中老年2型糖尿病合并高血压认知功能下降的影响因素分析

Analysis of influencing factors on cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus complicated by hypertension

摘要

目的: 分析中老年2型糖尿病（type 2 diabetes mellitus，T2DM）合并高血压（hypertension，HTN）与认知功能下降的关系及相关影响因素。方法: 纳入2020年9月—2022年9月在南京医科大学附属逸夫医院就诊的中老年受试者，分为T2DMH组（T2DM合并HTN患者）、T2DM组（单纯T2DM患者）、HTN组（单纯HTN患者）、HC组（健康对照）。收集4组患者的临床资料，采用蒙特利尔认知评估量表（Montreal cognitive assessment，MoCA）、听觉词语学习测验（auditory verbal learning test，AVLT）、连线测验（trail making test，TMT）、数字广度测验（digit span test，DST）评估认知功能。主要比较4组的认知功能并通过多元回归分析相关的影响因素。结果: 共纳入369例患者，其中T2DMH组105例、T2DM组106例、HTN组89例、HC组69例。T2DMH组胰岛β细胞功能指数（homeostatic model assessment of β-cell function，HOMA-β）高于T2DM组（P<0.05），但葡萄糖处置指数（disposition index，DI）与T2DM组差异无统计学意义（P > 0.05）；两指标均低于HTN组及HC组（P均<0.05）；其记忆力差于T2DM组、HTN组，各认知域指标均显著低于HC组（P均<0.05）。认知功能与受教育年限、T2DM和HTN病史、胰岛功能等指标显著相关（P<0.05）。多元线性回归分析显示，受教育年限与认知功能呈正相关，T2DM、HTN病史与其显著相关，饮酒史及部分肾功能指标与认知功能存在不同程度关联（P均<0.05）。结论: T2DM合并HTN患者存在更严重的代谢紊乱、脏器损伤及胰岛功能受损，其认知功能呈多维度显著下降，且程度重于单纯T2DM或HTN患者。T2DM、HTN病史与中老年人群认知功能下降呈显著独立关联，受教育年限较高及较好的肾功能、胰岛功能与认知功能可能呈保护性关联倾向，但其因果关系尚需前瞻性队列研究进一步验证。

Abstract

Objective: To analyze the relationship between type 2 diabetes mellitus（T2DM）complicated by hypertension（HTN）and cognitive decline in middle-aged and elderly individuals，as well as the associated influencing factors. Methods: Middle-aged and elderly subjects who were treated at Sir Run Run Hospital Affiliated to Nanjing Medical University from September 2020 to September 2022 were enrolled and divided into four groups：patients with T2DM complicated by HTN（T2DMH group），patients with T2DM alone（T2DM group），patients with HTN alone（HTN group），and healthy controls（HC group）. Clinical data were collected from the four groups. Cognitive and functional indicators were assessed using the Montreal cognitive assessment（MoCA），auditory verbal learning test（AVLT），trail making test（TMT）and digit span test（DST）. Cognitive performance was compared among the four groups，and multivariate regression analysis was conducted to explore associated influencing factors. Results: A total of 369 patients were enrolled in this study. These patients were assigned to four groups：the T2DMH group（n=105），T2DM group（n=106），HTN group（n=89），and HC group（n=69）. No statistically significant differences were observed in age and years of education among the four groups（P > 0.05），indicating good comparability. The T2DMH group had higher HOMA-β than the T2DM group（P<0.05），but DI did not differ between the two groups（P > 0.05）；both were significantly lower than those in the HTN and HC groups（all P<0.05）. In terms of cognitive functions，the T2DMH group had worse performance in memory cognitive dimensions than the T2DM and HTN groups，and all indicators of cognitive domains in this group were significantly lower than those in the HC group（all P<0.05）. Cognitive function was significantly correlated with years of education，histories of T2DM and HTN，islet function and other indicators（P<0.05）. Multiple linear regression showed that years of education were positively associated with cognitive function；T2DM and HTN histories were significantly correlated with cognition，and alcohol consumption history as well as partial renal function parameters had varying degrees of correlation with cognitive performance（all P<0.05）. Conclusion: Patients with T2DM combined with HTN suffer from more severe metabolic disorders，organ damage and impaired islet function，accompanied by significant multidimensional cognitive decline，which is more severe than that in patients with isolated T2DM or isolated HTN. Disease duration of T2DM and HTN is independently and significantly associated with cognitive decline in middle-aged and elderly individuals. Higher education，better renal and islet function showed protective associations with cognition，though causal relationships require further validation in prospective cohort studies.

关键词

2型糖尿病 / 高血压 / 认知功能 / 饮酒 / 胰岛素抵抗 / 尿酸

Key words

type 2 diabetes mellitus / hypertension / cognitive function / alcohol consumption / insulin resistance / uric acid

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基金资助

中国中医药科技发展中心中西医协同慢病管理研究(CXZH2024047)