目的:探讨经颅直流电刺激对2型糖尿病合并轻度认知功能障碍的临床效果。方法:回顾性分析了我院2020年6月~2021年9月就诊的100例2型糖尿病合并早期认知功能障碍患者的临床资料,对照组与实验组均给予常规降糖药物,实验组额外给予经颅直流电刺激,于治疗前、治疗4周及治疗结束后3月检测2组患者认知功能情况;采用蒙特利尔认知评估量表:评估认知功能;听觉词语学习测验:评估记忆功能;连线测验:评估执行能力。结果:治疗4周后,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05);治疗结束后3月,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分、再认测试评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05)。结论:经颅直流电刺激能有效地改善2型糖尿病合并轻度认知功能障碍的症状,值得临床应用。 Objective: To investigate the clinical effect of transcranial direct current stimulation on type 2 diabetes mellitus with mild cognitive impairment. Methods: The clinical data of 100 patients with type 2 diabetes mellitus complicated with early cognitive impairment treated in our hospital in June 2020~September 2021 were retrospectively analyzed. The control group and the experimental group were given conventional hypoglycemic drugs. The experimental group received transcranial direct current stimulation, and the cognitive function of the 2 groups was detected before treatment, 4 weeks and 3 months after treatment. Montreal cognitive assessment scale was used to evaluate cognitive function; auditory verbal learning test: evaluate memory function; STT: evaluate executive ability. Results: After 4 weeks of treatment, the experimental group showed significant differences (p < 0.05) in MOCA scores, auditory verbal learning tests (immediate memory scores, long delayed recall scores) and STT (STT-A time-consuming, STT-B time-consuming) compared to the control group. At 3 months after the end of treatment, the experimental group showed significant differences (p < 0.05) in MOCA scores, auditory verbal learning tests (immediate memory scores, long delayed recall scores, recognition test scores) and STT (STT-A time spent, STT-B time spent) compared with the control group. Conclusion: Transcranial direct current stimulation can effectively improve the symptoms of type 2 diabetes mellitus with mild cognitive impairment, and is worthy of clinical application.
目的:探讨经颅直流电刺激对2型糖尿病合并轻度认知功能障碍的临床效果。方法:回顾性分析了我院2020年6月~2021年9月就诊的100例2型糖尿病合并早期认知功能障碍患者的临床资料,对照组与实验组均给予常规降糖药物,实验组额外给予经颅直流电刺激,于治疗前、治疗4周及治疗结束后3月检测2组患者认知功能情况;采用蒙特利尔认知评估量表:评估认知功能;听觉词语学习测验:评估记忆功能;连线测验:评估执行能力。结果:治疗4周后,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05);治疗结束后3月,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分、再认测试评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05)。结论:经颅直流电刺激能有效地改善2型糖尿病合并轻度认知功能障碍的症状,值得临床应用。
经颅直流电刺激,2型糖尿病,轻度认知功能障碍
Tengfei Gan1, Xiancong Bu2, Zengchao Li3, Yufeng Zuo1, Jinping Sun4*
1Department of Physical Therapy, Zaozhuang Municipal Hospital, Zaozhuang Shandong
2Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang Shandong
3Department of Rehabilitation and Physiotherapy, Zaozhuang Municipal Hospital, Zaozhuang Shandong
4Department of Emergency Neurology, Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Jan. 16th, 2022; accepted: Feb. 9th, 2022; published: Feb. 18th, 2022
Objective: To investigate the clinical effect of transcranial direct current stimulation on type 2 diabetes mellitus with mild cognitive impairment. Methods: The clinical data of 100 patients with type 2 diabetes mellitus complicated with early cognitive impairment treated in our hospital in June 2020~September 2021 were retrospectively analyzed. The control group and the experimental group were given conventional hypoglycemic drugs. The experimental group received transcranial direct current stimulation, and the cognitive function of the 2 groups was detected before treatment, 4 weeks and 3 months after treatment. Montreal cognitive assessment scale was used to evaluate cognitive function; auditory verbal learning test: evaluate memory function; STT: evaluate executive ability. Results: After 4 weeks of treatment, the experimental group showed significant differences (p < 0.05) in MOCA scores, auditory verbal learning tests (immediate memory scores, long delayed recall scores) and STT (STT-A time-consuming, STT-B time-consuming) compared to the control group. At 3 months after the end of treatment, the experimental group showed significant differences (p < 0.05) in MOCA scores, auditory verbal learning tests (immediate memory scores, long delayed recall scores, recognition test scores) and STT (STT-A time spent, STT-B time spent) compared with the control group. Conclusion: Transcranial direct current stimulation can effectively improve the symptoms of type 2 diabetes mellitus with mild cognitive impairment, and is worthy of clinical application.
