河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (6): 650-653,659.doi: 10.3969/j.issn.1007-3205.2023.06.006

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老年轻度认知功能障碍HOMA-IR水平与并发吞咽功能障碍的关系

  

  1. 河北中石油中心医院体检二科，河北 廊坊 065000
  • 出版日期:2023-06-25 发布日期:2023-06-29
  • 作者简介:李江花（1976-），女，河北廊坊人，河北中石油中心医院主管护师，医学学士，从事老年病护理研究。
  • 基金资助:
    廊坊市科学技术研究与发展计划（2020013134）

Relationship between HOMA-IR level and swallowing dysfunction in elderly patients with mild cognitive function impairment

  1. The Second Department of Physical Examination， Hebei Petro China Central Hospital, Langfang 065000, China

  • Online:2023-06-25 Published:2023-06-29

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摘要： 目的 探讨老年轻度认知功能障碍胰岛素抵抗指数（insulin resistance index,HOMA-IR）水平与并发吞咽功能障碍的关系。
方法 选取老年轻度认知功能障碍患者106例作为观察组，同时选取无认知功能障碍老年体检者100例作为对照组。比较观察组和对照组空腹血糖(fasting plasma glucose, FBG)、空腹胰岛素(fasting serum insulin，FINS)、糖化血红蛋白（glycosylated hemoglobin, HbA1c）和HOMA-IR;分析血糖指标与蒙特利尔量表（Montreal cognitive assessment, MoCA）评分的相关性。观察组根据是否伴有吞咽功能障碍分为伴吞咽功能障碍组和不伴吞咽功能障碍组，比较2组临床资料，分析吞咽功能障碍的影响因素，并分析Logistic回归方程预测吞咽功能障碍价值。
结果 观察组FBG、FINS、HbA1c和HOMA-IR明显高于对照组（P＜0.05）。FBG、FINS、HbA1c和HOMA-IR与MoCA评分呈负相关性（r=-0.311、-0.324、-0.308、-0.341，P＜0.05）。观察组中发生吞咽功能障碍22例，发生率为20.75%；伴吞咽功能障碍患者年龄≥70岁比例、糖尿病比例、视听觉障碍比例、牙齿缺损≥6颗比例、FINS、HOMA-IR明显高于不伴吞咽功能障碍患者（P＜0.05）。Logistic回归分析结果显示，年龄、视听觉障碍、牙齿缺损和HOMA-IR是老年轻度认知功能障碍伴吞咽功能障碍的影响因素（P＜0.05）。Logistic回归方程预测吞咽功能障碍的ROC曲线下面积为0.834（95%CI：0.733~0.936），敏感度为84.50%，特异度为63.00%。
结论 老年轻度认知功能障碍患者HOMA-IR水平升高，与患者MoCA评分呈负相关，同时是患者并发吞咽功能障碍的影响因素。


关键词: 认知功能障碍, 吞咽障碍, 胰岛素抵抗

Abstract: Objective To explore the relationship between insulin resistance index (HOMA-IR) and swallowing dysfunction in elderly patients with mild cognitive function impairment (CFI). 
Methods A total of 106 elderly patients with mild CFI were selected as the observation group, and 100 elderly physical examinees without CFI were selected as the control group. The fasting blood glucose (FBG), fasting serum insulin (FINS), glycosylated hemoglobin (HbA1c) and HOMA-IR were compared between the observation group and control group. The correlation between blood glucose index and Montreal cognitive assessment (MoCA) score was analyzed. The observation group was divided into two groups according to presence of swallowing dysfunction: swallowing dysfunction group and non-swallowing dysfunction group. The clinical data of the two groups were compared, and the influencing factors of swallowing dysfunction and the value of logistic regression equation in predicting swallowing dysfunction were analyzed. 
Results FBG, FINS, HbA1c and HOMA-IR in the observation group were significantly higher than those in the control group (P＜0.05). FBG, FINS, HbA1c and HOMA-IR were negatively correlated with MoCA scores (r=-0.311, -0.324, -0.308, -0.341, P＜0.05). In the observation group, swallowing dysfunction occurred in 22 patients (20.75%). The proportion of patients with dysphagia aged ≥ 70 years, diabetes, audiovisual impairment, tooth defect ≥ 6, and FINS, HOMA-IR was significantly higher than those of patients without dysphagia (P＜0.05). Logistic regression analysis showed that age, audiovisual impairment, tooth defect and HOMA-IR were the influencing factors of mild CFI with swallowing dysfunction in the elderly (P＜0.05). The area under the receiver operating characteristic (ROC) curve of the Logistic regression equation in predicting swallowing dysfunction was 0.834 (95%CI: 0.733-0.936), the sensitivity was 84.50%, and the specificity was 63.00%. 
Conclusion The level of HOMA-IR increases in the elderly with mild CFI, which is negatively correlated with MOCA score of patients, and is also an influencing factor of swallowing dysfunction in patients. 


Key words: cognitive dysfunction, dysphagia, insulin resistance

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