H型高血压合并2型糖尿病患者轻度认知功能障碍的影响因素

doi:10.3969/j.issn.1004-583X.2023.10.004

摘要/Abstract

摘要： 目的研究H型高血压合并2型糖尿病(T2DM)患者认知功能障碍的影响因素。方法选取2021年9月至2022年9月于鞍山市中心医院就诊H型高血压合并T2DM患者163例。行蒙特利尔认知评估量表(MoCA)及简单精神状态量表(MMSE)评分,MoCA<26分为轻度认知障碍组(MCI组),≥26分为认知功能正常组(NMCI组)。收集两组年龄、性别、吸烟史、饮酒史、受教育年限、体重指数(BMI)、高血压及糖尿病病程、其他疾病病史(冠心病史、血脂异常史),测量收缩压(SBP)、舒张压(DBP);空腹检测白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、血小板(PLT)、血清同型半胱氨酸(Hcy)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA-1)、载脂蛋白B(ApoB)、脂蛋白a(LPa)、糖化血红蛋白(HbA₁c)、空腹血糖(FPG)、肌酐(Scr)、尿酸(SUA)、尿微量白蛋白(ALB);行颈动脉彩超测定颈动脉内膜中层厚度(CIMT)及斑块形成情况;采用二元Logistic回归分析发生MCI的影响因素,受试者工作特征曲线(ROC)预测其影响因素的价值。结果 MCI组年龄、吸烟、病程、SBP、FPG、HbA₁c、HDL-C、LDL-C、ApoA-1、SUA、Hcy、CIMT及斑块检出率均高于NMCI组(P<0.05),受教育程度低于NMCI组(P<0.05)。Logistic回归分析结果显示,年龄、HDL-C、Hcy、CIMT为MCI发生的独立危险因素;ROC曲线结果显示,年龄、HDL-C、Hcy、CIMT预测MCI发生的曲线下面积(AUC)为0.975、0.637、0.647及0.842。结论高龄、低HDL-C、高Hcy、CIMT增厚为H型高血压合并T2DM患者发生MCI的独立危险因素,监测血脂及Hcy有利于预防MCI发生。

关键词: 糖尿病,2型, 认知功能障碍, 动脉粥样硬化, 同型半胱氨酸, H型高血压

Abstract: Objective To study the influencing factors for cognitive dysfunction in type H hypertension patients combined with type 2 diabetes mellitus (T2DM). Methods A total of 163 type H hypertension patients combined with T2DM who were treated in the Anshan Central Hospital from September 2021 to September 2022 were recruited. All patients were surveyed with the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE). According to the scoring results, patients with MoCA < 26 points were included in the mild cognitive impairment group (MCI group), and those with MoCA ≥ 26 points were included in the normal cognitive function group (NMCI group). General data of the two groups of patients were collected, including age, gender, smoking history, drinking history, years of education, body mass index (BMI), duration of hypertension and diabetes, history of other diseases like coronary heart disease and dyslipidemia, systolic blood pressure (SBP) and diastolic blood pressure (DBP). In a fasting state, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), platelet count (PLT), serum homocysteine (Hcy), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA-1), apolipoprotein B (ApoB), lipoprotein a (LPa), glycated hemoglobin (HbA₁c), fasting plasma glucose (FPG), serum creatinine (Scr), serum uric acid (SUA), and urinary microalbumin (ALB) were measured. Carotid artery color ultrasound were performed to measure the carotid intima-media thickness (CIMT) and plaque formation. The influencing factors for MCI in type H hypertension patients combined with T2DM were analyzed by binary logistic regression, and their prediction values were assessed by the receiver operating characteristic (ROC) curves. Results The age, smoking, hypertension and diabetes course, SBP, FPG, HbA₁c, HDL-C, LDL-C, APOA-1, SUA, Hcy, CIMT and plaque detection rate in MCI group were significantly higher than those of NMCI group (P<0.05), and the education level was significantly lower (P<0.05). The results of binary logistic regression analysis showed that age, HDL-C, Hcy, and CIMT were independent risk factors for MCI in type H hypertension patients combined with T2DM. ROC curves showed that the area under the curve (AUC) of age, HDL-C, Hcy, and CIMT in predicting MCI in type H hypertension patients combined with T2DM was 0.975, 0.637, 0.647, and 0.842, respectively. Conclusion Elderly, low HDL-C, high Hcy and CIMT thickening are independent risk factors for MCI in type H hypertension patients combined with T2DM. Monitoring blood lipid and Hcy is beneficial to prevent MCI in this population.

