Diabetes Care：临床和亚临床大血管疾病标志物可预测老年T2DM患者认知减退

大血管疾病促使2型糖尿病患者认知加速减退的风险增加。为了确定在认知健康的老年2型糖尿病患者中大血管疾病指标与认知改变的相关性，来自英国苏格兰爱丁堡大学人口健康科学中心的Price博士等人进行了一项研究，研究发现，老年2型糖尿病患者中风、亚临床心区不适标志物和全身性动脉粥样硬化与认知减退具有显著相关性。研究结果在线发表于2013年4月11日的美国《糖尿病护理》(Diabetes Care)杂志上。
研究对象为爱丁堡2型糖尿病研究(ET2DS)中的受试者，831名男性和女性(年龄60-75岁)参加了两个阶段的研究。测定基线、临床和亚临床大血管疾病，包括心血管病史、颈动脉内膜中层厚度(cIMT)、踝肱比(ABI)、血清N末端前脑钠肽(NT-proBNP)。在基线和随访4年后对参与者实施7项神经心理测验，将认知评分与标准化的一般能力因子 (g)合并。校正随访期g的基线g，用于评价4年认知改变。校正词汇(评估病前能力)用于评价生存期内认知改变。
结果显示，认知减退与中风、NT-proBNP、ABI、cIMT显著相关，但是与非中风性血管事件不相关。中风与估计的生存期内认知减退升高(标准回归系数β，-0.12)，以及亚临床指标与实际的4年认知减退(NT-proBNP、ABI、cIMT的β分别为-0.12、0.12和-0.15)的相关性达到Bonferroni校正的统计学显著水平(P<0.006)。校正血管危险因素后，结果仅有轻微改变。
研究表明，老年2型糖尿病患者中风、亚临床心区不适标志物和全身性动脉粥样硬化与认知减退具有相关性。作者认为，使用亚临床血管疾病标志物预测认知减退仍需要进一步的研究。
与糖尿病相关的拓展阅读：

• Diabetes Care：糖尿病患者早期控制血压可降低心血管事件发生
• Stroke：糖尿病患者缺血性卒中风险或无种族差异
• Clin Gastroenterol H：巴雷特食管与2型糖尿病相关
• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013：糖尿病治疗方案
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Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study.
OBJECTIVE
Macrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes.
RESEARCH
DESIGN AND METHODS Eight-hundred thirty-one men and women (aged 60–75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change.
RESULTS
Measures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, −0.12) and of subclinical markers with actual 4-year decline (standardized β, −0.12, 0.12, and −0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P < 0.006). Results altered only slightly on adjustment for vascular risk factors.
CONCLUSIONS
Stroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.