社区老年2型糖尿病患者合并轻度认知功能障碍危险因素分析

目的探讨分析2型糖尿病患者轻度认知功能障碍（mild cognitive impairment，MCI）的相关危险因素。方法以简易智能精神状态量表（MMSE）对社区老年2型糖尿病患者进行认知功能测评，收集MCI患者82例（MCI组），认知功能正常者86例（NC组）。问卷调查受试者病史、年龄、糖尿病肾病、糖尿病足等资料；测定受试者血压、身高、体质量、血脂、血糖、胰岛素（Ins）、糖化血红蛋白（HbA1c）；计算胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、体质量指数（BMI）、腰臀比（WHR）并筛查其危险因素。结果（1）与NC组比较，MCI组患者糖尿病病程、糖尿病肾病、空腹血糖（FBG）、餐后2h血糖（2hPBG）、空腹胰岛素（Fins）、HbA1c、HOMA—IR水平显著升高；而2组间年龄、糖尿病足、BMI、WHR、血压、餐后2h胰岛素（2hlns）、HOMA-B及血脂水平比较，差异均无统计学意义。（2）MCI患者MMSE量表评分与糖尿病病程、FBG、2hPBG、Fins、HOMA—IR具有相关性；而NC组仅发现与糖尿病病程、FBG相关。（3）Logistic回归分析显示糖尿病病程、FBG、HOMA-IR可能与糖尿病患者MCI独立相关。结论糖尿病病程、血糖控制水平、胰岛素抵抗程度等可能与2型糖尿病患者发生MCI密切相关，有效控制各危险因素有助于预防认知功能障碍的发生发展。

Risk factors of mild cognitive impairment in the elderly patients with type 2 diabetes

Objective To evaluate the risk factors of mild cognitive impairment （MCI） in the elderly patients with type 2 diabetes mellitus （T2DM）. Methods Mini-mental state examination （MMSE） was applied as cognition assessment implement. One hundred and sixty-eight elderly patients with T2DM were enrolled in the study. There were 82 patients with MCI （MMSE score〈27） in MCI group and 86 with normal cognitive function （MMSE score≥27） in control group. The data of disease duration, age, diabetic nephropathy, diabetic foot, blood pressure （ BP）, height, werght, blood lipid, blood glucose, insulin, HbAlc were collected. Then HOMA-IR and HOMA-beta, body mass index （BMI）, waist-to-hip ratio（WHR） were calculated and risk factors were analyzed. Results There were significant differences in the disease course of diabetes mellitus, diabetic nephropathy, fasting blood glucose （FBG）, 2 h postprandial blood glucose （2hPBG）, fasting insulin （Fins）, HOMA-IR, and there were no significant differences in the age, diabetic foot, BMI, WHR, BP, 2 h postprandial insulin （2hlns）, HOMA-β and blood lipids between control group and MCI group. MMSE scores were negatively correlated with the duration of DM, FBG, 2hPBG, Fins, HOMA-IR. Logistic regression analysis showed that the duration of DM, FBG,HOMA-IR were significantly independent risk factors for MCI. Conclusions Longer duration of diabetes, higher blood glucose, more severe insulin resistance, and microvascular diseases could be risk factors of MCI in the patients with T2DM. This could have an important impact on the management of cognitive decline in the diabetic patients.