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糖尿病认知功能障碍的临床与实验研究现状

Current status of clinical and experimental researches on cognitive impairment in diabetes.

作者信息

Liang Xiao-chun, Guo Sai-shan, Hagino Nobuyoshi

机构信息

Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730.

出版信息

Chin J Integr Med. 2006 Mar;12(1):68-74. doi: 10.1007/BF02857437.

Abstract

This article reviews the clinical and experimental researches on cognitive impairment related to diabetes in the recent decade. Most clinical studies indicate that the cognitive impairment in patients with type 1 diabetes mellitus is related to recurrent hypoglycemia closely. There is little research about whether or not hyperglycemia is related to cognitive impairment in patients with type 1 diabetes mellitus. Most studies indicate that the cognitive impairment in type 2 diabetes involves multiple factors through multiple mechanisms, including blood glucose, blood lipid, blood pressure, level of insulin, medication, chronic complication, etc. But, there has been no large-scale, multi-center, randomized controlled clinical trial in China recently. And what is more, some problems exist in this field of research, such as the lack of golden criterion of cognitive function measurement, different population of studied objects, and incomprehensive handling of confounding factors. Experimental studies found that hippocampal long-term potentiation (LTP) was impaired, which were manifested by impairment of spatial memory and decreased expression of LTP, but it's relation to hyperglycemia, the duration of diabetes, learning and memory has always been differently reported by different researches. Thus, there are a lot of unknown things to be explored and studied in order to clarify its mechanism. TCM has abundant clinical experience in treating cerebral disease with medicine that enforces the kidney and promotes wit. However, there has been no research on treating diabetic cognitive impairment, which requires work to be done actively and TCM to be put into full play, in order to improve the treatment of diabetes and enhance living quality of patients.

摘要

本文综述了近十年来糖尿病相关认知障碍的临床及实验研究。多数临床研究表明,1型糖尿病患者的认知障碍与反复低血糖密切相关。关于1型糖尿病患者高血糖是否与认知障碍相关的研究较少。多数研究表明,2型糖尿病的认知障碍涉及多种因素和多种机制,包括血糖、血脂、血压、胰岛素水平、药物治疗、慢性并发症等。但近期国内尚无大规模、多中心、随机对照临床试验。而且,该研究领域存在一些问题,如认知功能测量缺乏金标准、研究对象人群不同、混杂因素处理不全面等。实验研究发现海马长时程增强(LTP)受损,表现为空间记忆障碍和LTP表达降低,但不同研究对其与高血糖、糖尿病病程、学习记忆的关系报道不一。因此,为阐明其机制,仍有许多未知有待探索和研究。中医在运用补肾益智药物治疗脑病方面有丰富的临床经验。然而,目前尚无关于治疗糖尿病认知障碍的研究,需要积极开展工作,充分发挥中医优势,以改善糖尿病的治疗,提高患者生活质量。

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