發(fā)布時間：2018-05-09 18:33

  本文選題：2型糖尿病 + 代謝手術　； 參考：《第三軍醫(yī)大學》2017年碩士論文

【摘要】：背景和目的:糖尿病已成為威脅人類生命健康的重要危險因素。全世界有4.15億成人糖尿病,預計到2040年將超過6.4億。2型糖尿病(T2DM)占糖尿病患者中的比例為90-95%,心腦血管相關疾病是影響其最終結局的重要因素[1]。糖尿病微血管病變是糖尿病的常見并發(fā)癥之一,有研究表明慢性高血糖導致微血管性腦損傷[2]。糖尿病患者中約有70%合并有神經(jīng)病變,其中包括中樞神經(jīng)病變[3]。據(jù)估計,全世界有4000萬人患有老年癡呆癥,這個數(shù)字預計將每20年翻一番,到2050年的超過1.1億[4]。最常見的癡呆癥是阿爾茨海默病(AD),而認知功能障礙是老年癡呆癥的一個重要前驅狀態(tài)[5]。輕度認知功能障礙(MCI)是介于正常衰老與癡呆之間的一種認知損傷狀態(tài),主要表現(xiàn)為記憶障礙,尤其是情節(jié)記憶缺陷,也可是命名障礙,但總體認知功能正常,日常生活能力正常[6]。有研究表明[7],與沒有糖尿病的人群相比,隨訪20年里,中年糖尿病患者的認知能力會下降大約19%,存在早期認知功能障礙。代謝手術(Metabolic Surgery)曾稱為減重手術,最開始是用于減重治療的,后來人們發(fā)現(xiàn)它同時有降低糖尿病患者血糖的作用,因此逐漸將其用于治療糖尿病。已有研究報道代謝手術能明顯改善糖尿病患者體重、血糖、血脂、血壓等,但有關其對糖尿病患者認知功能影響的研究尚欠缺。本研究擬通過觀察非糖尿病患者、單純常規(guī)藥物治療以及行代謝手術治療的2型糖尿病患者的代謝指標和認知功能情況,橫向及縱向分析2型糖尿病患者認知功能的變化特點、代謝手術治療與常規(guī)藥物治療對2型糖尿病患者認知功能的作用及其代謝手術前后認知功能的變化情況,以進一步了解代謝手術對2型糖尿病患者認知功能的影響,為預防老年癡呆提供新的途徑和方法。一、對象和方法1、研究對象2015年4月至2017年2月在大坪醫(yī)院高血壓內(nèi)分泌科住院或門診就診的非糖尿病患者、單純常規(guī)藥物治療以及于我院胃腸外科行代謝手術治療的2型糖尿病患者共150例。其中60例為第一部分研究對象,觀察2型糖尿病患者認知功能的變化特點,其余90例為第二部分研究對象,分別觀察代謝手術治療和常規(guī)藥物治療對2型糖尿病患者認知功能作用的比較及代謝手術改善2型糖尿病患者認知功能的作用。第一部分研究對象:2型糖尿病患者及非糖尿病患者各30例,共計60例,糖尿病組平均年齡43±8.8歲,男性19例,非糖尿病組平均年齡42±8.6歲,男性21例。兩組研究對象在年齡、性別及教育年限上無統(tǒng)計學差異。第二部分研究對象:常規(guī)藥物治療的2型糖尿病患者35例,平均年齡45.8±8.5歲,男性22例;行代謝手術治療后的2型糖尿病患者30例,平均年齡45±10歲,男性15例,平均術后隨訪時間為1.4年。此兩組研究對象在年齡、性別及教育年限上無統(tǒng)計學差異。其余為我科先期評估合格后于胃腸外科行代謝手術治療的2型糖尿病患者25例,并定期隨訪6月,平均年齡39±10.1歲,其中男性11例。2、方法及指標全部研究對象均由專人完成一般情況記錄(包括年齡、性別、教育年限等),測定身高、體重、腰圍(WC)、血壓(BP)等,完成認知功能相關量表測試(具體量表見附表):包括簡易精神狀態(tài)量表(MMSE)、臨床癡呆量表(CDR)、記憶與執(zhí)行功能量表(MES)、詞匯記憶測試(RAVLT)、注意力與定向力測試(連線測試TMT)、數(shù)字廣度測試(DST)、語言流暢性測試(動物詞匯流暢ANT)、視覺空間能力測試(畫鐘測試CDT);注明:記憶與執(zhí)行功能量表(MES)測試包括記憶力(MES-M)與執(zhí)行力(MES-E)兩部分,詞匯記憶測試(RAVLT)測試包括總體記憶詞匯數(shù)量(RAVL)、延遲記憶(LDFR)和回顧性記憶(RVL)部分,連線測試(TMT)包括連線測試A(TMT-A)和連線測試B(TMT-B)部分,數(shù)字廣度測試(DST)包括順背(DST-順背)和倒背(DST-倒背)部分;靜脈采血查總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、超敏C反應蛋白(hs-CRP)、空腹葡萄糖(FPG)、空腹胰島素(FINS)、糖化血紅蛋白(HbA1C)。其中手術病人手術后按時間隨訪完成上述所有檢查。且手術病人分別在術前與術后6月隨訪時完善聽覺事件相關誘發(fā)電位(ERP)腦電信息采集。二、結果(一)、2型糖尿病患者認知功能變化特點1.2型糖尿病患者組的FPG、HbA1c均高于非糖尿病對照組(P0.05),FINS均低于非糖尿病對照組(P0.05)。2.2型糖尿病患者的認知功能明顯低于非糖尿病對照組,差異有統(tǒng)計學意義(P0.05),主要表現(xiàn)在:總體認知評估、(MMSE)、記憶與執(zhí)行功能(MES-T)、記憶力(MES-M)、臨床癡呆量表(CDR)方面。(二)、代謝手術對2型糖尿病患者認知功能的作用1.代謝手術治療與常規(guī)藥物治療對2型糖尿病患者認知功能作用的比較1.1手術組與藥物組患者的代謝指標BMI、WC、BP、Hb A1C、FPG、TG存在統(tǒng)計學差異(P0.05)。1.2手術組與藥物組校正一般代謝指標之前,在MMSE、CDR、MES(MES-T,MES-M,MES-E)、RAVL、LDFR、RVL、ANT、CDT、DST方面,手術組優(yōu)于藥物組(P0.05);兩組校正一般代謝指標之后,手術組在MES-T、MES-E、RAVL、RVL、ANT方面,顯著優(yōu)于藥物組(P0.05)。2.前瞻性觀察代謝手術改善2型糖尿病患者認知功能的作用2.1 2型糖尿病患者代謝手術后6月認知功能與術前相比,MMSE、MES-T、MES-M、RAVL、RVL、ANT、TMT-A、TMT-B、DST-順背、DST-倒背均有改善(P0.05)。2.2 2型糖尿病患者術后6月的聽覺神經(jīng)誘發(fā)電位P300波波幅較術前有增高、潛伏期較術前有縮短,差異有統(tǒng)計學意義(P0.05)。三、結論1、2型糖尿病患者可能較易出現(xiàn)認知功能障礙,早期主要表現(xiàn)在總體認知評價以及記憶力方面。2、代謝手術改善2型糖尿病患者認知功能,如記憶力、執(zhí)行力、語言流暢性、注意力與定向力等方面。3、代謝手術能明顯改善反應認知功能的腦電信號P300波的波幅和潛伏期,其機制可能與代謝手術改變腦功能相關。
[Abstract]:Background and objective: diabetes has become an important risk factor for human life and health. There are 415 million adult diabetes in the world. It is expected that by 2040, more than 640 million.2 type diabetes (T2DM) is the proportion of diabetes mellitus (90-95%). Cardio cerebrovascular disease is an important factor affecting the final outcome of [1]. diabetic microvascular disease One of the common complications of diabetes, studies have shown that chronic hyperglycemia leads to microvascular brain damage in about 70% of [2]. diabetic patients with neuropathy, including central neuropathy [3]., which is estimated to have 40 million people in the world with Alzheimer's disease, which is expected to double every 20 years to more than 110 million in 2050. The most common