影响老年糖尿病患者发生认知障碍的危险因素分析

胡金艳 王冬

摘   要：目的  探討影响老年糖尿病患者发生认知障碍的危险因素。方法  选取2015年10月～2017年10月解放军第三二二医院内分泌科收治的115例老年糖尿病患者为研究对象。根据简明精神状态量表评估结果，将患者分为认知正常组72例与认知功能障碍组43例，收集患者的体格检查资料、量表评分结果、实验室检查指标，统计分析可能影响认知功能障碍发生的危险因素。结果  ①与认知正常组相比，认知功能障碍组患者的冠心病发生率、SBP、DBP较高，差异有统计学意义（P<0.05）。②两组患者FPG、FINS、C-P、2hPG、2hINS、2hC-P、HOMA-IR、HbAI、TG、TC、LDL-C、HDL-C、ALB、前白蛋白等，差异无统计学意义（P>0.05）。③认知功能障碍组患者的ADL评分、GDS评分高于认知正常组，差异有统计学意义（P<0.05）。但两组患者的多病共存、多重用药、视力下降、便秘、听力下降的发生率、ICI-Q-SF评分、MNA-SF评分，差异无统计学意义（P>0.05）。④正常组仅有6例患者未出现并发症，分别有16例、20例、18例、10例、2例患者合并存在1种、2种、3种、4种、5种并发症。认知功能障碍组有7例患者未合并并发症，分别有9例、14例、8例、3例、2例患者合并存在1种、2种、3种、4种、5种并发症。两组患者的慢性并发症数量，差异无统计学意义（P>0.05）。⑤多因素Logistic分析结果发现，仅有舒张压、ADL评分、GDS评分是影响患者认知功能障碍发生的独立性危险因素（P<0.05）。结论  舒张压偏高、日常生活功能低下、存在抑郁倾向是影响老年糖尿病患者发生认知功能障碍的主要危险因素。

关键词：糖尿病;认知功能;抑郁

中图分类号： R587.1                                  文献标识码：A                               DOI：10.3969/j.issn.1006-1959.2018.16.015

文章编号：1006-1959（2018）16-0055-04

Analysis of Risk Factors Affecting Cognitive Impairment in Elderly Diabetic Patients

HU Jin-yan，WANG Dong

（Department of Endocrinology，the 322 Hospital of PLA，Datong 037000，Shanxi，China）

Abstract：Objective  To investigate the risk factors affecting cognitive impairment in elderly diabetic patients.Methods  A total of 115 elderly patients with diabetes mellitus admitted to the Department of Endocrinology，322 Hospital of PLA from October 2015 to October 2017 were selected as subjects.According to the assessment results of the Concise Mental Status Scale，the patients were divided into normal cognitive group（72 cases）and cognitive impairment group（43 cases）.The physical examination data，scale scores and laboratory tests were collected，and the risk factors that might affect the occurrence of cognitive impairment were statistically analyzed. Results  ①Compared with the normal cognitive group，the incidence of coronary heart disease，SBP and DBP were higher in the cognitive dysfunction group，the difference was statistically significant（P<0.05）.②Groups of patients with FPG，FINS，CP，2hPG，2hINS， 2hC-P，HOMA-IR，HbAI，TG，TC，LDL-C，HDL-C，ALB，prealbumin，etc.，the difference was not statistically significant（P>0.05）.③The ADL score and GDS score of the cognitive dysfunction group were higher than those of the normal cognitive group，the difference was statistically significant（P<0.05）.However，the coexistence of multiple diseases，multiple medications，decreased vision，constipation， hearing loss，ICI-Q-SF score，and MNA-SF score were not statistically significant（P>0.05）.④There were only 6 patients in the normal group without complications.There were 16 patients，20 patients，18 patients，10 patients，and 2 patients with one，two，three，four，and five complications.In the cognitive dysfunction group，7 patients had no complications，and 9 patients，14 patients，8 patients，3 patients，and 2 patients had one，two，three，four，and five complications.There was no significant difference in the number of chronic complications between the two groups（P>0.05）.⑤Multivariate logistic analysis found that only diastolic blood pressure，ADL score，GDS score were independent risk factors affecting cognitive dysfunction（P<0.05）.Conclusion  High diastolic blood pressure，low daily living function and depression tendency are the main risk factors for cognitive dysfunction in elderly diabetic patients.

Key words：Diabetes;Cognitive function;Depression

随着我国社会人口结构逐步老龄化，老年人群的健康问题越来越受到重视。老年人生理功能下降，对疾病抵抗能力下降，往往存在多病共存现象[1]。老年综合征是一组由于多种疾病导致的同一临床表现的老年病症，常见的类型包括跌倒、认知功能下降、二便失禁、谵妄、抑郁倾向、疼痛等[2]。认知功能障碍是严重影响老年人及主要照顾者生活质量的危险因素，且在世界范圍内，认知功能障碍的发生率呈明显的上升趋势[3]。有……