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目的探讨胰岛素治疗联合口服降糖药对阿尔茨海默病(Alzheimer’s disease,AD)合并糖尿病患者认知功能损害的影响。方法选取承德医学院附属医院2011年3月~2013年3月期间收治的135名AD合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者,根据用药情况分为两组,口服降糖药组(A组)65例和胰岛素治疗联合口服降糖药组(B组)70例。随访12个月,采用Folstein等的简易智能状态检查量表(MMSE)和临床综合印象量表(CGI)评价认知功能。结果治疗12个月后,A组患者MMSE评分较治疗前下降明显(P=0.000),B组无明显变化(P=0.281)。治疗6个月和12个月后,两组的CGI改变量表(CGI-C)评分都较治疗前明显恶化,A组与B组相比,患者CGI-C评分恶化比例较高(24.6%vs 11.4%,P=0.045;30.8%vs 14.3%,P=0.021)。结论胰岛素联合口服降糖药治疗能够有效减缓AD患者的认知功能下降。
Objective To investigate the effect of insulin treatment combined with oral hypoglycemic agents on cognitive impairment in Alzheimer’s disease (AD) patients with diabetes mellitus. Methods A total of 135 patients with type 2 diabetes mellitus (T2DM) admitted to the Affiliated Hospital of Chengde Medical College from March 2011 to March 2013 were divided into two groups according to their medical conditions: oral hypoglycemic agents A group of 65 patients and insulin treatment combined oral hypoglycemic group (B group) 70 cases. The patients were followed up for 12 months. The cognitive function was assessed using MMSE and clinical CGI (Folstein et al.). Results After 12 months of treatment, MMSE score of group A decreased significantly compared with that before treatment (P = 0.000). There was no significant change in group B (P = 0.281). After 6 months and 12 months of treatment, the CGI-C scores of both groups were significantly worse than those before treatment, and the CGI-C scores were significantly worse in group A and group B (24.6% vs 11.4%, P = 0.045; 30.8% vs 14.3%, P = 0.021). Conclusion Insulin combined with oral hypoglycemic agents can effectively reduce the cognitive decline in patients with AD.