dementia in [4]. is Blzheimer's disease (AD), and cognitive dysfunction is an important precursor of Alzheimer's disease, [5]. mild cognitive impairment (MCI), a cognitive impairment between normal aging and dementia, mainly manifested in memory disorders, especially episodic memory defects, but also named disorder. Normal physical cognitive function and normal daily life [6]. study showed that the cognitive ability of middle-aged diabetic patients decreased by about 19% and early cognitive impairment compared with those in the non diabetic group for 20 years. Metabolic surgery (Metabolic Surgery) was once called weight reduction surgery and was first used in weight reduction treatment. Later, it was used as a weight reduction treatment. It has been reported that metabolic surgery can improve the weight, blood sugar, blood lipid and blood pressure of diabetic patients. However, the study of the effects on cognitive function of diabetic patients is still deficient. This study is to observe non diabetic patients. The metabolic index and cognitive function of patients with type 2 diabetes treated with simple conventional medication and metabolic surgery. The characteristics of cognitive function in type 2 diabetes patients were analyzed horizontally and longitudinally. The cognitive function of metabolic surgery and conventional drug therapy on patients with type 2 diabetes and cognitive function before and after metabolic surgery were studied. To further understand the effect of metabolic surgery on cognitive function of patients with type 2 diabetes and to provide new ways and methods for the prevention of Alzheimer's disease. 1, object and method 1, non diabetic patients who were hospitalized in the hospital or outpatient department of the hypertension Department of endocrinology in Daping Hospital from April 2015 to February 2017. A total of 150 patients with type 2 diabetes were treated and treated with metabolic surgery in the gastrointestinal surgery of our hospital. Of them, 60 were the first part of the study. The changes in cognitive function of type 2 diabetic patients were observed. The remaining 90 cases were studied in second parts. The cognitive functions of metabolic surgery and conventional drug therapy on type 2 diabetes patients were observed respectively. Functional comparison and metabolic surgery to improve the cognitive function of patients with type 2 diabetes. The first part of the study: 30 cases of type 2 diabetes and non diabetic patients, a total of 60 cases, the average age of the diabetes group was 43 + 8.8 years, the male 19 cases, the average age of 42 + 8.6, and 21 in the non diabetic group. The study object in the two group was age and sex. There was no statistical difference in the number of years of education. Second subjects: 35 cases of type 2 diabetes, average age 45.8 + 8.5, 22 men, and 30 patients with type 2 diabetes after metabolic surgery. The average age was 45 + 10 years, and the average age was 1.4 years. The subjects of this group of subjects were age, sex, and sex. There were no statistical differences in the number of years of education. The rest were 25 cases of type 2 diabetic patients who were eligible for metabolic surgery in the gastroenterological surgery. The average age was 39 + 10.1 years old in June. The average age was 39 + 10.1 years old. Among them, the male 11 cases were.2. All the methods and indexes were recorded by the specialists (including age, sex, teaching). The height, weight, waist circumference (WC), blood pressure (BP) and so on were measured, and the cognitive function related scale was tested (specific table), including the simple