胰激肽原酶治疗老年2型糖尿病轻度认知功能障碍的疗效观察

doi:10.3969/j.issn.1003-9198.2024.06.011

摘要/Abstract

摘要： 目的探究胰激肽原酶在老年T2DM伴轻度认知功能障碍(MCI)病人中的疗效。方法选取本院2021年3月至2023年3月间收治的96例老年T2DM伴MCI病人,采用随机数表法分成对照组和观察组,每组各48例。对照组予以常规治疗(盐酸二甲双胍+盐酸多奈哌齐片),观察组在对照组的基础上增加胰激肽原酶治疗。比较2组血糖控制、认知功能、炎症水平、肾功能、胰岛功能及用药安全性。结果治疗后,2组FPG、HbA1c水平均低于治疗前(P＜0.05),但组间差异均无统计学意义(P＞0.05)。治疗后,2组胰岛素抵抗指数(HOMA-IR)、S100β蛋白、TNF-α、IL-6、血肌酐(Scr)、胱抑素C(Cys C)水平均低于治疗前,空腹C肽(FCP)水平、胰岛素分泌指数(HOMA-β)及MoCA评分均高于治疗前,且观察组上述指标改善情况均优于对照组,差异均有统计学意义(P＜0.05)。2组用药不良反应总发生率比较,差异无统计学意义(P＞0.05)。结论胰激肽原酶可有效提升老年T2DM伴MCI病人的认知功能,同时改善肾功能及胰岛功能,降低炎症水平,且用药安全可控。

关键词: 2型糖尿病, 轻度认知功能障碍, 胰激肽原酶, 炎症水平, 老年人

Abstract: Objective To explore the efficacy of pancreatic kallidinogenase in the elderly patients with type 2 diabetes mellitus (T2DM) combined with mild cognitive impairment (MCI). Methods Ninety-six elderly T2DM patients with MCI admitted to our hospital from June 2021 to June 2023 were enrolled in this study, and they were divided into the control group and the observation group by random number table method, with 48 cases in each group. The control group received routine treatment (metformin combined with donepezil hydrochloride). The observation group received pancreatic kallidinogenase treatment on the basis of the control group. The levels of blood glucose control, cognitive function, inflammatory factors, renal function, islet function and medication safety were compared between the two groups. Results After treatment, the levels of fasting blood glucose and glycosylated hemoglobin in both groups were lower than those before treatment (P<0.05), but there were no statistical differences between the two groups (P>0.05). After treatment, the levels of insulin resistance index (HOMA-IR), S100β protein, tumor necrosis factor-α, interleukin-6, serum creatinine and cystatin C in both groups were lower than those before treatment, and the levels of fasting C-peptide and insulin secretion index (HOMA-β), and the score of Montreal Cognitive Assessment (MoCA) in both groups were higher than those before treatment, especially in the observation group (P<0.05). There was no statistically significant difference in the total incidence rate of adverse reactions between the two groups (P>0.05). Conclusions Pancreatic kallidinogenase in the clinical treatment of elderly patients with T2DM and MCI can effectively improve the cognitive function, renal function and islet function, reduce the level of inflammation, and the medication is safe and controllable.

Key words: type 2 diabetes mellitus, mild cognitive impairment, pancreatic kininogenase, inflammation level, aged

中图分类号:

时雯, 朱平, 周洁, 颜婷, 黄玉杰, 严妍. 胰激肽原酶治疗老年2型糖尿病轻度认知功能障碍的疗效观察[J]. 实用老年医学, 2024, 38(6): 587-591.

SHI Wen, ZHU Ping, ZHOU Jie, YAN Ting, HUANG Yujie, YAN Yan. Effect of pancreatic kallidinogenase on mild cognitive impairment in elderly patients with type 2 diabetes mellitus[J]. Practical Geriatrics, 2024, 38(6): 587-591.

