胰岛素降解酶活性与2型糖尿病患者认知功能障碍的相关性研究

Association of activity of insulin degrading enzyme with cognitive dysfunction in type 2 diabetic patients

摘要:

目的  探讨胰岛素降解酶（IDE）活性与2型糖尿病（T2DM）患者认知功能障碍的相关性。方法  筛选2015年5月-2015年7月在唐山市工人医院内分泌二科住院的T2DM患者80例为病例组，同期体检健康者80例为对照组，收集所有研究对象的一般资料，包括性别、年龄、受教育年限、收缩压（SBP）、舒张压（DBP）、体重指数（BMI）、病程等，以及生化指标，包括超敏C反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）、空腹血糖（FPG）、空腹胰岛素（FIN）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）等。计算稳态胰岛素评价指数（HOMA-IR）（空腹胰岛素×空腹血糖/22.5）并进行可重复的成套神经心理状态测量量表（RBANS）评分。应用IDE活性试剂盒（IDE Immunoca Pture Act）检测血清IDE活性水平，比较对照组与病例组IDE活性及认知功能是否存在差异，并分析IDE与认知功能的相关性。将病例组按照IDE活性中位数水平分为高IDE活性水平组和低IDE活性水平组，比较两组之间认知功能是否存在差异。结果  ①与对照组比较，病例组患者病程长，BMI、FPG、HbA1c、TC、TG、LDL-C、hs-CRP、Hcy、HOMA-IR水平较高，IDE活性水平降低（P <0.05），而年龄、性别、受教育年限、血压、HDL比较，差异无统计学意义（P >0.05）；②与对照组比较，病例组RBANS量表即时记忆、言语功能、注意力、延迟记忆、总分降低（P <0.05）；③在病例患者中，与高IDE活性水平组相比，低IDE活性水平组即时记忆、视觉广度、言语功能、注意力、延迟记忆评分以及总分降低（P <0.01）；④在病例患者中，IDE活性与IR呈负相关（P <0.01）；⑤在病例患者中，IDE与即刻记忆、视觉广度、言语功能、注意力、延迟功能、总分呈正相关（P <0.01）。结论  病例患者血清IDE活性水平下降是认知功能降低的危险因素之一。

Abstract:

 Objective To investigate the association of the activity of insulin degrading enzyme (IDE) with cognitive deficits in T2DM patients. Methods Eighty patients in Tangshan Gongren Hospital and 80 controls without T2DM from the Medical Examination Center between May 2015 and July 2015 were recruited. The data on demographic characteristics (including gender, age, education, duration of illness and BMI) and clinical parameters (including FPG, FIN, HbA1c, TC, TG, LDL-C, HDL-C, hs-CRP and Hcy) were collected. IDE was measured by IDE Immunoca Pture Act. Cognitive performance was assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) which consists of five subtests including immediate memory, visuospatial constructional, language, attention and delayed memory; and the scores from the above five subtests are scaled together to create a total score. Difference in RBANS scores was compared between the T2DM group and control group. T2DM patients were divided into high-IDE-activity group and low-IDE-activity group according to the median level of IDE activity, and the difference in cognitive function was compared between the two groups. Results Serum FPG, HbA1c, TC, TG, LDL-C, hs-CRP, Hcy and HOMA-IR levels, and BMI of the T2DM patients were higher than those of the controls; and duration of illness was longer and the activity of IDE were lower than that of the controls (P < 0.05). Age, gender, education, SBP, DBP and serum HDL-C were similar in both groups (P > 0.05). RBANS scores were lower in the T2DM patients than in the controls on the total score and all subtests (P < 0.05) expect for constructional of RBANS. In the T2DM patients, immediate memory, visuospatial/constructional, language, attention, delayed memory and total score of the patients with high IDE were higher than those of the patients with low IDE (P < 0.01). Stepwise regression analysis showed that the activity of IDE inversely correlated with IR; and the activity of IDE positively correlated with immediate memory, visuospatial/constructional, language, attention, delayed memory and total score in the T2DM patients (P < 0.01). Conclusions Decreased activity of IDE may be one of the risk factors of cognitive deficits in T2DM patients.