Meng Qi-Zhe, Wang Yang, Li Bing, Xi Zhi, Wang Ming, Xiu Jia-Qi, Yang Xiao-Peng
Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China.
World J Clin Cases. 2023 Feb 16;11(5):1019-1030. doi: 10.12998/wjcc.v11.i5.1019.
Lacunes are the manifestations of lacunar infarction which can lead many patients to the clinical outcome of disability or dementia. However, the relationship between lacune burden, cognitive function and blood glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) complicated with lacunes is not very clear.
To explore the correlation between glucose variability, lacune burden and cognitive function in patients with lacunes complicated with T2DM.
The clinical and imaging data of 144 patients with lacunes combined with T2DM were reviewed retrospectively. 72 h continuous glucose monitoring was performed. The Montreal Cognitive Assessment was used to assess cognitive function. The burden of lacunes was evaluated using magnetic resonance imaging performance. Multifactorial logistic regression analysis was used to study the affecting the lacune load and cognitive impairment in patients. To predict the value of patients' cognitive impairment with lacunes complicated with T2DM, a receiver operating characteristic (ROC) curve and a nomogram prediction model were constructed.
The standard deviation (SD) of the average blood glucose concentration, percentage coefficient of variation (%CV) and time of range (TIR) were significantly different between the low and the high load groups ( < 0.05). The SD, %CV and TIR of the cognitive impairment group and non-cognitive impairment group were significantly different ( < 0.05). SD (odds ratio (OR): 3.558, 95% confidence interval (CI): 1.268-9.978, = 0.006), and %CV (OR: 1.192, 95%CI: 1.081-1.315, < 0.05) were the risk factors for an increased infarct burden in lacunes patients complicated with T2DM. TIR (OR: 0.874, 95%CI: 0.833-0.928, < 0.05) is a protective factor. In addition, an increased SD (OR: 2.506, 95%CI: 1.008-6.23, = 0.003), %CV (OR: 1.163, 95%CI: 1.065-1.270, < 0.05) were the risk factors for cognitive impairment in patients with lacunes complicated with T2DM, TIR (OR: 0.957, 95%CI: 0.922-0.994, < 0.05) is a protective factor. A nomogram prediction model of the risk of cognitive impairment was established based on SD, %CV and TIR. Decision curve analysis and the internal calibration analysis were used for internal verification and showed that the model was clinical benefit. The area under the ROC curves for predicting cognitive impairment in patients with lacunes complicated with T2DM was drawn were %CV: 0.757 (95%CI :0.669-0.845, < 0.05), TIR: 0.711 (95%CI: 0.623-0.799, < 0.05).
Blood glucose variability is closely associated with the level of lacune burden and cognitive dysfunction in lacune patients combined with T2DM. %CV, TIR have a certain predictive effect in cognitive impairment in lacune patients.
腔隙灶是腔隙性脑梗死的表现形式，可导致许多患者出现残疾或痴呆的临床结局。然而，2型糖尿病（T2DM）合并腔隙灶患者的腔隙灶负荷、认知功能与血糖波动之间的关系尚不完全清楚。
探讨T2DM合并腔隙灶患者血糖变异性、腔隙灶负荷与认知功能之间的相关性。
回顾性分析144例T2DM合并腔隙灶患者的临床及影像学资料。进行72小时连续血糖监测。采用蒙特利尔认知评估量表评估认知功能。利用磁共振成像表现评估腔隙灶负荷。采用多因素logistic回归分析研究影响腔隙灶负荷及患者认知障碍的因素。为预测T2DM合并腔隙灶患者认知障碍的发生价值，构建受试者工作特征（ROC）曲线及列线图预测模型。
低负荷组与高负荷组平均血糖浓度标准差（SD）、变异系数百分比（%CV）及血糖波动时间范围（TIR）比较，差异有统计学意义（P<0.05）。认知障碍组与非认知障碍组的SD、%CV及TIR比较，差异有统计学意义（P<0.05）。SD（比值比（OR）：3.558，95%置信区间（CI）：1.268 - 9.978，P = 0.006）及%CV（OR：1.192，95%CI：1.081 - 1.315，P<0.05）是T2DM合并腔隙灶患者梗死灶负荷增加的危险因素。TIR（OR：0.874，95%CI：0.833 - 0.928，P<0.05）是保护因素。此外，SD增加（OR：2.506，95%CI：1.008 - 6.23，P = 0.003）、%CV增加（OR：1.163，95%CI：1.065 - 1.270，P<0.05）是T2DM合并腔隙灶患者认知障碍的危险因素，TIR（OR：0.957，95%CI：0.922 - 0.994，P<0.05）是保护因素。基于SD、%CV及TIR建立了认知障碍风险的列线图预测模型。采用决策曲线分析及内部校准分析进行内部验证，结果显示该模型具有临床应用价值。绘制预测T2DM合并腔隙灶患者认知障碍的ROC曲线下面积分别为：%CV：0.757（95%CI：0.669 - 0.845），TIR：0.711（95%CI：0.623 - 0.799），差异有统计学意义（P<0.05）。
血糖变异性与T2DM合并腔隙灶患者的腔隙灶负荷水平及认知功能障碍密切相关。%CV、TIR对腔隙灶患者认知障碍有一定的预测作用。
