糖尿病肾病患者认知功能障碍与血清β淀粉样蛋白的关系

doi:10.3969/j.issn.1004-583X.2022.09.009

摘要/Abstract

摘要：

目的探讨糖尿病肾病(diabetic kidney disease,DKD)患者认知功能障碍与人β淀粉样蛋白1-42(human β Amyloid 1-42,Aβ1-42)的关系。方法选取2020年5月至2021年5月在徐州医科大学附属医院内分泌科治疗的2型糖尿病(type 2 diabetes mellitus,T2DM)患者161例,根据尿白蛋白/肌酐比值(urine albumin creatine ratio,UACR)水平分为正常白蛋白尿(DM)组(n=60)、微量白蛋白尿(DKD1)组(n=58)和大量白蛋白尿(DKD2)组(n=43)。采用蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评估患者认知功能。检测患者Aβ1-42、UACR、胱抑素C(Cystatin C,CysC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR),并分析上述指标与MoCA评分的关系。结果与DM组比较,DKD1和DKD2组CysC、Aβ1-42均升高(P<0.05),eGFR降低(P<0.05)。与DKD1组比较,DKD2组CysC升高(P<0.05),eGFR降低(P<0.05)。与DM组相比,DKD1组、DKD2组MoCA评分均降低(P<0.05)。与DKD1组比较,DKD2组MoCA评分降低(P<0.05)。3组MoCA评分与Aβ1-42、UACR、CysC呈负相关(均P<0.01),与eGFR呈正相关(P<0.01)。3组Aβ1-42与UACR、CysC呈正相关(均P<0.01),与eGFR呈负相关(P<0.01)。多因素线性回归分析结果显示,Aβ1-42、UACR是影响DKD患者MoCA评分的影响因素,Aβ1-42、UACR水平越高,MoCA评分越低,患者认知功能越差。结论 DKD患者存在认知功能障碍,与Aβ1-42水平及肾损害严重程度密切相关。

关键词: 糖尿病肾病, 糖尿病,2型, 认知功能障碍, 淀粉样β肽类

Abstract:

Objective To investigate the relationship between cognitive dysfunction and human β Amyloid 1-42 (Aβ1-42) in patients with diabetic kidney disease (DKD). Methods In this study, patients(n=161) with type 2 diabetes mellitus (T2DM) who were treated in the Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University from May 2020 to May 2021 were as subjects. These patients were enrolled into normoalbuminuria (DM) group (n=60), microalbuminuria (DKD1) group (n=58) and macroalbuminuria (DKD2) group (n=43) according to urine albumin creatine ratio(UACR)levels. The patients' cognitive function was assessed by the Montreal Cognitive Assessment (MoCA) scale. Aβ1-42, UACR, Cystatin C (CysC), estimated glomerular filtration rate (eGFR) were detected, and the relationship between the above indicators and MoCA score was analyzed.Results Compared with DM group, CysC and Aβ1-42 in DKD1 and DKD2 groups increased (P<0.05), and eGFR decreased (P<0.05). Compared with DKD1 group, CysC increased and eGFR drcreased in DKD2 group(P<0.05). The MoCA scores in the DKD groups were superior to those in DM group (P<0.05), which in the DKD2 group were prevalent (P<0.05). MoCA scores in the three groups were negatively correlated with Aβ1-42, UACR, and CysC (all P<0.01), and positively correlated with eGFR (P<0.01). Aβ1-42 in the three groups was positively correlated with UACR and CysC (all P<0.01), and negatively correlated with eGFR (P<0.01). The results of multivariate linear regression analysis showed that Aβ1-42 and UACR were the influencing factors for MoCA score in DKD patients. Conclusion Cognitive dysfunction exists in DKD patients, which is closely related to the level of Aβ1-42 and the severity of renal damage.

Key words: diabetic nphropathies, diabetes mellitus, type 2, cognitive dysfunction, amyloid beta-peptides

中图分类号:

R587.24

姚瑶, 褚敏. 糖尿病肾病患者认知功能障碍与血清β淀粉样蛋白的关系[J]. 临床荟萃, 2022, 37(9): 813-816.

