老年2型糖尿病患者认知功能障碍影响因素分析

Influencing factors associated with cognitive dysfunction in the elderly with type 2 diabetes mellitus

摘要:

目的 探讨老年2型糖尿病(T2DM)患者认知功能障碍发生的影响因素。方法 回顾性分析2017年6月至2018年5月首都医科大学宣武医院内分泌科2型糖尿病患者204例,根据简易版蒙特利尔认知评估(MoCA)量表结果分为认知功能障碍组98例和认知功能正常组106例。记录2组患者实验室检查结果,慢性肾脏病流行病学合作研究(CKD-EPI)公式计算估算肾小球滤过率(eGFR)。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验、Mann-Whitney U检验或χ²检验。多因素logistic回归分析认知功能障碍的危险因素。结果 认知功能障碍组相比认知功能正常组患者年龄[(68.4±7.7) vs(66.0±6.7)岁]、骨质疏松[35.71%(35/98) vs 19.81%(21/106)]和eGFR＜60ml/(min·1.73m²)比例[26.53%(26/98) vs 12.26%(13/106)]高,MoCA分值[(20.36±4.07) vs(27.02±1.49)分]和受教育时间[(8.85±4.14) vs(12.35±3.30)年]低,差异均具有统计学意义(P＜0.05)。多因素logistic回归分析结果表明年龄(OR=1.05,5%CI 1.01～1.10；P=0.011)和eGFR＜60ml/(min·1.73m²)[OR=2.15,5%CI 1.08～4.26；P=0.029]为老年2型糖尿病患者认知功能障碍的独立危险因素。结论 年龄和eGFR＜60ml/(min·1.73m²)是老年2型糖尿病患者认知功能障碍的危险因素,控制患者血糖同时要监测患者肾功能,预防认知功能障碍的发生和进展。

Abstract:

Objective To explore the influencing factors associated with cognitive dysfunction in the elderly with type 2 diabetes mellitus (T2DM). Methods A total of 204 hospitalized T2DM old patients (≥60 years old) admitted in our department from June 2017 to May 2018 were enrolled in the study. According to the result of Montreal Cognitive Assessment (MoCA) test, they were divided into the cognitive dysfunction group (n=98) and normal cognitive function group (n=106). The indicators of physical examination and laboratory tests were collected. The estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. SPSS statistics 19.0 was used for data analysis, and Chi-square test, Student′s t test or Mann-Whitney U test was employed for comparison between the groups. Multivariate logistic regression analysis was used to assess the risk factors for cognitive dysfunction. Results The cognitive dysfunction group was older in age [(68.4±7.7) vs (66.0±6.7)years], and had significantly higher proportions of the patients with osteoporosis [35.71%(35/98) vs19.81%(21/106)] and eGFR <60ml/(min·1.73m²) [26.53%(26/98) vs 12.26%(13/106)], but lower MoCA score [(20.36±4.07) vs (27.02±1.49)] and shorter educational duration [(8.85±4.14) vs (12.35±3.30)years] when compared with the normal cognitive function group (all P<0.05). Multivariate logistic regression analysis showed that age (OR=1.05,5%CI 1.01-1.10; P=0.011) and eGFR <60ml/(min·1.73m²) (OR=2.15,5%CI 1.08-4.26; P=0.029) were independent risk factors for cognitive dysfunction. Conclusions Age and eGFR <60ml/(min·1.73m²) are risk factors for cognitive dysfunction in the elderly with T2DM. So, controlling blood glucose and monitoring renal function are helpful to prevent the occurrence and progress of cognitive dysfunction.