老年人抑郁共病糖尿病血糖、血脂水平与认知功能的关系

目的 探讨老年人罹患抑郁症及共病2型糖尿病后的血糖、血脂水平改变及其与认知功能的关系。方法 以2017年11月1日至12月30日接受健康体检的60～79岁老年人作为研究对象，根据入组、排除标准最终纳入抑郁共病糖尿病组（共病组） 59例、单纯抑郁组106例、单纯糖尿病组84例、无糖尿病或抑郁症（对照组）248例。统计各组老年人下述资料：基本生理指标（身高、体质量、腰围、臀围与血压）、体质量指数（BMI）及腰臀比（WHR）；血糖、血脂水平；蒙特利尔认知评估（MoCA）量表评估结果。分析各组间BMI、WHR、血压、血糖、血脂水平的差异，以及与MoCA量表评估的校正总分、各认知域之间的关系。结果 （1）各组老年人在身高、体质量、BMI、WHR及舒张压方面差异无统计学意义（P均>0.05）；收缩压和脉压差异均有统计学意义（P均<0.01），且单纯糖尿病组二者升高最显著。（2）与对照组相比，共病组与单纯糖尿病组空腹血糖（FBG）、口服葡萄糖耐量试验（OGTT）2 h血糖、糖化血红蛋白（HbA_1c）均升高（P均<0.01），单纯抑郁组差异无统计学意义（P>0.05）。共病组的三酰甘油（TG）水平较对照组升高（P<0.05），共病组与糖尿病组较对照组的高密度脂蛋白（HDL）均降低（P<0.05，P<0.01）。（3）各组老年人MoCA量表的校正总分差异无统计学意义（P>0.05）；与对照组相比，其他3组的注意力得分均降低（P均<0.01）；共病组的流畅性、定向得分较对照组降低（P<0.05，P<0.01），同时定向得分较糖尿病组也降低（P<0.05）。（4）简单线性回归分析显示，FBG、HbA_1c对MoCA量表的校正总分呈负向影响（b=－0.339，P=0.006；b=－0.482，P=0.023），FBG、OGTT 2 h血糖、HbA_1c对注意力得分呈负向影响（b=－0.119，P<0.001；b=－0.040，P=0.002；b=－0.161，P=0.006）。（5）多元线性回归模型分析显示，FBG对MoCA量表校正总分呈负向影响（B=－0.349，P=0.004）。结论 高血糖状态可能是抑郁共病糖尿病老年人认知功能障碍的危险因素。

Relationship between blood glucose and lipid levels and cognitive function in elderly patients with comorbidity of depression and type 2 diabetes mellitus

Objective To explore the relationship between blood glucose and lipid levels and cognitive function in elderly patients with comorbidity of depression and type 2 diabetes mellitus (T2DM). Methods The clinical data from elderly participants (60 to 79 years old) receiving physical examination between Nov. 1 and Dec. 30, 2017 were collected. According to inclusion and exclusion criteria, 59 cases with comorbidity of depression and T2DM were assigned to comorbid group, 106 depression cases were in depression group, 84 T2DM cases were in diabetes group and 248 were in control group (with no diabetes or depression). The general physiological indicators (height, body mass, waist circumference, hip circumference and blood pressure) were collected, the body mass index (BMI) and waist-to-hip ratio (WHR) were calculated, and blood glucose and lipid levels were determined. The Montreal Cognitive Assessment (MoCA) scale was used to assess the cognitive function of the elderly in each group. The differences in BMI, WHR, blood pressure, blood glucose level and blood lipid level among the groups were compared, and the relationships between these indicators and the adjusted total score and scores in each cognitive domain of MoCA scale were analyzed. Results (1) There were no significant differences in height, body mass, BMI, WHR or diastolic blood pressure (DBP) among four groups (all P>0.05), while the differences in systolic blood pressure (SBP) and pulse pressure (PP) were significant (both P<0.01), with the increase in the diabetes group being most obvious. (2) Compared with the control group, the fasting blood glucose (FBG) level, oral glucose tolerance test (OGTT) 2 h and glycosylated hemoglobin (HbA_1c) level were significantly higher in the comorbid group and the diabetes group (all P<0.01); while there was no significant difference between the control and the depression groups (P>0.05). The triglyceride (TG) level in the comorbid group was significantly higher than that in the control group (P<0.05), and the high-density lipoprotein (HDL) levels in the comorbidity and the diabetes groups were lower than that in the control group (P<0.05, P<0.01). (3) There was no significant difference in the adjusted total score of MoCA scale among the four groups (P>0.05). Compared with the control group, the attention scores of the other three groups were significantly lower (all P<0.01). The elderly in the comorbid group had significantly lower fluency and orientation scores compared with the elderly in the control group (P<0.05, P<0.01), and had significantly lower orientation score compared with the elderly in the diabetes group (P<0.05). (4) Simple linear regression analysis showed that the adjusted total score of MoCA scale was negatively correlated with FBG and HbA_1c levels (b=-0.339, P=0.006; b=-0.482, P=0.023), and the attention score was negatively correlated with FBG, OGTT 2h and HbA_1c levels (b=-0.119, P<0.001; b=-0.040, P=0.002; b=-0.161, P=0.006). (5) Multiple linear regression analysis revealed that FBG level was negatively correlated with the adjusted total score of MoCA scale (B=-0.349, P=0.004). Conclusion Hyperglycemia may be a risk factor of cognitive dysfunction of elderly patients with comorbid of depression and T2DM.