Yao Yao, Chu Min. Relationship between serum amyloid β-protein and cognitive dysfunction in patients with diabetic kidney disease[J]. Clinical Focus, 2022, 37(9): 813-816.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.09.009

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I9/813

图/表 6

参考文献 15

[1]	马楼艳, 李雷, 郭亚刚, 等. 2型糖尿病肾脏微血管病变与脑白质高信号及认知域损害的相关性研究[J]. 中国神经免疫学和神经病学杂志, 2022, 29(2):102-107.
[2]	Bijkerk R, Kallenberg MH, Zijlstra LE, et al. Circulating angiopoietin-2 and angiogenic microRNAs associate with cerebral small vessel disease and cognitive decline in older patients reaching end-stage renal disease[J]. Nephrol Dial Transplant, 2022, 37(3):498-506. doi: 10.1093/ndt/gfaa370 URL
[3]	朱金林, 陈信良. 血清β-淀粉样蛋白及晚期糖基化终末产物与2型糖尿病认知功能障碍的相关性研究[J]. 现代医院, 2017, 17(1):87-88, 91.
[4]	张利红, 王引娣, 吴冠吉, 等. 血清β淀粉样蛋白1-42水平与老年2型糖尿病患者认知功能关系研究[J]. 陕西医学杂志, 2021, 50(9):1077-1080, 1085.
[5]	Moreira RO, Campos SC, Soldera AL. Type 2 diabetes mellitus and Alzheimer's disease: From physiopathology to treatment implications[J]. Diabetes Metab Res Rev, 2013.
[6]	Etgen T, Sander D, Chonchol M, et al. Chronic kidney disease is associated with incident cognitive impairment in the elderly: The INVADE study[ J]. Nephrol Dial Transplant, 2009, 24(10): 3144-3150. doi: 10.1093/ndt/gfp230 URL
[7]	Fadili W, Al Adlouni A, Louhab N, et al. Prevalence and risk factors of cognitive dysfunction in chronic hemodialysis patients[J]. Aging Ment Health, 2014, 18(2):207-211. doi: 10.1080/13607863.2013.823375 pmid: 23906058
[8]	Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: The Chronic Renal Insufficiency Cohort (CRIC) study[J]. Clin J Am Soc Nephrol, 2011, 6(2):248-256. doi: 10.2215/CJN.02660310 URL
[9]	伊学军, 翟建新. 胱抑素C检测及其在肾脏相关疾病中的应用[J]. 医学信息, 2020, 33(4):55-58.
[10]	Nair P, Misra S, Nath M, et al. Cystatin C and risk of mild cognitive impairment: A systematic review and meta-analysis[J]. Dement Geriatr Cogn Disord, 2020, 49(5):471-482. doi: 10.1159/000510219 URL
[11]	侯越, 赵妍, 王友明, 等. 脑卒中患者血清胱抑素C水平与卒中后认知障碍相关性的Meta分析[J]. 现代检验医学杂志, 2022, 37(2):142-147.
[12]	张盼, 马雪英, 丁墩, 等. 终末期肾病患者左心室质量指数增加和认知功能下降的相关性研究[J]. 中国血液净化, 2018, 17(11): 735-738, 747
[13]	Jung S, Lee YK, Choi SR, et al. Relationship between cognitive impairment and depression in dialysis patients[J]. Yonsei Med J, 2013, 54(6):1447-1453. doi: 10.3349/ymj.2013.54.6.1447 pmid: 24142650
[14]	Asih PR, Tegg ML, Sohrabi H, et al. Multiple mechanisms linking type 2 diabetes and Alzheimer's disease: Testosterone as a modifier[J]. J Alzheimers Dis, 2017, 59(2):445-466. doi: 10.3233/JAD-161259 pmid: 28655134
[15]	Kuller LH. Dementia epidemiology research: It is time to modify the focus of research[J]. J Gerontol A Biol Sci Med Sci, 2006, 61(12):1314-1318. doi: 10.1093/gerona/61.12.1314 URL

