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目的探讨老年人代谢紊乱集簇与认知功能障碍的相关性。方法选择2006年12月至2013年12月在苏州大学附属第一医院老年科就诊的患者160例,记录入选对象的性别、年龄、文化程度等,检测身高、体重、血压、血脂、血糖、胰岛素等指标,采用稳态模型评价胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(ISI),根据蒙特利尔认知评估量表(Mo CA)评定认知功能。根据代谢综合征诊断标准将全部研究对象分为对照组(无代谢紊乱组)、1种代谢紊乱组(M1)、2种代谢紊乱组(M2)、3种或以上代谢紊乱组(M3)。各代谢紊乱组分别进行认知功能评定及相关性分析。结果随着代谢紊乱组分数目增加,体重指数(BMI)、收缩压(SBP)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、HOMA-IR逐渐升高,ISI及Mo CA评分逐渐下降。Mo CA各分项评分比较,各组视空间与执行功能、抽象概括、记忆评分逐渐下降,注意、语言及定向力在M3组才开始明显下降,而命名评分在各组差异无统计学意义。Spearman相关分析显示,FPG、SBP、BMI、TG、TC、HOMA-IR与Mo CA评分呈显著负相关(P<0.01),ISI与MoCA评分呈正相关。多元逐步回归分析显示,HOMA-IR、FPG、SBP、TG是影响老年代谢紊乱者Mo CA评分的独立危险凶素。结论老年人认知功能损害与代谢紊乱集簇显著相关,且其认知损害具有一定的选择特异性,血脂异常、高血糖、高血压和胰岛素抵抗是该年龄段人群认知功能损害的主要危险因素。
Objective To investigate the relationship between metabolic disorder clusters and cognitive dysfunction in the elderly. Methods From December 2006 to December 2013, 160 patients were enrolled in Department of Geriatrics, First Affiliated Hospital of Soochow University. The sex, age and education level of the selected subjects were recorded. The height, weight, blood pressure, blood lipids, blood glucose, insulin (HOMA-IR) and insulin sensitivity index (ISI) were evaluated by steady-state model, and cognitive function was evaluated according to Montreal Cognitive Assessment Scale (MoCA). According to the diagnostic criteria of metabolic syndrome, all subjects were divided into control group (no metabolic disorder group), one metabolic disorder group (M1), two metabolic disorder group (M2) and three or more metabolic disorder group (M3). Each metabolic disorder group were assessed cognitive function and correlation analysis. Results The body mass index (BMI), SBP, FPG, TC, TG and HOMA-IR increased with the increase of the number of metabolic disorders. The levels of ISI and Mo CA score decreased. MoCA scores in each sub-group, visual acuity and executive function, abstract summary, memory score decreased gradually, attention, language and orientation in the M3 group began to decline significantly, while the naming score in each group difference was not statistically significant. Spearman correlation analysis showed that there was a significant negative correlation between FPG, SBP, BMI, TG, TC, HOMA-IR and MoCA score (P <0.01). ISI was positively correlated with MoCA score. Multivariate stepwise regression analysis showed that HOMA-IR, FPG, SBP and TG were the independent risk factors influencing MoCA scores in elderly patients with metabolic disorders. Conclusion Cognitive impairment in the elderly is significantly related to the clustering of metabolic disorders and has certain selective specificity for cognitive impairment. Dyslipidemia, hyperglycemia, hypertension and insulin resistance are the major risk factors for cognitive impairment in this age group factor.