糖尿病脑病与缺血性脑血管病患者认知功能障碍的临床研究

目的 探讨糖尿病脑病与缺血性脑血管病患者认知功能障碍及事件相关电位（ERP）的特征、发病关系及临床意义.方法 对41例糖尿病合并缺血性脑血管病患者（观察组）、39例缺血性脑血管病患者（对照组）及32例健康者（健康组）进行蒙特利尔认知评估量表（MoCA）评分、事件相关电位检查.结果 （1）MoCA总分：观察组为（19.82±1.38）分,对照组为（24.76±1.27）分,与健康组（26.04±1.15）分比较差异有统计学意义（P＜0.05）,观察组与对照组比较差异亦有统计学意义（P〈0.01）.观察组患者视空间与执行功能、注意、语言、抽象思维、延迟记忆等5个亚项的评分均明显低于健康组（P＜0.01）.而实物命名和时间地点定向力3组间比较差异无统计学意义（P﹥0.05）.（2） P300潜伏期：观察组、对照组与健康组相比显著延长（P＜0.05）,观察组与对照组比较差异有统计学意义（P〈0.01）.3组患者P300潜伏期与MoCA总分呈负相关（r＝-0.64,P＜0.01）.结论 蒙特利尔认知评估量表中认知功能亚项的评估以及P300潜伏期的检测,对于早期发现糖尿病合并缺血性脑血管病患者的认知功能障碍（糖尿病脑病）具有重要临床价值.

The clinical study of mild cognitive impairment with diabetic encephalopathy and ischemic cerebrovascular disease

Objective To investigate the characteristic, pathogenetic relationship and clinical significance of neurop-sychology and event related potential（ERP） in patients with diabetic encephalopathy（DE） and vascular cognitive impairment（VCI）. Methods 41 Diabetes with ischemic cerebrovascular disease（DM ICVD） patients, 39 ischemic cerebrovascular disease（ICVD） patients and 32 normal subjects were explored by Montreal Cognitive Assessment（MoGA） and ERP neuroelectonic methods. Results（1） There were significant difference of MoCA scores among DE ICVD group（19. 82 士1.38）,ICVD group（24.76 ±1.27） and control group（26.04 ±1.15）（ P 0.01 or P 0.05）. The scores of sub items of MoCA were significant difference among DM ICVD group,ICVD group and control group including visual spatial executive function ability ,attention,abstractive thinking, delayed memory（ P 0.01）. There were no significant difference in nominal ability, time and spatial orientation ability（ P 0.05）.（2） In the DM ICVD group and ICVD group, the P300latencies were significantly prolonged with those in control group（ P 0.01 or P 0.05）. There were no significant differ？ence in P300 amplitudes, N100 latencies and amplitudes（ P 0. 05）. Using Pearson correlation coefficient analysis, the prolongation of P300 latencies showed a negative correlation to the total scores of MoCA in three groups（ r =-0. 64, P 0.01）. Conclusion The evaluation of sub items of MoCA have important clinical value to find cognitive impairment early in DE patients. The detecting of P300 helps early diagnosis of the diabetes encephalopathy patients with cognitive impairment.