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目的 本研究主要探究老年2型糖尿病(T2DM)患者中焦虑和抑郁与脑小血管病(CSVD)之间的相关性,并就焦虑与抑郁的影响因素进行分析.方法 回顾性分析2020年7月至2021年12月在福建医科大学第二附属医院内分泌科住院的101例老年T2DM住院患者的临床资料,收集各项临床特征、实验室检验和检查数据.采用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评估,焦虑的分界值为14分,抑郁的分界值为8分.使用3.0T磁共振扫描仪进行脑部扫描,扫描序列包括T1WI序列、T2WI序列、3D-FLAIR序列、SWI序列.根据Staals提出的CSVD的MRI总负荷评分标准,分别对CSVD的MRI影像学改变,即腔隙灶(LIs)、脑微出血(CMBs)、血管周围间隙(PVSs)、白质高信号(WMHs)进行分析并负荷评分,负荷评分≥1分定义为CSVD组.依据以上标准将入选患者分为有无抑郁组、有无焦虑组,分别对各自两组之间的临床特征、生化检验数据和CSVD的MRI影像学改变特征进行单因素分析,然后采用Spearman相关分析法分析老年T2DM伴焦虑、抑郁的相关因素,运用二元Logistic分析对老年T2DM合并抑郁、焦虑的危险因素进行分析.结果 与无抑郁组相比,老年T2DM伴抑郁组患者年龄更大,女性更多,且WMHs和DWMHs的发生率更高(P＜0.05);与无焦虑组相比,老年T2DM伴焦虑组患者WMHs和DWMHs的发生率更高(P＜0.05).Spearman 相关性分析显示,年龄(r=0.224,P=0.024)、WMHs(r=0.231.P=0.020)、PWMHs(r=0.201,P=0.044)、DWMHs(r=0.274,P=0.006)与老年 T2DM 伴抑郁均呈正相关,性别(r=-0.225,P=0.024)、ALT(r=-0.208,P=0.037)、AST(r=-0.204,P=0.04 1)与老年 T2DM 伴抑郁均呈负相关;WMHs(r=0.213,P=0.033)、DWMHs(r=0.270,P=0.006)与老年T2DM伴焦虑均呈正相关.AST(r=-0.292,P=0.003)与老年T2DM伴焦虑呈负相关.二元 Logistic 回归分析显 示,性别(OR=0.359,95％CI:0.130～0.990,P=0.048)、DWMHs(OR=4.373,95％CI:1.290～14.828,P=0.018)均为老年 T2DM 伴抑郁的影响因素,DWMHs(OR=5.000,95％CI:1.444～17.317,P=0.011)为老年 T2DM 伴焦虑的影响因素.结论 DWMHs 与老年T2DM患者抑郁和焦虑发病密切相关,提示CSVD可能参与 了老年T2DM患者抑郁和焦虑发生发展.

Objective To explored the correlation between anxiety and depression and cerebral small vessel disease(CSVD)in the elderly patients with type 2 diabetes mellitus(T2DM),and analyzed the influencing factors of anxiety and depression.Methods Clinical data of 101 elderly T2DM inpatients admitted to the Department of Endocrinology,the Second Affiliated Hospital of Fujian Medical University from July 2020 to December 2021 were retrospectively analyzed,and clinical features,laboratory tests and examination data were collected.The Hamilton Depression Scale and the Hamilton Anxiety Scale were used for assessment,with a cut-off value of 14 points for anxiety and 8 points for depression.Brain scans were performed using 3.0T magnetic resonance scanner,including T1WI sequence,T2WI sequence,3D-FLAIR sequence,SWI sequence.According to the total MRI load scoring standard of CSVD proposed by Staals,MRI imaging changes of CSVD,namely lacunar foci(LIs),cerebral microhemorrhage(CMBs),perivascular space(PVSs),and white matter high signal(WMHs),were analyzed and scored respectively.Load score 1 was defined as CSVD group.According to the above criteria,the enrolled patients were divided into depression group and anxiety group,and the clinical characteristics,biochemical test data and MRI imaging characteristics of CSVD between the two groups were analyzed by single factor analysis,and then Spearman correlation analysis was used to analyze the related factors of the elderly T2DM with anxiety and depression.Binary logistic analysis was used to analyze the risk factors of depression and anxiety in the elderly patients with T2DM.Results Compared with the non-depressed group,the elderly T2DM patients with depression were older,more female,and the incidence of WMHs and DWMHs was higher(P＜0.05).Compared with the non-anxious group,the incidence of WMHs and DWMHs in the elderly T2DM patients with anxiety group was higher(P＜0.05).Spearman correlation analysis showed that age(r=0.224,P=0.024),WMHs(r=0.231,P=0.020),PWMHs(r=0.201,P=0.044),DWMHs(r=0.274,P=0.006)was positively correlated with depression in the elderly T2DM,while gender(r=-0.225,P=0.024)、ALT(r=-0.208,P=0.037)、AST(r=-0.204,P=0.041)was negatively correlated with depression in the elderly T2DM.WMHs(r=0.213,P=0.033)and DWMHs(r=0.270,P=0.006)were positively correlated with anxiety in the elderly T2DM.Binary logistic regression analysis showed that gender(OR=0.359,95％CI:0.130-0.990,P=0.048),DWMHs(OR=4.373,95％CI:1.290-14.828,P=0.018)were the influencing factors for the elderly T2DM patients with depression,and DWMHs(OR=5.000,95％CI:1.444-17.317,P=0.011)was the influencing factors for the elderly T2DM patients with anxiety.Conclusions DWMHs is closely related to the onset of depression and anxiety in the elderly T2DM patients,suggesting that CSVD may be involved in the development of depression and anxiety in the elderly T2DM patients.