Keywords:Transcranial Direct Current Stimulation, Type 2 Diabetes Mellitus, Mild Cognitive Impairment
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糖尿病作为一种严重危害人类健康的疾病,在我国呈现出越来越高的发病率,我国目前有1.16亿糖尿病患者,位居世界首位 [
本研究的对象来自2020年6月~2021年9月在枣庄市立医院就诊的2型糖尿病合并早期认知功能障碍的100例住院病人,入选参照《美国糖尿病协会2008糖尿病诊断与分型标准》及《2018中华医学会中国痴呆与认知障碍诊治指南》 [
纳入标准:1) 早期认知功能障碍符合临床诊断标准,不存在痴呆情况,蒙特利尔认知评估量表评分低于26分;2) 年龄 > 18岁,右利手,病程半年以上,积极配合治疗;3) 药物控制血压正常;4) 文化水平为初中以上。
排除标准:1) 有糖耐量减低、1型糖尿病或其它特殊类型糖尿病、酮症酸中毒或存在甲状腺机能亢进等内分泌系统疾病;2) 既往脑卒中、癫痫、精神药物使用史、脑外伤或其它对认知功能有影响的疾病史;3) 合并心肝肾或其它系统严重疾病;4) 因听力、视力或语言功能障碍等各种原因无法配合临床治疗;5) 体内有金属异物等经颅磁刺激禁忌情况等。
按照随机数字量表法,将100例病人1:1比例分为对照组和实验组,对照组给予常规降糖药物控制血糖水平,实验组在对照组基础上给予经颅直流电刺激,收集患者的一般临床资料,包括性别、年龄、种族、慢病(高血压、冠心病)、教育年限(初中以上文化水平)、饮酒、吸烟、血糖水平、BMI,并于治疗前、治疗4周后及治疗结束后3月检测2组患者认知功能情况;患者认知功能评估包含如下内容:1) 蒙特利尔认知评估量(Montreal Cognitive Assessment, MOCA),评估患者认知功能;2) 听觉词语学习测验华山版(Auditory verbal learning test, AVLT) [
本研究所得计量资料以( X ¯ ± S )表示,采用SPSS 26.0版统计学软件包进行数据分析,由于大部分计量资料不符合正态分布,为保证数据的一致性,所有计量资料以中位数(四分位间距)表示,两组间差异采用非参数检验,计数资料以例数或百分比表示,采用χ2检验进行统计学比较,p < 0.05表示差异具有统计学意义。
1) 实验组与对照组在一般临床资料上无明显差异(p > 0.05),两组具有可比性,具体见表1,表2。
项目 | 实验组 | 对照组 | χ2 | p值 |
---|---|---|---|---|
男性(%) | 25 (50) | 27 (54) | 0.160 | 0.689 |
吸烟史(%) | 34 (68) | 32 (64) | 0.178 | 0.673 |
饮酒史(%) | 25 (50) | 28 (56) | 0.361 | 0.548 |
高血压(%) | 21 (42) | 28 (56) | 1.961 | 0.161 |
冠心病(%) | 14 (28) | 11 (22) | 0.480 | 0.488 |
表1. 实验组与对照组:一般资料中的计数资料信息
项目 | 实验组 | 对照组 | Z | p值 |
---|---|---|---|---|
年龄(岁) | 64.83 (57.74~72.03) | 66.53 (61.02~70.62) | −0.400 | 0.689 |
教育年限(年) | 9.41 (8.14~11.49) | 9.73 (8.0~12) | −0.079 | 0.937 |
BMI (kg/m2) | 27.68 (25.4~30.14) | 27.44 (25.89~29.37) | −0.372 | 0.710 |
血糖水平(mmol/l) | 7.03 (5.99~7.75) | 7.0 (6.58~7.62) | −0.552 | 0.581 |
治疗前MOCA评分 | 20.94 (19.29~22.07) | 20.83 (19.64~22.01) | −0.076 | 0.94 |
AVLT即刻记忆评分 | 7.18 (6.44~7.90) | 6.81 (5.85~7.90) | −1.158 | 0.247 |
AVLT长延迟回忆评分 | 5.85 (5.15~6.81) | 3.12 (2.0~5.28) | −0.786 | 0.432 |
AVLT再认记忆评分 | 5.84 (4.18~7.33) | 5.35 (4.0~7.26) | −0.376 | 0.707 |
STT-A耗时(秒) | 140 (97.23~250.59) | 157.66 (84.11~217.20) | −0.014 | 0.989 |
