Abstract: Background　Previous studies have shown that hypertension，dyslipidemia and arterial stiffness are risk factors for cognitive dysfunction，while diabetes is an aggregation of the aforementioned three and other risk factors.As the incidence of diabetes-associated cognitive impairment is increasing annually，it is necessary to determine whether arterial stiffness has an effect on cognitive function in diabetic patients.Objective　To explore the association between arterial stiffness and cognitive function among diabetic patients.Methods　We enrolled 3 610 employed and retired workers with diabetes of Kailuan（Group） Limited Liability Corporation who underwent annual physical examination in KaiLuan General Hospital and its affiliated 11 hospitals in 2016，and divided them into group 1（the first tertile：baPWV<16.11 m/s），group 2（the second tertile：baPWV 16.11-19.30 m/s），and group 3（the third tertile：baPWV>19.30 m/s） by the baPWV level.We collected their baseline data，Mini-Mental State Examination（MMSE） score and detection rate of cognitive impairment.We performed multivariate Logistic regression analysis to explore the influence of baPWV on cognitive function in diabetes population.Results　There were significant differences in mean age，systolic blood pressure，diastolic blood pressure，mean arterial pressure，baPWV，glycosylated hemoglobin，and eGFR，prevalence of smoking，secondary and post-secondary education level，history of hypertension，treatment with antihypertensive drugs and hypoglycemic drugs among the three groups（P<0.05）.The mean MMSE score，and the prevalence of cognitive impairment in all the participants were （27.01±3.29），11.77%（425 /3 610），respectively.The mean MMSE score differed significantly in baPWV tertile groups（F=12.40，P<0.001）.Pairwise comparisons showed that group 1 had lower mean MMSE score than other two groups（P<0.05）．The prevalence of cognitive impairment also differed significantly in baPWV tertile groups（χ2=17.89，P<0.001）.In particular，group 1 had lower prevalence of cognitive impairment compared with other two groups（P<0.016 7）.Multivariate Logistic regression analysis showed that after adjusting for age，sex，mean arterial pressure，body mass index，low- and high-density lipoprotein，triglyceride，glycosylated hemoglobin，eGFR，alcohol consumption，smoking and physical exercise，the second tertile〔OR=1.49，95%CI（1.01，2.19）〕and third tertile〔OR=1.52，95%CI（1.02，2.28）〕 of baPWV（higher baPWV） were associated with increased risk of cognitive impairment.Conclusion　The degree of arterial stiffness（baPWV≥16.11 m/s） is an independent risk factor for cognitive impairment in diabetic patients.

Key words: Arteriosclerosis, Diabetes mellitus, Cognition disorders, Brachial ankle pulse wave velocity

摘要： 背景　已有研究表明高血压、血脂异常、动脉硬化等是认知功能障碍的危险因素，而糖尿病患者是高血压、血脂异常、动脉硬化等危险因素的聚集体。随着糖尿病认知功能障碍患病率逐年上升，明确动脉硬化是否对糖尿病认知功能有影响十分必要。目的　探究动脉硬化程度对糖尿病人群认知功能的影响。方法　选取2016年在开滦总医院及所属11家医院进行年度体检的开滦集团在职和离退休职工3 610例为研究对象。按照臂踝脉搏波传导速度（baPWV）三分位数将受检者分为3组，第1分位组baPWV<16.11 m/s，第2分位组baPWV 16.11~19.30 m/s，第3分位组baPWV>19.30 m/s。观察各组基线资料、简易智力状态检查量表（MMSE）评分及认知功能障碍检出率。采用多因素Logistic回归分析动脉硬化水平对糖尿病人群认知功能的影响。结果　三组年龄、收缩压、舒张压、平均动脉压、baPWV、糖化血红蛋白、肾小球滤过率估计值（eGFR）及吸烟、文化程度为高中及以上、有高血压病史、服用降压药及服用降糖药占比比较，差异有统计学意义（P<0.05）。总人群平均MMSE评分为（27.01±3.29）分，认知功能障碍检出率为11.77%（425/3 610）。baPWV三分位组MMSE评分比较，差异有统计学意义（F=12.40，P<0.001）；进一步两两比较显示，第2、3分位组MMSE评分低于第1分位组，差异有统计学意义（P<0.05）。baPWV三分位组间认知功能障碍检出率比较，差异有统计学意义（χ2=17.89，P<0.001）；进一步两两比较显示，第2、3分位组认知功能障碍检出率高于第1分位组，差异有统计学意义（P<0.016 7）。校正年龄、性别、平均动脉压、BMI、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、三酰甘油、糖化血红蛋白、eGFR、饮酒、吸烟、体育锻炼变量后，多因素Logistic回归分析结果显示，与第1分位组相比，第2、3分位组均为认知功能障碍的危险因素，其OR（95%CI）分别为1.49（1.01，2.19）、1.52（1.02，2.28）。结论　高动脉硬化程度（baPWV≥16.11 m/s）是糖尿病人群发生认知障碍的危险因素。

关键词: 动脉硬化, 糖尿病, 认知障碍, 臂踝脉搏波传导速度