糖尿病酮症酸中毒对 1 型糖尿病儿童执行功能的影响：威斯康星卡片分类测验表现的证据。

Effects of Diabetic Ketoacidosis on Executive Function in Children With Type 1 Diabetes: Evidence From Wisconsin Card Sorting Test Performance.

机构信息

From the Medical Psychological Center, The Second Xiangya Hospital (J. He, J. Zhu, Du, Sh. Li, Si. Li, X. Zhu), Central South University, Changsha, China; Department of Psychology (J. He), The First Normal University, Changsha, China; Hunan Key Laboratory of Children's Psychological Development and Brain Cognitive Science (J. He), Changsha, China; Medical Psychological Institute of Central South University (J. Zhu, Du, Sh. Li, Si. Li, X. Zhu), Changsha, China; National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital (X. Zhu), Changsha, China; Department of Metabolism and Endocrinology, The Second Xiangya Hospital (Xie, X. Li, Zhou), Central South University, Changsha, China; National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital (Xie, X. Li, Zhou), Changsha, China; and Children's Healthcare Institution, Hu Nan Children's Hospital (W. He), The University of South China Academy of Pediatrics, Changsha, China.

出版信息

Psychosom Med. 2020 May;82(4):359-365. doi: 10.1097/PSY.0000000000000797.

DOI:10.1097/PSY.0000000000000797

PMID:32358324

Abstract

OBJECTIVE

Diabetic ketoacidosis (DKA) in patients with type 1 diabetes mellitus (T1DM) is known to affect memory function, but little is known about its impact on executive function. This study aimed to determine whether a history of DKA was associated with changes in executive function in children with T1DM.

METHODS

The sample consisted of 99 patients with T1DM with histories of DKA, 82 patients with T1DM without DKA, and 100 healthy controls aged 7 to 18 years. Neuropsychological function and emotion assessments were performed in all participants. The Wisconsin Card Sorting Test (WCST) was used to assess executive function.

RESULTS

Compared with healthy controls, the DKA group (but not the non-DKA group) had a significantly lower mean intelligence quotient (IQ; p = .006, Cohen d = 0.528) and a significantly higher rate of WCST perseverative errors (p = .006, Cohen d = 0.475). In the DKA group, the age at DKA onset was significantly associated with the IQ (p = .001) and the number of completed WCST categories (p = .046). Higher hemoglobin A1c levels were associated significantly with lower IQ (p < .001), increased rate of WCST perseverative errors (p = .015), and completion of fewer WCST categories (p = .027).

CONCLUSIONS

DKA has implications for executive function in children with T1DM. These findings emphasize the importance of DKA prevention in patients with known T1DM, especially younger children with newly diagnosed T1DM.

摘要

目的

已知 1 型糖尿病（T1DM）患者的糖尿病酮症酸中毒（DKA）会影响记忆功能，但对其对执行功能的影响知之甚少。本研究旨在确定 DKA 病史是否与 T1DM 患儿的执行功能变化有关。

方法

该样本包括 99 名有 DKA 病史的 T1DM 患者、82 名无 DKA 病史的 T1DM 患者和 100 名年龄在 7 至 18 岁的健康对照者。所有参与者均进行神经心理学功能和情绪评估。威斯康星卡片分类测验（WCST）用于评估执行功能。

结果

与健康对照组相比，DKA 组（而非非 DKA 组）的平均智商（IQ；p =.006，Cohen d = 0.528）明显较低，WCST 持续错误率（p =.006，Cohen d = 0.475）明显较高。在 DKA 组中，DKA 发病年龄与 IQ（p =.001）和完成的 WCST 类别数（p =.046）显著相关。较高的糖化血红蛋白水平与较低的智商（p <.001）、WCST 持续错误率增加（p =.015）和 WCST 类别完成数减少（p =.027）显著相关。