功能障碍的益处,教育、营养、保健和生活方式的改变,各种可控危险因素的控制将成为减轻全球老年认知障碍负担的强大策略。本文对老年认知功能障碍可控危险因素展开综述,旨在为更好地预防其发病和进展提供一定帮助。