STT-B耗时(秒) | 452 (292.21~673.84) | 509.76 (356.02~651.27) | −0.372 | 0.710 |
表2. 实验组与对照组:一般资料中的计量资料信息
2) 治疗4周后,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分、再认测试评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05),见表3。
项目 | 实验组 | 对照组 | Z | p值 |
---|---|---|---|---|
MOCA评分 | 24.0 (22.0~25.38) | 20.53 (20~22.96) | −6.016 | <0.001 |
AVLT即刻记忆评分 | 9.77 (9.0~10.95) | 8.94 (7.99~9.96) | −3.941 | <0.001 |
AVLT长延迟回忆评分 | 8.0 (6.0~10.0) | 4.0 (2.0~6.39) | −5.569 | <0.001 |
AVLT再认记忆评分 | 8.67 (6.98~10.0) | 7.28 (6.0~8.33) | −3.204 | 0.001 |
STT-A耗时(秒) | 120.67 (77.23~230.59) | 174.47 (153.03~195.52) | −2.054 | 0.04 |
STT-B耗时(秒) | 375.65 (215.1~596.78) | 488.57 (420.15~527.78) | −2.068 | 0.039 |
表3. 4周后患者认知、记忆、执行功能评分信息
3) 治疗3月后,实验组较对照组在MOCA评分、听觉词语学习测验(即刻记忆评分、长延迟回忆评分、再认测试评分)以及连线测验(STT-A耗时、STT-B耗时)具有明显差异(p < 0.05),见表4。
项目 | 实验组 | 对照组 | Z | p值 |
---|---|---|---|---|
MOCA评分 | 27.0 (26~28.25) | 22.0 (20.75~24.0) | −7.674 | <0.001 |
AVLT即刻记忆评分 | 10.63 (10~11.27) | 9.0 (8.0~10.0) | −6.129 | <0.001 |
AVLT长延迟回忆评分 | 8.62 (6.19~10.24) | 5.24 (3.89~7.62) | −4.453 | <0.001 |
AVLT再认记忆评分 | 10.33 (8.76~11.56) | 8.0 (7.0~9.09) | −5.535 | <0.001 |
STT-A耗时(秒) | 115.27 (71.84~225.20) | 165.60 (153.21~184.60) | −2.020 | 0.043 |
STT-B耗时(秒) | 379.55 (219.0~600.68) | 495.83 (386.81~574.82) | −1.985 | 0.047 |
表4. 治疗结束3月后患者认知、记忆、执行功能评分信息
随着社会经济状况的发展和饮食习惯的改变,糖尿病的发病呈现越来越年轻化的趋势,而且糖尿病病人合并认知功能障碍的患者越来越多,如何预防及有效的治疗措施一直是人们关注的焦点,本文对2型糖尿病合并轻度认知功能障碍的病人采用经颅直流电刺激治疗,通过治疗后3月的随访发现,患者在MOCA评分、听觉词语即刻记忆评分、长延迟回忆评分、再认测试评分、STT-A耗时、STT-B耗时方面较对照组均具有明显的改善,经颅直流电刺激是一种有效的治疗方法。
糖尿病患者的认知功能障碍具有多方面的原因,除了糖尿病本身可以导致大脑血管发生动脉粥样硬化性改变,导致局部血流量减少,另外神经递质的病变也是糖尿病患者认知功能障碍发病过程重要的影响因素,王宪玲等人通过对糖尿病小鼠的大脑解剖后研究发现,脑内杏仁核、海马等区域的胆碱酶系统的酶活性下降,影响大脑乙酰胆碱的合成与释放 [
综上所述,对于2型糖尿病患者合并轻度认知功能障碍的患者,经颅直流电刺激能够在改善认知功能、记忆功能、执行功能方面起到明显的改善效果,是一种安全有效、无痛的治疗手段,可以在临床上推广应用。
甘腾飞,卜宪聪,李增超,左玉峰,孙锦平. 经颅直流电刺激对2型糖尿病合并轻度认知功能障碍的影响Effect of Transcranial Direct Current Stimulation on Type 2 Diabetes Mellitus with Mild Cognitive Impairment[J]. 临床医学进展, 2022, 12(02): 1074-1079. https://doi.org/10.12677/ACM.2022.122158