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目的探讨2型糖尿病(T2DM)患者血清单核细胞趋化蛋白-1(monocyte chemotactic protein 1,MCP-1)、血清淀粉样蛋白A(serum amyloid A protein,SAA)水平与认知功能的关系,为临床T2DM伴认知功能障碍的预防和治疗提供新思路。方法选取2014年1-9月在唐山市工人医院内分泌二科住院的66例T2DM患者为研究对象(糖尿病组),其中男性39例,女性27例,年龄20~69岁,平均(47.9±13.4)岁,另选同期本院体检健康者50例为健康对照组,男性29例,女性21例,年龄20~69岁,平均(46.5±12.4)岁。采用收集临床指标、测定血清MCP-1和SAA水平和重复性成套神经心理状态(RBANS)独立检测认知功能量表评价认知功能等方法,以探讨临床指标及血清MCP-1、SAA与认知功能的关系。结果糖尿病组血清MCP-1、SAA、体质指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)分别为267.99(236.15,294.61)ng/L、(555.75±122.51)μg/L、24.85(22.63,27.33)kg/m2、2.62(2.22,3.39)mmol/L、10.02(7.52,10.97)mmol/L,与对照组[分别为201.58(171.48,237.20)ng/L、(503.19±120.76)μg/L、21.61(19.38,26.09)kg/m2、1.28(1.06,2.60)mmol/L、4.94(4.69,5.38)mmol/L]比较明显升高,差异均有统计学意义(P<0.01,P<0.05),高密度脂蛋白胆固醇(HDL-C)、视觉广度、延迟记忆、标准化总分显著减低,差异有统计学意义(P<0.05);糖尿病组相关性分析结果表明,血清MCP-1水平与FPG、糖化血红蛋白(Hb A1C)、SAA呈正相关(r值分别为0.592、0.307和0.304),与教育年限呈负相关(r=-0.388),差异均有统计学意义(P<0.05,P<0.01);血清SAA与总胆固醇(TC)、甘油三酯(TG)、LDL-C、FPG和Hb A1C呈正相关(r值分别为0.630、0.254、0.318、0.692和0.403),与HDL-C呈负相关(r=-0.283),差异均有统计学意义(P<0.05);MCP-1、SAA均与即刻记忆、视觉广度、言语功能、注意力、延迟记忆和标准化总分呈负相关(P<0.05)。糖尿病组回归分析结果表明,MCP-1是言语功能、注意力、延迟记忆和标准化总分的独立危险因素,SAA是即刻记忆、视觉广度、注意力、延迟记忆和标准化总分的独立危险因素。结论血清MCP-1、SAA水平在T2DM患者中升高,是T2DM认知功能障碍的重要预测因子。
Objective To investigate the relationship between serum monocyte chemotactic protein 1 (MCP-1), serum amyloid A protein (SAA) and cognitive function in type 2 diabetes mellitus (T2DM) It provides new ideas for the prevention and treatment of clinical T2DM with cognitive dysfunction. Methods Sixty-six patients with T2DM admitted to Department of Endocrinology, Tangshan Workers Hospital from January to September of 2014 were selected as subjects, including 39 males and 27 females, ranging in age from 20 to 69 years with an average of 47.9 ± 13.4 ), And another 50 healthy people in the same hospital were selected as healthy control group. There were 29 males and 21 females, aged from 20 to 69 years (average 46.5 ± 12.4 years). The clinical indexes, serum MCP-1 and SAA levels and RBANS independent cognitive function questionnaire were used to evaluate the clinical function, serum levels of MCP-1 and SAA Know the function of the relationship. Results The levels of serum MCP-1, SAA, BMI, LDL-C and FPG in diabetic group were 267.99 (236.15,294.61) ng / L, 555.75 ± 122.51 μg /L,24.85(22.63,27.33)kg/m2,2.62(2.22,3.39)mmol/L,10.02(7.52,10.97)mmol/L, compared with the control group [201.58 (171.48,237.20] ng / L, ( (P <0.05), and the difference was statistically significant (P <0.05), and the difference was statistically significant (503.19 ± 120.76μg / L, 21.61μg / m2, 1.28mmol / L, (P <0.01, P <0.05). HDL-C, visual breadth, delayed memory and normalized score were significantly decreased (P <0.05). The results of correlation analysis of diabetic group showed that HDL- , Serum MCP-1 level was positively correlated with FPG, Hb A1C and SAA (r = 0.592, 0.307 and 0.304, respectively), but negatively correlated with years of education (r = -0.388) (P <0.05, P <0.01). Serum SAA was positively correlated with total cholesterol (TC), triglyceride (TG), LDL-C, FPG and Hb A1C (r values were 0.630,0.254,0.318,0.692 and 0.403 ), And HDL-C was negatively correlated (r = -0.283), the differences were statistically significant Yi (P <0.05); MCP-1, SAA and have immediate memory, visual span, speech function, attention, and delayed memory normalized scores were negatively correlated (P <0.05). Regression analysis showed that MCP-1 was an independent risk factor for speech function, attention, delayed memory and standardized total score. SAA was an independent risk factor for immediate memory, visual breadth, attention, delayed memory and standardized scores. Conclusions Serum levels of MCP-1 and SAA are elevated in T2DM patients and are important predictors of cognitive dysfunction in T2DM.