糖尿病急性并發癥繼發輕度認知功能障礙的預測模型及時間窗分析

明淑萍， 劉 玲， 周 黎， 羅 瑋

糖尿病急性并發癥繼發輕度認知功能障礙的預測模型及時間窗分析

明淑萍1，2， 劉 玲1，2， 周 黎3， 羅 瑋4

目的搜集糖尿病急性并發癥(Acute diabetic complications，ADC)患者的相關臨床指標，構建預測模型以評判繼發輕度認知功能障礙(Mild Cognitive Impairment，MCI)的預測價值，并驗證其應用性。方法2014年4月～2016年4月期間湖北省中醫院、2015年1月～2016年4月期間湖北省中山醫院及武漢市中醫院收治的ADC患者為研究隊列，搜集相關臨床資料，對其進行為期1 y的隨訪以確認預后轉歸。依據隨訪結果預判繼發MCI風險的影響性指標，并分析繼發MCI時間窗以驗證應用性。結果(1)Cox回歸分析顯示，ADC患者繼發MCI的風險模型由DM病程及HOMA-IR、NSE、IGF-1含量組成，其中IGF-1為保護性因素、其余為風險性因素；(2)DM病程≥13.349 y、HOMA-IR≥4.107 mmol/L*mIU/L、IGF-1<107.420 ng/L的ADC患者，繼發MCI的時間窗更短，其中DM病程及IGF-1含量的臨界值指標具有更高的評判效能。結論DM病程及HOMA-IR、NSE、IGF-1含量是ADC患者繼發MCI的獨立影響因素，且DM病程≥13.349 y、IGF-1<107.420 ng/L為衡量ADC患者隨訪期內繼發MCI的臨界點。

糖尿??； 糖尿病急性并發癥； 認知功能

Abstract：ObjectiveTo collect the relevant clinical indexes of patients with acute diabetic complications (ADC)，construct the prediction model to evaluate the predictive value of the secondary Mild Cognitive Impairment (MCI)，and then verify its applicability.MethodsContinuity into the continuity into the 2014 April to 2016 April period of Hubei Provincial Hospital，January 2015 to 2016 in April during the Zhong-shan Hospital of Hubei Province and Wuhan City Hospital of ADC patients admitted to the study cohort，The clinical data were collected and a one-year follow-up was conducted to confirm the prognosis. According to the follow-up results predictive secondary MCI risk impact index，analyzed the secondary MCI time window to verify the applicability.Results(1)Cox regression analysis showed that ADC patients with secondary MCI risk model by the DM course and HOMA-IR，NSE，IGF-1 content，where IGF-1 was a protective factor and the rest was a risk factor；(2)The time window of secondary MCI was shorter in ADC patients with IOP-1<107.420 ng/L，HOMA-IR≥4.107 mmol/L*mIU/L，which DM course and IGF-1 content of the critical value of indicators with higher performance.ConclusionThe duration of DM and HOMA-IR，NSE and IGF-1 levels were the independent influencing factors of secondary MCI in ADC patients；The duration of DM was≥13.34 years，and IGF-1<107.420 ng / L was the critical point for measuring MCI secondary to ADC patients during follow-up.

Keywords： Diabetes； Acute diabetic complications； Cognitive function

糖尿病(diabetes mellitus，DM)作為嚴重威脅人類健康的世界范圍非傳染性疾病，近年來患病率正急劇上升。據國際糖尿病聯盟(International Diabetes Federation，IDF)統計，當前全球糖尿病患者已達2.85億[1]；另據國內流行病調查資料顯示，截止2008年，我國成年人的糖尿病發病率高達9.7%[2]，已占全球總發病人數的1/3強。作為基礎疾病，近年來DM的各項慢性并發癥逐漸為臨床醫生所重視，遠期不良預后得到顯著控制。但包括許多非內分泌?？漆t生在內的臨床醫生，對于DM的急性并發癥的危害性缺乏足夠重視，使得DM病情加劇并誘發其他并發癥的發生，對預后轉歸產生顯著不良影響。

糖尿病急性并發癥(acute diabetic complications，ADC)是指短時間內胰島素缺乏、嚴重感染、降糖藥物使用不當等原因導致血糖急驟波動而出現的急性代謝紊亂?！?br>