Key words: diabetes, type 2, cognitive dysfunction, atherosclerosis, homocysteine, type H hypertension

中图分类号:

R544.1

徐阳, 薛凌. H型高血压合并2型糖尿病患者轻度认知功能障碍的影响因素[J]. 临床荟萃, 2023, 38(10): 887-892.

Xu Yang, Xue Ling. Influencing factors for mild cognitive impairment in type H hypertension patients combined with type 2 diabetes mellitus[J]. Clinical Focus, 2023, 38(10): 887-892.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.10.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I10/887

图/表 7

表1 两组一般资料比较[$\bar{x}$±s, n(%)]

Tab. 1 Comparison of general information between groups ($\bar{x}$±s, n[%])

组别	例数(男/女)	年龄(岁)	受教育程度(年)	吸烟史	饮酒史	高血压病史(年)
MCI组	101(60/41)	74.880±7.658	8.140±2.054	51(50.2)	47(46.5)	11.510±6.437
NMCI组	62(46/16)	59.100±9.769	11.970±2.673	20(32.3)	32(51.6)	7.080±3.923
$t$ /χ²值	3.645	11.483	-10.281	5.197	0.397	5.465
$P$ 值	0.055	<0.001	<0.001	0.023	0.529	<0.001
组别	糖尿病病史(年)	冠心病病史	高脂血症史	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)
MCI组	10.900±6.900	34(33.7)	31(30.7)	24.670±3.175	149.190±12.335	85.800±13.369
NMCI组	5.630±3.838	20(32.3)	15(24.2)	25.150±3.578	145.320±15.982	83.980±12.570
$t$ /χ²值	5.511	0.034	0.801	-0.908	-2.457	1.732
$P$ 值	<0.001	0.853	0.371	0.365	0.015	0.085

表1 两组一般资料比较[$\bar{x}$±s, n(%)]

Tab. 1 Comparison of general information between groups ($\bar{x}$±s, n[%])

组别	例数(男/女)	年龄(岁)	受教育程度(年)	吸烟史	饮酒史	高血压病史(年)
MCI组	101(60/41)	74.880±7.658	8.140±2.054	51(50.2)	47(46.5)	11.510±6.437
NMCI组	62(46/16)	59.100±9.769	11.970±2.673	20(32.3)	32(51.6)	7.080±3.923
$t$ /χ²值	3.645	11.483	-10.281	5.197	0.397	5.465
$P$ 值	0.055	<0.001	<0.001	0.023	0.529	<0.001
组别	糖尿病病史(年)	冠心病病史	高脂血症史	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)
MCI组	10.900±6.900	34(33.7)	31(30.7)	24.670±3.175	149.190±12.335	85.800±13.369
NMCI组	5.630±3.838	20(32.3)	15(24.2)	25.150±3.578	145.320±15.982	83.980±12.570
$t$ /χ²值	5.511	0.034	0.801	-0.908	-2.457	1.732
$P$ 值	<0.001	0.853	0.371	0.365	0.015	0.085

表2 两组实验室指标比较($\bar{x}$±s)

Tab. 2 Comparison of laboratory indexes between groups ($\bar{x}$±s)

组别	例数	WBC (10⁹/L)		RBC (10¹²/L)		HGB (g/L)		PLT (10⁹/L)		FBG (mmol/L)	HbA₁c (%)		TC (mmol/L)		TG (mmol/L)
MCI组	101	6.360±1.240		4.540±0.520		144.530±25.454		213.100±49.814		7.720±1.972	6.800±0.830		5.200±1.620		2.250±1.550
NMCI组	62	6.790±1.650		4.690±0.570		148.350±16.268		221.600±39.979		7.200±2.052	7.370±1.420		5.000±1.710		2.740±1.860
$t$ /χ²值		-1.888		-1.771		-1.056		-1.198		0.397	-2.865		0.785		-1.823
$P$ 值		0.061		0.078		0.293		0.233		0.038	0.005		0.434		0.070
组别	HDL-C (mmol/L)		LDL-C (mmol/L)		ApoA-1 (g/L)		ApoB (g/L)		LPa (mg/L)	Scr (μmol/L)		SUA (mmol/L)		Hcy (μmol/L)		ALB (mg/L)
MCI组	1.000±0.310		3.360±0.990		1.130±0.280		1.000±0.340		216.140±145.210	72.740±10.060		306.510±93.440		23.340±6.520		61.820±56.110
NMCI组	1.200±0.370		3.200±1.170		1.220±0.300		1.050±0.250		202.700±139.260	71.870±14.880		358.490±90.420		20.740±5.660		50.370±56.400
$t$ /χ²值	-3.743		-2.241		-1.989		-1.249		0.583	0.306		-3.420		2.598		0.469
$P$ 值	<0.001		0.025		0.048		0.214		0.561	0.760		0.001		0.010		0.640

