合併併發症之糖尿病患發生阿茲海默症風險探討

背景：糖尿病已確認為失智症的危險因子，且合併併發症會增加罹患失智症的風險，然而阿茲海默症為失智症當中最常見的疾病，且美國已將失智症擴增定義為認知障礙症，並將阿茲海默症視為其中一類，過往研究較少探討合併併發症之糖尿病患單獨對阿茲海默症的影響。目的：本研究期望了解糖尿病族群有無合併併發症對於罹患阿茲海默症的風險。方法：本研究使用的是全民健保資料庫的糖尿病例抽樣歸人檔。在2000年的檔案排除已經有失智症的診斷者後，參考糖尿病嚴重評估工具(Diabetes Complications Severity Index)所列出的糖尿病併發症，將族群分為「併發症組」及「無併發症組」。追蹤至2010年底後，以Cox迴歸分析兩組在控制性別、年齡跟共病後，罹患阿茲海默氏症的風險。結果：分析後發現粗風險比為2.58，考量年齡、性別、高血壓、高血脂、慢性阻塞性肺疾病、憂鬱症、焦慮症後的校正後風險比為1.56。更進一步分析發現55種併發症中，背景性視網膜病變、其他視網膜病變、腎病症候群、腎炎、未明示型態腎衰竭、中風、其他形態之慢性缺血性心臟病等7種併發症有顯著。結論：糖尿病患者若合併併發症的發生，罹患阿茲海默症的風險將會更高，當中主要為腎病類、腦血管疾病類、心血管疾病類的併發症會增加阿茲海默症的風險。除此之外，背景性及其他視網膜病變也會有比較高的阿茲海默症風險。

關鍵字

糖尿病；併發症；阿茲海默症

並列摘要

Background: Diabetes mellitu has confirmed a risk factor of dementia, and it combines with complications increase the risk of dementia. However, Alzheimer's disease is the most common disease in dementia, and the United States has expanded the definition of dementia as neurocognitive disorder. Alzheimer's disease is considered as one of the types. Previous studies have less explored the effects of Alzheimer's disease combined with complications of diabetes mellitus. Aim: This study expects to realize whether complications in diabetes mellitus is a risk factor of Alzheimer's disease. Methods: This study used Longitudinal Cohort of Diabetes Patients in National Health Insurance data. We exclude the patient with dementia diagnosis from data in 2001, and divided into "complications groups" and "non- complications groups", in accordance with the definition of complications of diabetes mellitus from Diabetes Complications Severity Index (DCSI). A Cox proportional hazard regression model was used to analyze the hazard ratio (HR) for development of Alzheimer's disease among patients, controling age, sex and comorbidity for 9 years following. Results: After analysing, the crude risk ratio was 2.58. The adjusted risk ratio controlling age, gender, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, depression, and anxiety was 1.56. Further analysis found that background retinopathy, other retinopathy, nephrotic syndrome, nephritis/nephropathy, renal failure NOS, stroke, and other chronic ischemic heart disease were significant from 55 complications. Conclusion: Diabetes patients with complications is the risk of Alzheimer's disease, mainly with the nephropathy, cerebrovascular, cardiovascular complications. In addition, background and other retinopathy also have a higher risk of Alzheimer's disease.