组别	例数	年龄(岁)		性别 [例(%)]				合并脑血管疾病 [例(%)]
组别	例数	年龄(岁)		男		女		是		否
DM	60		67.03±5.46		31(51.7)		29(48.3)		9(15.0)		51(85.0)
DKD1	58		67.93±8.38		32(55.2)		26(44.8)		12(20.7)		46(79.3)
DKD2	43		68.56±7.99		25(58.1)		18(41.9)		10(23.2)		33(76.8)
统计值			F=0.572		χ²=0.430				χ²=0.210
P值			0.577		0.810				0.549

组别	例数	年龄(岁)		性别 [例(%)]				合并脑血管疾病 [例(%)]
组别	例数	年龄(岁)		男		女		是		否
DM	60		67.03±5.46		31(51.7)		29(48.3)		9(15.0)		51(85.0)
DKD1	58		67.93±8.38		32(55.2)		26(44.8)		12(20.7)		46(79.3)
DKD2	43		68.56±7.99		25(58.1)		18(41.9)		10(23.2)		33(76.8)
统计值			F=0.572		χ²=0.430				χ²=0.210
P值			0.577		0.810				0.549

组别	例数	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)	FPG (mmol/L)	HbA₁c (%)	eGFR (ml/min)	CysC (mg/L)	Aβ1-42 (pg/ml)
DM	60	4.49 (3.63,5.57)	1.47 (0.84,2.0)	1.06 (0.92,1.28)	2.80 (2.08,3.56)	7.92 (6.39,11.69)	8.4 (6.8,10.0)	119.28 (104.85,120.00)	0.78 (0.70,0.87)	23.9 (15.95,28.22)
DKD1	58	4.27 (3.77,5.03)	1.33 (0.93,2.17)	1.05 (0.85,1.24)	2.52 (2.05,3.05)	7.48 (6.08,10.02)	7.8 (6.7,9.45)	100.85 (82.02,120)^*	0.97 (0.82,1.19)^*	147.60 (116.38,185.23)^*
DKD2	43	4.45 (3.49,5.49)	1.56 (1.11,2.05)	1.08 (0.81,1.32)	2.25 (1.87,3.32)	7.82 (6.16,9.58)	8.4 (7.7,9.2)	70.65 (49.56,107.12)^*#	1.24 (0.94,1.62)^*#	137.20 (108.80,178.80)^*
H值		1.126	1.301	0.813	3.826	1.717	2.131	36.412	52.454	112.646
P值		0.573	0.522	0.679	0.158	0.420	0.349	<0.05	<0.05	<0.05

组别	例数	TC (mmol/L)	TG (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)	FPG (mmol/L)	HbA₁c (%)	eGFR (ml/min)	CysC (mg/L)	Aβ1-42 (pg/ml)
DM	60	4.49 (3.63,5.57)	1.47 (0.84,2.0)	1.06 (0.92,1.28)	2.80 (2.08,3.56)	7.92 (6.39,11.69)	8.4 (6.8,10.0)	119.28 (104.85,120.00)	0.78 (0.70,0.87)	23.9 (15.95,28.22)
DKD1	58	4.27 (3.77,5.03)	1.33 (0.93,2.17)	1.05 (0.85,1.24)	2.52 (2.05,3.05)	7.48 (6.08,10.02)	7.8 (6.7,9.45)	100.85 (82.02,120)^*	0.97 (0.82,1.19)^*	147.60 (116.38,185.23)^*
DKD2	43	4.45 (3.49,5.49)	1.56 (1.11,2.05)	1.08 (0.81,1.32)	2.25 (1.87,3.32)	7.82 (6.16,9.58)	8.4 (7.7,9.2)	70.65 (49.56,107.12)^*#	1.24 (0.94,1.62)^*#	137.20 (108.80,178.80)^*
H值		1.126	1.301	0.813	3.826	1.717	2.131	36.412	52.454	112.646
P值		0.573	0.522	0.679	0.158	0.420	0.349	<0.05	<0.05	<0.05

组别	例数	MoCA评分(分)
DM	60	25(23,26)
DKD1	58	17.5(15,22)^*
DKD2	43	13(11,18)^*#
H值	112.646	86.269
P值	<0.05	<0.05