空腹糖耐量受损及空腹血糖偏低和老年人轻度认知障碍的关系探讨

目的探讨轻度认知障碍(MCI)风险与血糖代谢异常的相关性,并为MCI的预防提供依据。方法本研究对1074例认知功能正常且无糖尿病、高脂血症、痛风的老年门诊患者进行了调查。随访5年,根据简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能评估,有121例受试者被诊断出患有MCI。此外,监测受试者每年血糖、糖化血红蛋白。结果入组的1074例受试者根据认知功能的不同分为MCI组和非MCI组,与非MCI组相比,MCI组中空腹血糖(FBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)和总胆固醇(TC)的平均值更高(均P<0.05)。在高血糖组中,FBG的临界值为6.2 mmol/L(敏感性=84.1%,特异性=90.9%,曲线下面积=0.875,P<0.001);在低血糖组中,FBG的临界值为4.5 mmol/L(灵敏性=77.4%,特异性=87.3%,曲线下面积=0.823,P<0.001)。HbA1c的临界值为5.5%(敏感性=76.0%,特异性=87.0%,曲线下面积=0.815,P<0.001)。多元Logistic回归分析MCI的风险增加与空腹血糖平均值<4.5 mmol/L和≥6.2 mmol/L(RR:1.69,95%CI:1.11~2.59;RR:1.81,95%CI:1.15~2.86)以及糖化血红蛋白平均值≥5.5%(RR:2.13,95%CI:1.51~2.99)相关。结论空腹糖耐量受损及空腹血糖偏低是老年人MCI发生风险的独立危险因素。

The correlation between mild cognitive impairment in the elderly and impaired fasting glucose tolerance and low fasting blood glucose

Objective To investigate the correlation between mild cognitive impairment(MCI)and abnormal glucose metabolism and thus to provide a basis for MCI prevention.Methods A total of 1074 elderly outpatients with normal cognitive function and without confirmed diabetes mellitus,hyperlipoidemia or gout were enrolled.During a five-year follow-up period,121 subjects were diagnosed with MCI based on the mini mental state examination(MMSE)and the Montreal cognitive assessment(MoCA).Furthermore,annual blood glucose and glycated hemoglobin monitoring was carried out to examine the long-term effects of abnormal glucose metabolism on MCI risk.Results According to cognitive function,1074 subjects were divided into the MCI group and the non-MCI group.Compared with the non-MCI group,the mean values of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),triglycerides(TG)and total cholesterol(TC)in the MCI group were elevated(P<0.05).The receiver operating characteristic(ROC)curve showed that the cut-off value of FBG was 6.2 mmol/L for the hyperglycemia group(sensitivity:84.1%,specificity:90.9%,area under curve:0.875,P<0.001)and 4.5mmol/L for the hypoglycemic group(sensitivity:77.4%,specificity:87.3%,area under curve:0.823,P<0.001);the cut-off value of HbA1c was 5.5%(sensitivity:76.0%,specificity:87.0%,area under curve:0.815,P<0.001).Multiple Logistic regression analysis showed that increased risk of MCI was associated with the mean values of fasting blood glucose<4.5 mmol/L(RR:1.69,95%CI:1.11-2.59)or≥6.2 mmol/L(RR:1.81,95%CI:1.15-2.86)and of glycosylated hemoglobin≥5.5%(RR:2.13,95%CI:1.51-2.99).Conclusions Impaired fasting glucose tolerance and low fasting blood glucose are independent risk factors for MCI in the elderly.