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【Diabetes Care】1型糖尿病认知功能下降的生物医学
in type 1 diabetes: an 18 year follow-up of the Diabetes
Control and Complications Trial (DCCT) cohort
1型糖尿病认知功能下降的生物医学危险因素：糖尿病控制和并发症研究（DCCT）18年随访的队列研究
A. M. Jacobson & C. M. Ryan & P. A. Cleary &
B. H. Waberski & K. Weinger & G. Musen & W. Dahms &
and the DCCT/EDIC Research Group
Abstract
Aims/hypothesis In patients with type 1 diabetes, there has
been concern about the effects of recurrent hypoglycaemia
and chronic hyperglycaemia on cognitive function. Because
other biomedical factors may also increase the risk of
cognitive decline, this study examined whether macro-
vascular risk factors (hypertension, smoking, hypercholes-
terolaemia, obesity), sub-clinical macrovascular disease
(carotid intima–media thickening, coronary calcification)
and microvascular complications (retinopathy, nephropathy)
were associated with decrements in cognitive function over
an extended time period.
摘要
目的/假设 在1型糖尿病患者，反复发作性低血糖及慢性高血糖对认知功能的影响备受关注。由于其它生物医学因素也可能增加认知能力下降的风险，本研究的目的是观察大血管危险因素（高血压、吸烟、高胆固醇血症、肥胖），亚临床大血管疾病（颈动脉内膜中层增厚、冠状动脉钙化）及微血管并发症（视网膜病变、肾脏病变）是否与认知功能下降相关。
Methods Type 1 diabetes patients (n=1,144) who had
completed a comprehensive cognitive test battery at entry
into the Diabetes Control and Complications Trial were re-
assessed at a mean of 18.5 (range: 15–23) years later.
Univariate and multivariable models examined the relation-
ship between cognitive change and the presence of micro-
and macrovascular complications and risk factors.
方法 在入组时进行了全面认知测验的糖尿病控制和并发症研究中的1型糖尿病患者（n=1,144），在平均18.5年（范围：15-23岁）之后进行了重新评估。用单变量和多变量模型观察了认知改变和微血管并发症、大血管并发症及危险因素的关系。 Results Univariate modelling showed that smoking history
wasmodestly associatedwith decrements in learning,memory,
spatial information-processing and psychomotor efficiency;
hypertension was associated with only psychomotor slowing.
Multivariable modelling demonstrated that HbA1c level, and
retinal and renal complications were each independently
associated with decrements in psychomotor efficiency. In
contrast, no macrovascular risk factors were significant after
correcting for multiple comparisons. No interactions were
found between these predictors and sex, severe hypoglycaemic
events or presence of the APOE ε4allele.
结果 单因素模型分析表明，吸烟史与学习、记忆、空间信息处理和心理活动的效率下降中度相关；高血压仅与精神运动下降相关。多变量模型分析表明，糖化血红蛋白水平、视网膜和肾脏并发症均与精神运动效率下降独立相关。相反，在矫正多种因素后，无大血管危险因素显著相关。未发现这些预测因子和性别、严重低血糖事件或载脂蛋白APOE ε4等位基因存在相互作用。
Conclusions/interpretation In relatively healthy, middle-
aged adults with type 1 diabetes who had been followed
for an average of 18.5 years, long-term metabolic control
and microvascular factors are independently associated with
a decline in cognitive function specifically affecting
measures of psychomotor efficiency.
结论/解释 在相对健康的中年1型糖尿病患者平均随访18.5年后，长期代谢控制和微血管因素与认知功能衰退独立相关。
Trial registration ClinicalTrials.gov NCT00360893
试验注册 ClinicalTrials.gov NCT00360893 Funding This study is supported by NIH grant number
5RO1 DK062218-02. The DCCT/EDIC project is supported
by contracts with the Division of Diabetes, Endocrinology
and Metabolic Diseases of the National Institute of Diabetes
and Digestive and Kidney Diseases, the National Eye
Institute, the National Institute of Neurological Disorders
and Stroke, the General Clinical Research Centers Program,
the Clinical and Translational Science Awards Program, the
National Center for Research Resources and by Genentech
through a Cooperative Research and Development Agree-
ment with the National Institute of Diabetes and Digestive
and Kidney Diseases.
资助 该研究由NIH资助，项目编号5RO1 DK062218-02。DCCT/ EDIC项目由国家糖尿病和消化及肾病研究院内分泌和代谢病研究所、糖尿病科，国家眼科研究所，神经疾病与中风研究所，一般临床研究中心项目，临床和转化科学奖励计划，国家研究资源中心和遗传技术研究公司通过合作研究和开发协议与国家糖尿病和消化及肾脏疾病研究院支持。
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作者:admin@医学,生命科学 2011-02-06 12:38
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