摘要
目的探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者神经元烯醇化酶(neuron-specific enolase,NSE)和血管内皮生长因子(vascular endothelial growth factor,VEGF)表达水平及其与认知功能的关系。方法216例老年T2DM患者,采用简明精神状态量表(Mini-Mental State Examination Scale,MMSE)评估患者认知功能,并根据MMSE评分分为非认知功能障碍(MMSE 27~30分)组54例(对照组)、轻度认知功能障碍(MMSE 21~26分)组76例(轻度组)、中度认知功能障碍(MMSE 10~20分)组48例(中度组)和重度认知功能障碍(MMSE<10分)组38例(重度组)。采用ELISA法检测患者血清NSE和VEGF水平,采用Pearson相关分析血清NSE与VEGF水平的相关性及其与MMSE评分的相关性,采用多因素logistic回归分析老年T2DM患者发生认知功能障碍的影响因素。结果轻、中、重度组糖尿病病程长于对照组,受教育时间短于对照组,空腹血糖、糖化血红蛋白、同型半胱氨酸水平高于对照组,MMSE评分低于对照组(P<0.05)。轻、中、重度组血清NSE水平依次增高[(14.23±3.65)、(18.70±2.67)、(24.61±3.80)ng/L](P<0.05),均高于对照组[(10.02±2.94)ng/L](P<0.05),血清VEGF水平依次降低[(21.68±3.53)、(17.13±2.95)、(13.40±3.62)ng/L](P<0.05),均低于对照组[(25.65±2.34)ng/L](P<0.05)。老年T2DM合并认知功能障碍患者血清NSE水平与VEGF水平、MMSE评分呈负相关(r=—0.952,P<0.001;r=—0.956,P<0.001),血清VEGF水平与MMSE评分呈正相关(r=0.921,P<0.001)。受教育时间(OR=4.57,95%CI:2.57~10.37,P=0.006)、同型半胱氨酸(OR=1.86,95%CI:1.61~2.84,P=0.002)、NSE(OR=2.53,95%CI:1.28~5.64,P=0.003)及VEFG水平(OR=1.39,95%CI:1.09~1.49,P=0.007)是老年T2DM患者发生认知功能障碍的独立影响因素。结论老年T2DM伴认知功能障碍患者血清NSE水平升高,VEGF水平降低,NSE和VEGF与认知功能评分存在相关性,在老年T2DM患者发生认知功能障碍的发生、发展中发挥重要作用。
Objective To investigate the expression levels of neuron-specific enolase(NSE)and vascular endothelial growth factor(VEGF)in elderly patients with type 2 diabetes mellitus(T2 DM)and their relationships with cognitive function.Methods According to the cognitive function assessed by Mini-Mental State Examination Scale(MMSE),216 elderly patients with T2 DM were divided into 54 patients with MMSE score 27 to 30(control group),76 patients with MMSE score 21 to 26(mild cognitive impairment group),48 patients with MMSE score 10 to 20(moderate cognitive impairment group)and 38 patients with MMSE score<10(severe cognitive impairment group).The levels of NSE and VEGF were detected by ELISA method.Pearson correlation analysis was used to assess the correlations between serum NSE and VEGF levels as well as the correlations of serum NSE and VEGF levels with MMSE score.Multivariate logistic regression was used to analyze the influencing factors for cognitive impairment in elderly patients with T2 DM.Results The history of diabetes was longer and the schooling year was shorter,the levels of fasting plasma glucose,glycosylated hemoglobin and homocysteine were higher,and MMSE score was lower in mild,moderate and severe cognitive impairment groups than that in control group(P<0.05).The NSE level increased gradually((10.02±2.94),(14.23±3.65),(18.70±2.67),(24.61±3.80)ng/L)and the VEGF level decreased gradually((25.65±2.34),(21.68±3.53),(17.13±2.95),(13.40±3.62)ng/L)in turns in control group,mild cognitive impairment group,moderate cognitive impairment group and severe cognitive impairment group(P<0.05).The NSE level was negatively correlated with VEGF expression level(r=-0.952,P<0.001)and MMSE score(r=-0.956,P<0.001),while the VEGF level was positively correlated with MMSE score(r=0.921,P<0.001)in elderly T2 DM patients with cognitive impairment.The schooling year(OR=4.57,95%CI:2.57-10.37,P=0.006),homocysteine(OR=1.86,95%CI:1.61-2.84,P=0.002),NSE(OR=2.53,95%CI:1.28-5.64,P=0.003)and VEFG level(OR=1.39,95%CI:1.09-1.49,P=0.007)were the independent influencing factors for cognitive impairment in elderly T2 DM patients.Conclusion The NSE level increases,and the VEGF level decreases in elderly T2 DM patients with cognitive impairment.The levels of NSE and VEGF are correlated with MMSE score,and play an important role in the occurrence and development of cognitive impairment in elderly T2 DM patients.
作者
张依
杜维桓
严之红
纪红
ZHANG Yi;DU Weihuan;YAN Zhihong;JI Hong(Department of Geriatrics,Aerospace Center Hospital,Beijing 100049,China)
出处
《中华实用诊断与治疗杂志》
2020年第8期822-825,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
2019年中国航天科工集团课题项目(2019-LCYL-012)。
关键词
2型糖尿病
认知功能障碍
神经元烯醇化酶
血管内皮生长因子
type 2 diabetes mellitus
cognitive impairment
neuron-specific enolase
vascular endothelial growth factor
