| Abstract |
摘要 目的 探讨帕金森病（Idiopathic Parkinson’s disease，PD）伴认知功能障碍患者（mild cognitive impairment in Parkinsons disease，PD-MCI）脑血管储备功能降低、脂代谢异常与胰岛素抵抗之间的联系。方法 以我院收治的96例PD-MCI患者为研究对象，根据HOMA稳态模型计算出胰岛素抵抗指数（HOMA-IR）分为胰岛素抵抗PD-MCI组（A组）与非胰岛素抵抗PD-MCI组（B组），同期选择经我院体检显示健康的志愿者50例为C组，比较三组研究对象临床资料，并分析PD-MCI患者的脑血管储备功能、脂糖代谢情况，分析其异常指标与HOMA-IR之间的相关性。结果 三组CVR比较，显示三组间脑血管收缩储备、扩张储备及整体储备功能均存在明显差异，CVR功能由高到低依次是C、B、A组，组间各指标存在显著差异（P<0.05）；三组脂代谢比较，A组TG、TC、LDL-C、VLDL-C均明显高于B、C两组，HDL-C明显低于B、C两组，差异均显著（P<0.05）；三组糖代谢比较，A组血糖、C肽、胰高血糖素、HOMA-IR均明显高于其他两组，ISI明显低于B、C组（P<0.05）；对HOMA-IR影响因素分析，显示患者的BMI、病程、、CVR、TG、HDL-C及C肽均于HOMA-IR呈正相关，ISI呈负相关，均是影响HOMA-IR的危险因素。结论 帕金森患伴认知功能障碍患者可出现脑储备功能下降、脂代谢异常等，且脑储备功能、脂代谢与机体胰岛素抵抗呈正相关，三者间关系密切，临床需结合患者胰岛素抵抗情况予以相应诊治。关键词：帕金森病；认知功能障碍；脑血管储备功能；脂代谢；胰岛素抵抗Relationship between cerebrovascular reserve capacity decline, lipid metabolism abnormalities and insulin resistance in patients with cognitive impairment of Parkinsons diseaseZhang jinhong,Mao xueye,Wuyan,Duyu,ChenglanSichuan university huaxi care hospital internal medicine Sichuan Chengdu 610000Abstract Objective To investigate the relationship between cerebrovascular reserve (CVR) capacity decline, lipid metabolism abnormalities and insulin resistance in patients with mild cognitive impairment of Parkinsons disease (PD-MCI). Methods 96 cases of patients with PD-MCI in our hospital were enrolled in the study. According to the HOMA steady-state model, the insulin resistance index (HOMA-IR) was calculated and patients were divided into the insulin resistant PD-MCI group (A group) and non-insulin resistant PD-MCI group (B group). 50 cases of healthy volunteers receiving physical examination were selected as C group. The clinical data were compared among the three groups. The cerebrovascular reserve capacity, lipid and glucose metabolism in patients with PD-MCI were analyzed, and the correlation between abnormal indexes and HOMA-IR was also analyzed. Results There were significant differences in cerebrovascular systolic reserve, diastolic reserve and overall reserve function among the three group. The CVR from high to low was C group, B group and A group (P<0.05). TG, TC, LDL-C and VLDL-C in A group were significantly higher than those in B group and C group, while HDL-C was significantly lower than that in B group and C group (P<0.05). The blood glucose, C peptide, glucagon and HOMA-IR in A group were significantly higher than those in the other two groups, and ISI was significantly lower than that in the other two groups (P<0.05). BMI, course of disease, CVR, TG, HDL-C and C peptide were positively correlated with HOMA-IR, ISI was negatively correlated HOMA-IR. All of the above indexes were the risk factors influencing HOMA-IR. Conclusion There is CVR decline and abnormal lipid metabolism in patients with PD-MCI. CVR and lipid metabolism are positively correlated with insulin resistance. Patients should be diagnosed and treated according to their actual condition.
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