参考文献

[1] KRAIWONG R, VONGSIRINAVARAT M, RUEANKAM M, et al. Effects of physical-cognitive training on physical and psychological functions among older adults with type 2 diabetes and balance impairment: a randomized controlled trial[J]. J Exerc Rehabil, 2021, 17(2):120-130.
[2] BAHGAT F F, FETYANI I M, ALNASSER A H, et al. The relationship between fatigue severity and mild cognitive impairment in Saudi patients with type 2 diabetes mellitus[J]. J Pak Med Assoc, 2022, 72(6):1255-1259.
[3] LIU J, YANG W, LUO H Y, et al. Brain-derived neurotrophic factor Val66Met polymorphism is associated with mild cognitive impairment in elderly patients with type 2 diabetes: a case-controlled study[J]. Aging Clin Exp Res, 2021, 33(6):1659-1666.
[4] ZHANG Y, DENG S F, ZHONG H F, et al. Exploration and clinical verification of the blood co-expression genes of type 2 diabetes mellitus and mild cognitive dysfunction in the elderly[J]. Biomedicines, 2023, 11(4):993.
[5] 陈慧泽, 孟胜喜, 王兵, 等. 恒清Ⅱ号方联合盐酸多奈哌齐片对阿尔茨海默病病人血清硫氧还蛋白、褪黑素水平的影响[J]. 中西医结合心脑血管病杂志, 2022, 8(20):3690-3693.
[6] 孔竹青. 胰激肽原酶对急性脑梗死患者的神经保护作用[J]. 中国药业, 2015, 24(24):56-58.
[7] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志, 2021, 37(4):311-398.
[8] 中国痴呆与认知障碍诊治指南写作组, 中国医师协会神经内科医师分会认知障碍疾病专业委员会. 2018中国痴呆与认知障碍诊治指南(五):轻度认知障碍的诊断与治疗[J]. 中华医学杂志, 2018, 98(17):1294-1301.
[9] QIAO J, WANG X, LU W, et al. Validation of neuropsychological tests to screen for dementia in Chinese patients with Parkinson’s disease[J]. Am J Alzheimers Dis Other Demen, 2016, 31(4):368.
[10] BESNIER F, GAGNON C, MONNET M, et al. Acute effects of a maximal cardiopulmonary exercise test on cardiac hemodynamic and cerebrovascular response and their relationship with cognitive performance in individuals with type 2 diabetes[J]. Int J Environ Res Public Health, 2023, 20(8):5552.
[11] FINDIKOGLU G, ALTINKAPAK A, ALKAN H, et al. Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy[J]. Croat Med J, 2022, 63(6):544-552.
[12] 李全, 贾斯婷, 关慧波. 地黄饮子辅助治疗肾虚髓减型2型糖尿病合并轻度认知功能障碍的临床疗效观察[J]. 时珍国医国药, 2022, 33(2):410-412.
[13] KOLODKA T, CHARLES M L, RAGHAVAN A, et al. Preclinical characterization of recombinant human tissue kallikrein-1 as a novel treatment for type 2 diabetes mellitus[J]. PLoS One, 2014, 9(8):e103981.
[14] MANEVA-RADICHEVA L, AMATYA C, PARKER C, et al. Autoimmune diabetes is suppressed by treatment with recombinant human tissue Kallikrein-1[J]. PLoS One, 2014, 9(9):e107213.
[15] GAO P, JIN Z B, WANG P, et al. Effects of intracranial interventional embolization and intracranial clipping on the cognitive and neurologic function of patients with intracranial aneurysms[J]. Arch Clin Neuropsychol, 2022, 37(8):1688-1698.
[16] AL-KURAISHY H M, AL-GAREEB A I, NAJI M T. Statin therapy associated with decreased neuronal injury measured by serum S100β levels in patients with acute ischemic stroke[J]. Int J Crit Illn Inj Sci, 2021, 11(4):246-252.
[17] 倪孝兵, 王思宏, 黄崇兵. 依帕司他联合胰激肽原酶治疗2型糖尿病周围神经病变临床效果及对炎性因子、肌电图指标的影响[J]. 解放军医药杂志, 2022, 34(4):88-91.
[18] BORLONGAN M C, KINGSBURY C, SALAZAR F E, et al. IL-2/IL-2R antibody complex enhances treg-induced neuroprotection by dampening TNF-α inflammation in an in vitro stroke model[J]. Neuromolecular Med, 2021, 23(4):540-548.
[19] YOO J, PARK J, KIM D, et al. Novel benzoxazoles containing 4-amino-butanamide moiety inhibited LPS-induced inflammation by modulating IL-6 or IL-1β mRNA expression[J]. Int J Mol Sci, 2022, 23(10):5331.
[20] WANG H J, WANG F Y, WANG Y J, et al. Study on the mechanism of BMSCs in regulating NF-κB signal pathway by targeting miR-449a to improve the inflammatory response to peripheral nerve injury[J]. J Musculoskelet Neuronal Interact, 2022, 22(4):546-561.
[21] 姚瑶, 褚敏. 糖尿病肾病患者认知功能障碍与血清β淀粉样蛋白的关系[J]. 临床荟萃, 2022, 37(9):813-816.
[22] LU P, LIN D J, CHEN N, et al. CNN-assisted SERS enables ultra-sensitive and simultaneous detection of Scr and BUN for rapid kidney function assessment[J].Anal Methods, 2023, 15(3):322-332.
[23] ZHOU Y F, DONG W T, WANG L K, et al. Lower serum cystatin C level predicts poor functional outcome in patients with hypertensive intracerebral hemorrhage independent of renal function[J]. J Clin Hypertens, 2023, 25(1):86-94.