明淑萍， 刘 玲， 周 黎， 罗 玮

糖尿病急性并发症继发轻度认知功能障碍的预测模型及时间窗分析

明淑萍1，2， 刘 玲1，2， 周 黎3， 罗 玮4

目的搜集糖尿病急性并发症(Acute diabetic complications，ADC)患者的相关临床指标，构建预测模型以评判继发轻度认知功能障碍(Mild Cognitive Impairment，MCI)的预测价值，并验证其应用性。方法2014年4月～2016年4月期间湖北省中医院、2015年1月～2016年4月期间湖北省中山医院及武汉市中医院收治的ADC患者为研究队列，搜集相关临床资料，对其进行为期1 y的随访以确认预后转归。依据随访结果预判继发MCI风险的影响性指标，并分析继发MCI时间窗以验证应用性。结果(1)Cox回归分析显示，ADC患者继发MCI的风险模型由DM病程及HOMA-IR、NSE、IGF-1含量组成，其中IGF-1为保护性因素、其余为风险性因素；(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，继发MCI的时间窗更短，其中DM病程及IGF-1含量的临界值指标具有更高的评判效能。结论DM病程及HOMA-IR、NSE、IGF-1含量是ADC患者继发MCI的独立影响因素，且DM病程≥13.349 y、IGF-1<107.420 ng/L为衡量ADC患者随访期内继发MCI的临界点。

糖尿病； 糖尿病急性并发症； 认知功能

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)作为严重威胁人类健康的世界范围非传染性疾病，近年来患病率正急剧上升。据国际糖尿病联盟(International Diabetes Federation，IDF)统计，当前全球糖尿病患者已达2.85亿[1]；另据国内流行病调查资料显示，截止2008年，我国成年人的糖尿病发病率高达9.7%[2]，已占全球总发病人数的1/3强。作为基础疾病，近年来DM的各项慢性并发症逐渐为临床医生所重视，远期不良预后得到显著控制。但包括许多非内分泌专科医生在内的临床医生，对于DM的急性并发症的危害性缺乏足够重视，使得DM病情加剧并诱发其他并发症的发生，对预后转归产生显著不良影响。

糖尿病急性并发症(acute diabetic complications，ADC)是指短时间内胰岛素缺乏、严重感染、降糖药物使用不当等原因导致血糖急骤波动而出现的急性代谢紊乱。……