2型糖尿病患者认知功能特点及相关影响因素研究

Objective: Type 2 diabetes patients’ performances of action memory , semantic memory and working memory and the related factors were explored. Methods: 60 Type 2 diabetes patients were compared with 60 age and gender and level of education matched non-diabetes controls. Mood were tested by SAS and SDS, MMSE was used to test the basic cognitive function, Trail Making Test A and B, Verbal fluency test, Go-No/Go test, and Stroop color-word test were used to investigate the executive function of Type 2 diabetes patients and normal controls (NC). Patients’ GLU, TG, TCH, HbA1c, insulin and Cp were tested and correlated with their action memory and working memory. Results: There was no difference between NC group and Type 2 diabetes patients in MMSE scores. There is depression and anxiety mood in Type 2 diabetes patients. Type 2 diabetes patients get lower score in action memory test. Comparing to NC group, Type 2 diabetes patients performed significantly worse in Trail Making Test A and B and verbal fluency test. In Stroop Test, NC group showed significant Stroop Effect and Repeated Distraction Promotion Effect and Negative Priming Effect. However, In Type 2 diabetes group, only the Stroop Effect appeared, but no Repeated Distraction Promotion Effect and Negative Priming Effect. There is no difference between Type 2 diabetes and NC in Stroop Effect. In Go-No/Go test, both of two groups showed significant Stroop Effect, however, there was no difference between them. And also there is no difference on error rate of all levels between them. The course of disease, GL, HbA1c, TG, TCH, INS and Cp affected action memory and working memory. Conclusion: Type 2 diabetes patients’ action memory, semantic memory and working memory were partially impaired. Controlling the levels of GLU, TG and TCH can delay these kinds of impairment.

目的：研究2型糖尿病（T2DM）患者动作记忆、语义记忆及工作记忆特点及相关影响因素。方法：采用病例对照研究方法。来自北京华信医院就诊及住院的2型糖尿病患者共60例。对照组为同期于北京华信医院接受健康检查的非糖尿病者、电子城小区健康居民及部分本院职工。对照组与病例组按年龄、性别、文化程度进行频数匹配。以SDS、SAS测量情绪状况；采用MMSE测查患者基本认知能力；TMTA、TMTB测量知觉运动速度及认知计划能力；e-prime编程词汇测试患者动作记忆；Stroop及Go-No/Go测试工作记忆部分抑制及停止能力；词语流畅性测试部分记忆能力及认知加工速度；采用方差分析的方法分析两组结果的差异。检查患者相关临床资料，测定其GLU、HbA1c、TG、TCH、INS、CP等生化指标，用相关及多重线性回归分析这些指标对患者动作记忆、语义记忆及工作记忆的影响。结果：病例组与对照组MMSE得分差异不显著;2型糖尿病患者有显著抑郁与焦虑情绪，t(SDS)=6.27,p<0.001;t(SAS)=5.32,p<0.001；2型糖尿病组想象自由回忆、动作自由回忆以及想象再认和动作再认成绩均比正常对照组差，统计学差异显著,p值均小于0.01;2型糖尿病患者词语流畅性（水果、动物）、TMTA、TMTB成绩均低于正常对照组，F(水果)=27.011,p<0.001; F(动物)=27.011,p<0.001; F(TMTA)=27.011,p<0.001; F(TMTB)=27.011,p<0.001，说明其认知执行功能受损；2型糖尿病患者Stroop与Go-No/Go各条件下反应时均比正常对照组长，统计学差异显著,p值均小于0.01，但其Stroop干扰效应与正常对照组无显著差异，重复分心字促进效应及负启动效应消失；2型糖尿病组停止能力保持完好。在动作记忆、语义记忆及工作记忆的影响因素中，2型糖尿病患者的病程、血糖控制水平、血脂水平、胰岛素水平均对认知功能有一定的影响。结论：2型糖尿病患者动作记忆、语义记忆及工作记忆均受到损伤。控制血糖、血脂水平可延缓2型糖尿病患者动作记忆、语义记忆及工作记忆的损伤。