表2 两组实验室指标比较($\bar{x}$±s)

Tab. 2 Comparison of laboratory indexes between groups ($\bar{x}$±s)

组别	例数	WBC (10⁹/L)		RBC (10¹²/L)		HGB (g/L)		PLT (10⁹/L)		FBG (mmol/L)	HbA₁c (%)		TC (mmol/L)		TG (mmol/L)
MCI组	101	6.360±1.240		4.540±0.520		144.530±25.454		213.100±49.814		7.720±1.972	6.800±0.830		5.200±1.620		2.250±1.550
NMCI组	62	6.790±1.650		4.690±0.570		148.350±16.268		221.600±39.979		7.200±2.052	7.370±1.420		5.000±1.710		2.740±1.860
$t$ /χ²值		-1.888		-1.771		-1.056		-1.198		0.397	-2.865		0.785		-1.823
$P$ 值		0.061		0.078		0.293		0.233		0.038	0.005		0.434		0.070
组别	HDL-C (mmol/L)		LDL-C (mmol/L)		ApoA-1 (g/L)		ApoB (g/L)		LPa (mg/L)	Scr (μmol/L)		SUA (mmol/L)		Hcy (μmol/L)		ALB (mg/L)
MCI组	1.000±0.310		3.360±0.990		1.130±0.280		1.000±0.340		216.140±145.210	72.740±10.060		306.510±93.440		23.340±6.520		61.820±56.110
NMCI组	1.200±0.370		3.200±1.170		1.220±0.300		1.050±0.250		202.700±139.260	71.870±14.880		358.490±90.420		20.740±5.660		50.370±56.400
$t$ /χ²值	-3.743		-2.241		-1.989		-1.249		0.583	0.306		-3.420		2.598		0.469
$P$ 值	<0.001		0.025		0.048		0.214		0.561	0.760		0.001		0.010		0.640

表3 两组颈动脉超声结果比较[$\bar{x}$±s,n(%)]

Tab. 3 Comparison of carotid artery ultrasound results between groups ($\bar{x}$±s, n[%])

组别	例数	CIMT(mm)	颈动脉斑块检出率
MCI组	101	2.06±0.77	66(60.0)
NMCI组	62	1.32±0.31	29(46.0)
$t$ /χ²值		7.318	5.450
$P$ 值		<0.001	0.020

表3 两组颈动脉超声结果比较[$\bar{x}$±s,n(%)]

Tab. 3 Comparison of carotid artery ultrasound results between groups ($\bar{x}$±s, n[%])

组别	例数	CIMT(mm)	颈动脉斑块检出率
MCI组	101	2.06±0.77	66(60.0)
NMCI组	62	1.32±0.31	29(46.0)
$t$ /χ²值		7.318	5.450
$P$ 值		<0.001	0.020

表4 MCI组与NMCI组认知功能评分的比较($\bar{x}$±s,分)

Tab. 4 Comparison of cognitive function scores between MCI group and NMCI group ($\bar{x}$±s, Score)

组别	例数	MMSE	MOCA	视空间与执行能力	命名	注意力	语言	抽象	延迟记忆	定向力
MCI组	101	23.140±1.710	20.580±2.132	2.640±0.810	2.750±0.430	2.610±0.790	2.770±0.420	1.950±0.220	2.380±0.750	5.480±0.540
NMCI组	62	27.600±0.640	26.160±0.410	3.940±0.770	2.870±0.340	4.790±0.520	2.890±0.320	1.960±0.210	4.100±0.590	5.630±0.490
$t$ 值		-23.660	-25.523	-10.114	-1.947	-21.305	-1.969	-0.032	-16.273	-1.877
$P$ 值		<0.01	<0.01	-10.114	0.053	<0.01	0.051	0.975	<0.01	0.063

表4 MCI组与NMCI组认知功能评分的比较($\bar{x}$±s,分)