mental state scale (MMSE), the clinical dementia scale (CDR), the memory and execution function scale (MES), the vocabulary memory test (RAVLT), the attention and orientation test (connection test TMT), and the digital breadth. Test (DST), language fluency test (animal vocabulary fluency ANT), visual spatial ability test (CDT); note: memory and execution function scale (MES) tests include two parts of memory (MES-M) and execution (MES-E), and lexical memory test (RAVLT) test including total memory vocabulary (RAVL), delayed memory (LDFR) and retrospective memory (RV). L) part, the connection test (TMT) includes the line test A (TMT-A) and the connection test B (TMT-B) part. The digital breadth test (DST) includes the CIS back (DST- CIS back) and the backback (DST- inverted back) part; the venous blood collection of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low density lipoprotein, hypersensitive reactive protein, and Vitis Vitis Glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C). All of the patients were followed up to complete the above examination after operation. And the patients were followed up and followed up in June to improve the auditory evoked potential (ERP) EEG information. Two, results (1), the characteristics of cognitive function changes in type 2 diabetic patients were 1.2. The FPG and HbA1c of patients with type 2 diabetes were higher than those of non diabetic control group (P0.05). The cognitive function of FINS was lower than that of non diabetic control group (P0.05), and the difference was significantly lower than that of non diabetic control group (P0.05), mainly in total cognitive assessment, (MMSE), memory and execution function (MES-T), memory (MES), and memory (MES). -M, clinical dementia scale (CDR). (two) the role of metabolic surgery on cognitive function in type 2 diabetic patients 1. the comparison of cognitive function between metabolic surgery and conventional medication for patients with type 2 diabetes mellitus, 1.1, WC, BP, Hb A1C, FPG, and TG (P0.05).1.2 operation group MMSE, CDR, MES (MES-T, MES-M, MES-E), RAVL, MES-T, MES-M, MES-E, RAVL, LDFR, ANT, CDT, DST, the operation group is superior to the drug group before the drug group corrects the general metabolic index. Cognitive function of patients with type 2.12 diabetes mellitus after metabolic surgery in June, cognitive function compared with preoperative, MMSE, MES-T, MES-M, RAVL, RVL, ANT, TMT-A, TMT-B, DST- CIS back, DST- inverted back all have improved (P0.05).2.2 2 diabetic patients after the auditory nerve evoked potential increased in June, the latency is shorter than before the operation, The difference was statistically significant (P0.05). Three, conclusion the patients with type 1,2 diabetes may be more likely to have cognitive impairment, early mainly in the overall cognitive evaluation and memory.2. Metabolic surgery improves the cognitive function of type 2 diabetic patients, such as memory, execution, verbal fluency, attention and orientation,.3, metabolic surgery. It can obviously improve the amplitude and latency of P300 wave of EEG signal in response to cognitive function, and its mechanism may be related to metabolic surgery and brain function.

【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1;R656.6

【參考文獻】

相關期刊論文 前5條

1 任慶貴;李昆;狄建忠;;手術治療2型糖尿病的研究進展[J];腹腔鏡外科雜志;2015年10期

2 祝之明;;代謝手術治療糖尿病的光明前景與現(xiàn)實挑戰(zhàn)[J];中國糖尿病雜志;2015年09期

3 ;中國2型糖尿病防治指南(2013年版)[J];中國醫(yī)學前沿雜志(電子版);2015年03期

4 李先濤;趙倩華;郭起浩;洪震;;記憶與執(zhí)行篩查量表在判斷阿爾茨海默病嚴重度中的作用[J];中國臨床神經(jīng)科學;2013年05期

5 白雪梅;;2型糖尿病患者認知功能障礙影響因素研究進展[J];河北聯(lián)合大學學報(醫(yī)學版);2012年04期

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