血浆载脂蛋白A1水平与中老年2型糖尿病患者轻度认知障碍的关系

赵琦; 朱平辉; 马力; 吕泰宏; 陈玉茹

doi:10.16766/j.cnki.issn.1674-4152.004030

血浆载脂蛋白A1水平与中老年2型糖尿病患者轻度认知障碍的关系

doi: 10.16766/j.cnki.issn.1674-4152.004030

1.
首都医科大学附属北京天坛医院全科医疗科，北京 100070
2.
国家卫生健康委中国健康教育中心，北京 100011

基金项目:

2022年度首都全科医学研究专项 22QK13

高层次公共卫生技术人才建设项目学科带头人-02-09

中国社区卫生协会“社区卫生科研基金”项目 2021-1-05

详细信息

通讯作者:
马力，E-mail：mali_ttyy@126.com

中图分类号: R587.1 R749.24
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-11
- 网络出版日期: 2025-09-04

Relationship between plasma apolipoprotein A1 level and mild cognitive impairment in middle-aged and elderly patients with type 2 diabetes mellitus

1.
Department of General Practice, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

摘要

摘要: 目的近年血脂水平与认知障碍的关系受到许多关注，但关于血浆载脂蛋白A1(APOA1)的研究较少，本文旨在探讨APOA1水平与中老年2型糖尿病(T2DM)患者认知功能的关系。方法选取2023年10月—2024年3月于北京天坛医院住院的223例T2DM患者，采用简易智能状态检查(MMSE)量表将患者分为轻度认知障碍(MCI)组(81例)和认知正常(NC)组(142例)，比较2组患者一般情况及血脂情况，并分析血浆APOA1水平对MCI的影响。结果 223例T2DM患者中，MCI组81例，占比36.3%。调整混杂因素后，血浆APOA1水平是T2DM患者发生MCI的独立影响因素(OR=6.359, P=0.022)，年龄分层研究后发现这种相关性在60岁以上的人群中更为显著。此外，合并T2DM的患者中，不同MMSE得分患者血浆APOA1水平差异有统计学意义(P＜0.001)。结论血浆APOA1浓度与T2DM患者发生MCI相关，应采取综合管理措施积极控制T2DM患者血浆APOA1水平。
- 2型糖尿病 /
- 轻度认知障碍 /
- 中老年 /
- 血浆载脂蛋白A1
Abstract: Objective In recent years, the relationship between blood lipid level and cognitive impairment has received much attention, but there are few studies on plasma apolipoprotein A1 (APOA1). The objective of this study was to investigate the relationship between APOA1 levels and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 223 T2DM patients admitted to Beijing Tiantan Hospital from October 2023 to March 2024 were enrolled by mini-mental state examination. The patients were divided into mild cognitive impairment (MCI) group (n=81) and normal cognitive (NC) group (n=142) with MMSE. The general condition and blood lipid of the two groups were compared, and analyze the correlation between MCI and plasma APOA1 levels. Results Among 223 T2DM patients, 81 cases were in MCI group, accounting for 36.3%. After adjusting for confounders, plasma APOA1 levels plasma APOA1 levels were an independent risk factor for MCI in T2DM patients (OR=6.359, P=0.022), and this association was more significant in people over 60 years of age after age-stratified studies. In addition, among patients with T2DM, significant differences in plasma APOA1 levels were observed across different MMSE score groups (P < 0.001). Conclusion Plasma APOA1 concentration is associated with MCI in T2DM patients, and comprehensive management measures should be taken to actively control plasma APOA1 level in T2DM patients.
- Type 2 diabetes /
- Mild cognitive impairment /
- Middle and old age /
- Plasma apolipoprotein A1

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表 1 2组T2DM患者基线资料比较

Table 1. Comparison of baseline data between the two groups of patients with T2DM

项目	MCI组(n=81)	NC组(n=142)	统计量	P值
性别[例(%)]
男性	26(32.0)	87(61.2)	17.557^a	＜0.001
女性	55(67.9)	55(38.7)
年龄[M(P₂₅, P₇₅)，岁]	67(62，72)	60(55，65)	5.790^b	＜0.001
文化程度[例(%)]
高中以下	18(22.2)	19(13.3)	-3.892^b	＜0.001
高中	46(56.7)	54(38.0)
高中以上	17(20.9)	69(48.5)
吸烟[例(%)]
否	50(61.8)	83(58.5)	0.230^a	0.672
是	31(38.2)	59(41.5)
饮酒[例(%)]
否	54(66.6)	80(56.4)	2.294^a	0.155
是	27(33.3)	62(43.6)
高血压[例(%)]
否	49(60.4)	70(49.2)	2.599^a	0.125
是	32(49.6)	72(50.8)
BMI[M(P₂₅, P₇₅)]	24.68(22.91，27.42)	25.08(23.14，27.12)	-0.698^b	0.485
糖尿病病程[M(P₂₅, P₇₅)，年]	16.0(8.5，21.5)	10.0(5.0，13.0)	8.067^b	＜0.001
HbA1c[M(P₂₅, P₇₅)，%]	8.40(7.25，9.85)	8.00(6.90，9.15)	2.216^b	0.033
TC[M(P₂₅, P₇₅)，mmol/L]	4.90(3.81，5.78)	4.31(3.71，4.85)	3.700^b	＜0.001
TG[M(P₂₅, P₇₅)，mmol/L]	1.48(0.98，2.51)	1.63(1.17，2.25)	-1.051^b	0.293
DL-C[M(P₂₅, P₇₅)，mmol/L]	1.21(1.06，1.33)	1.18(1.09，1.35)	0.890^b	0.352
LDL-C[M(P₂₅, P₇₅)，mmol/L]	3.18(2.01，4.02)	2.76(2.22，3.10)	2.605^b	0.009
APOA1[M(P₂₅, P₇₅)，mmol/L]	1.29(1.19，1.45)	1.22(0.91，1.36)	2.524^b	0.014
APOB(x±s，mmol/L)	0.94±0.28	0.93±0.21	0.723^c	0.470
注：^a为χ²值，^b为Z值, ^c为t值。