Tab. 4 Comparison of cognitive function scores between MCI group and NMCI group ($\bar{x}$±s, Score)

组别	例数	MMSE	MOCA	视空间与执行能力	命名	注意力	语言	抽象	延迟记忆	定向力
MCI组	101	23.140±1.710	20.580±2.132	2.640±0.810	2.750±0.430	2.610±0.790	2.770±0.420	1.950±0.220	2.380±0.750	5.480±0.540
NMCI组	62	27.600±0.640	26.160±0.410	3.940±0.770	2.870±0.340	4.790±0.520	2.890±0.320	1.960±0.210	4.100±0.590	5.630±0.490
$t$ 值		-23.660	-25.523	-10.114	-1.947	-21.305	-1.969	-0.032	-16.273	-1.877
$P$ 值		<0.01	<0.01	-10.114	0.053	<0.01	0.051	0.975	<0.01	0.063

表5 Logistic回归分析 H型高血压合并T2DM发生MCI的危险因素

Tab. 5 Logistic regression analysis of risk factors for MCI in type H hypertension patients combined with T2DM

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	-1.821	0.631	8.335	0.004	0.162	0.047~0.557
受教育程度	-2.966	1.578	3.532	0.060	0.052	0.002~1.136
高血压病程	0.081	0.155	0.271	0.603	1.084	0.799~1.471
T2DM病程	0.002	0.168	0.001	0.990	1.002	0.721~1.392
吸烟史	0.908	1.060	0.734	0.392	2.478	0.311~4.950
HbA₁c	0.577	0.618	0.873	0.350	1.781	0.531~5.974
HDL-C	1.333	0.622	4.583	0.032	3.791	1.119~12.841
ApoA-1	0.660	0.680	0.941	0.322	1.934	0.510~7.332
SUA	0.010	0.007	2.300	0.129	1.010	0.997~1.024
Hcy	-0.075	0.031	6.214	0.013	0.928	0.875~0.984
CIMT	-3.047	0.686	25.329	<0.01	0.032	0.008~0.121

表5 Logistic回归分析 H型高血压合并T2DM发生MCI的危险因素

Tab. 5 Logistic regression analysis of risk factors for MCI in type H hypertension patients combined with T2DM

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	-1.821	0.631	8.335	0.004	0.162	0.047~0.557
受教育程度	-2.966	1.578	3.532	0.060	0.052	0.002~1.136
高血压病程	0.081	0.155	0.271	0.603	1.084	0.799~1.471
T2DM病程	0.002	0.168	0.001	0.990	1.002	0.721~1.392
吸烟史	0.908	1.060	0.734	0.392	2.478	0.311~4.950
HbA₁c	0.577	0.618	0.873	0.350	1.781	0.531~5.974
HDL-C	1.333	0.622	4.583	0.032	3.791	1.119~12.841
ApoA-1	0.660	0.680	0.941	0.322	1.934	0.510~7.332
SUA	0.010	0.007	2.300	0.129	1.010	0.997~1.024
Hcy	-0.075	0.031	6.214	0.013	0.928	0.875~0.984
CIMT	-3.047	0.686	25.329	<0.01	0.032	0.008~0.121

表6 年龄、HDL-C、Hcy、CIMT的AUC及95% CI

Tab. 6 AUC and 95% CI of age, HDL-C, Hcy, and CIMT

变量
年龄	0.975	0.901	0.903	0.804	66.500	0.957~0.993
HDL-C	0.637	0.931	0.355	0.286	0.745	0.546~0.728
Hcy	0.647	0.733	0.532	0.265	18.550	0.557~0.736
CIMT	0.842	0.644	0.903	0.547	1.625	0.701~0.902

表6 年龄、HDL-C、Hcy、CIMT的AUC及95% CI

Tab. 6 AUC and 95% CI of age, HDL-C, Hcy, and CIMT

变量
年龄	0.975	0.901	0.903	0.804	66.500	0.957~0.993
HDL-C	0.637	0.931	0.355	0.286	0.745	0.546~0.728
Hcy	0.647	0.733	0.532	0.265	18.550	0.557~0.736
CIMT	0.842	0.644	0.903	0.547	1.625	0.701~0.902

图1 H型高血压合并T2DM发生MCI的预测价值的ROC曲线

Fig. 1 ROC curve of the predictive value of MCI in type H hypertension patients combined with T2DM

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