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目的探讨帕金森病伴认知功能障碍(PD-MCI)患者脑血管储备功能(CVR)降低、脂代谢异常与胰岛素抵抗之间的联系。方法以我院收治的96例PD-MCI患者为研究对象,根据HOMA稳态模型计算出胰岛素抵抗指数(HOMA-IR)分为胰岛素抵抗PD-MCI组(A组)与非胰岛素抵抗PD-MCI组(B组),同期选择经我院体检显示健康的志愿者50例为C组,比较三组研究对象临床资料,并分析PD-MCI患者的脑血管储备功能、脂糖代谢情况,分析其异常指标与HOMA-IR之间的相关性。结果三组CVR比较,显示三组间脑血管收缩储备、扩张储备及整体储备功能均存在明显差异,CVR功能由高到低依次是C、B、A组,组间各指标存在显著差异(P<0.05);三组脂代谢比较,A组TG、TC、LDL-C、均明显高于B、C两组,HDL-C明显低于B、C两组,差异均显著(P<0.05);三组糖代谢比较,A组HOMA-IR均明显高于其他两组,ISI明显低于B、C组(P<0.05);对HOMA-IR影响因素分析,显示患者的BMI、病程、CVR、TG、HDL-C均与HOMA-IR呈正相关,ISI呈负相关,均是影响HOMA-IR的危险因素。结论帕金森患伴认知功能障碍患者可出现脑储备功能下降、脂代谢异常等,且脑储备功能、脂代谢与机体胰岛素抵抗呈正相关,临床需结合患者胰岛素抵抗情况予以相应诊治。
Objective To investigate the relationship between cerebral vascular reserve function (CVR) and dyslipidemia and insulin resistance in patients with Parkinson’s disease and cognitive impairment (PD-MCI). Methods 96 patients with PD-MCI admitted to our hospital were enrolled in this study. According to HOMA homeostasis model, insulin resistance index (HOMA-IR) was divided into insulin resistance PD-MCI group (group A) and non-insulin resistance PD- Group B (Group B). 50 healthy volunteers who were examined by our hospital during the same period were selected as Group C. The clinical data of three groups were compared. The cerebral vascular reserve function and glucose metabolism were analyzed in PD-MCI patients. Correlation between abnormal index and HOMA-IR. Results The comparison of CVR among the three groups showed that there were significant differences in cerebrovascular contractile reserve, dilatation reserve and overall reserve between the three groups. The CVR function in descending order was C, B, and A, with significant differences among the groups (P <0.05). Compared with B and C groups, TG, TC and LDL-C in group A were significantly lower than those in group B and C (P <0.05) ; The three groups of glucose metabolism, HOMA-IR in group A were significantly higher than the other two groups, ISI was significantly lower than those in group B and C (P <0.05); Analysis of HOMA-IR influencing factors showed that the BMI, duration of disease, CVR , TG and HDL-C were positively correlated with HOMA-IR and negatively correlated with ISI, all of which were risk factors of HOMA-IR. Conclusions Parkinson ’s patients with cognitive dysfunction may have decreased brain reserve and dyslipidemia. Brain reserve function and lipid metabolism are positively correlated with insulin resistance. Patients should be treated according to their insulin resistance.