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表 2 T2DM患者MCI发生影响因素的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of influencing factors of MCI in patients with T2DM

变量	B	SE	Waldχ²	P值	OR(95% CI)
性别	0.682	0.403	2.864	0.091	1.979(0.898~4.361)
年龄	0.161	0.033	24.493	＜0.001	1.175(1.102~1.252)
文化程度			9.904	0.007
高中	-0.074	0.507	0.021	0.844	0.929(0.344~2.508)
高中以上	-1.422	0.571	6.197	0.013	0.241(0.079~0.739)
糖尿病病程	0.104	0.028	13.771	＜0.001	1.109(1.050~1.172)
HbA1c	0.269	0.111	5.518	0.019	1.309(1.053~1.628)
TC	0.926	0.394	5.518	0.019	2.524(1.166~5.466)
LDL-C	-0.078	0.404	0.037	0.848	0.925(0.419~2.045)
APOA1	1.850	0.809	5.232	0.022	6.359(1.303~31.032)
注：各变量赋值如下，性别，男性=1，女性=2；文化程度，高中以下=1，高中=2，高中以上=3；认知正常=0，MCI=1；其余连续变量均以实际值赋值。

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表 3 临床参数与MCI患者MMSE得分的相关性

Table 3. Correlation between clinical parameters and MMSE scores in patients with MCI

组别	例数	APOA1 [M(P₂₅, P₇₅)，mmol/L]	年龄 (x±s，岁)	糖尿病病程 (x±s，年)	HbA1c [M(P₂₅, P₇₅)，%]	TC [M(P₂₅, P₇₅)，mmol/L]
M1	20	1.66(1.60，1.73)	73±6	18±10	9.25(7.10，10.25)	4.82(3.39，5.73)
M2	33	1.42(1.36，1.48)^a	66±7^a	17±9	8.98(7.85，10.25)	5.06(3.90，5.92)
M3	28	1.20(0.98，1.28)^ab	64±5^a	13±8	8.15(7.53，8.98)	4.93(3.67，5.42)
统计量		20.135^c	10.731^d	2.894^d	0.793^c	0.445^c
P值		＜0.001	＜0.001	0.061	0.673	0.801

组别	例数	TG [M(P₂₅, P₇₅)，mmol/L]	HDL-C [M(P₂₅, P₇₅)，mmol/L]		LDL-C [M(P₂₅, P₇₅)，mmol/L]	APOB (x±s，mmol/L)	BMI (x±s)
M1	20	1.57(1.13，2.79)	1.22(1.00，1.58)		3.22(2.20，3.79)	0.99±0.26	25.69±3.50
M2	33	1.42(0.92，2.68)	1.34(1.17，1.55)		3.14(1.92，4.22)	0.91±0.27	24.55±2.89
M3	28	1.49(0.70，2.33)	1.31(1.14，1.51)		3.14(1.92，3.93)	0.93±0.31	25.07±3.38
统计量		1.124^c	1.332^c		0.057^c	0.542^d	0.776^d
P值		0.570	0.514		0.972	0.584	0.464
注：与M1比较，^aP＜0.05；与M2比较, ^bP＜0.05, ^c为H值，^d为F值。

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表 4 不同年龄段T2DM患者发生MCI的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of MCI in T2DM patients of different age groups

分组	变量	OR(95% CI)	P值
Y1	性别	2.082(0.288~8.051)	0.467
	文化程度(1)	3.987(0.221~7.495)	0.348
	文化程度(2)	1.122(0.129~6.327)	0.941
	糖尿病病程	1.090(0.953~1.247)	0.207
	HbA1c	1.040(0.641~1.686)	0.875
	TC	4.707(1.431~7.483)	0.011
	APOA1	5.094(0.324~36.668)	0.223
Y2	性别	2.657(0.873~6.088)	0.085
	文化程度(1)	0.530(0.099~2.844)	0.459
	文化程度(2)	0.155(0.027~0.899)	0.038
	糖尿病病程	1.131(1.039~1.231)	0.004
	HbA1c	1.622(1.168~2.253)	0.004
	TC	1.806(1.040~3.136)	0.036
	APOA1	7.442(1.245~20.695)	0.031
Y3	性别	1.297(0.222~5.562)	0.773
	文化程度(1)	0.908(0.098~8.455)	0.932
	文化程度(2)	0.105(0.008~1.338)	0.083
	糖尿病病程	1.131(1.009~1.268)	0.034
	HbA1c	0.998(0.621~1.605)	0.994
	TC	2.088(0.650~6.705)	0.216
	APOA1	11.983(1.009~27.813)	0.045
注：文化程度(1)为高中与高中以下相比；文化程度(2)为高中以上与高中以下相比。

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