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。

Correlation of blood glucose and blood lipid with cognitive function in elderly patients

Objective To study the impairment of cognitive function in elderly patients and their possible risk factors of blood glucose and blood lipid. Methods There were 211 participants included in our study, 97 of which were in the diabetic group and 114 were in the nondiabetic group; 87 of which were in the hyperlipidemia group and 124 were in the nonhyperlipidemia group; 49 of which were in the diabetic complicated with hyperlipidemia group and 76 of which were in the nondiabetic and nonhyperlipidemia groups. The participants were evaluated by cognitive rating scales, including Minimental State Examination （MMSE）, Montreal Cognitive Assessment （MOCA）, Clinical Dementia Rating （CDR） and Global Deteriorate Scale （GDS）. Their fasting blood glucose （FBG）, two-hour postprandial blood glucose （2h-BG）, glycatedhemoglobinAlc （HbAlc）, total cholesterol （TC）, triglyceride （TG）, high densitylipoproteincholesterol （HDL- C）, low-density lipoprotein cholesterol （LDL-C） and lipoprotein （a） （Lpa） were analyzed, respectively. The cognitive scores were compared and their possible risk factors were evaluated by stepwise regression analysis. Results Compared with the nondiabetic group, the diabetic group had lower MMSE, MOCA scores （P〈0.01）. The hyperlipidemia group had lower MMSE, MOCA scores （P〈 0.01） than the nonhyperlipidemia group. The diabetic complicated with hyperlipidemia group had lower MMSE, MOCA scores （P〈0.01） than the nondiabetic and nonhyperlipidemia groups. The stepwise regression analysis was carried out, taking MMSE as the dependent variable and age, education and the biochemical indices mentionede above as independent variables. The obvious correlations of the MMSE scores with the HDL-C （β=0.253, P〈0.001）, education （β=0.150, P=0.035）, TC （β=-0.161, P=0.011）, age （β=-0.165, P=0.023） and2hBG （β=-0.143, P=0.029 ） were found. Conclusions The cognitive function in the elderly patients was impaired. Apart from age and education, TC and 2h-BG are important risk factors for cognitive decline of the elderly patients and HDL-C are positive factors for cognitive decline.