DTI联合~1H-MRS检测T2DM患者后扣带回损伤与认知功能障碍的相关性研究

发布时间：2018-03-01 11:50

  本文关键词： 2型糖尿病 后扣带回 弥散张量成像 磁共振波谱　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:联合运用DTI和~1H-MRS技术检测和评估2型糖尿病(type 2 diabetes mellitus,T2DM)患者后扣带回(posterior cingulate cortex,PCC)区脑白质微结构损伤及脑代谢物异常改变,并探讨其可能的机制以及与患者认知障碍的相关性及其临床意义。研究对象与方法:收集2016年4月-2017年1月期间在大连大学附属中山医院住院治疗并确诊的T2DM患者43例,年龄范围45-70岁(平均年龄:60.53±5.56岁),其中T2DM+CD(congitive dysfunction,CD)组21例(男性8例,女性13例),T2DM不伴认知损伤组22例(男性14例,女性8例);在门诊体检人群中招募年龄、性别及受教育年限相匹配的健康自愿者23例(男性8例,女性15例)。本研究经伦理委员会批准,所有被试均签署之情同意书,并行3.0T MRI扫描,主要扫描序列为DTI及~1H-MRS,软件自动读取PCC区代谢物胆碱(cho-line,Cho)、N-乙酰天门冬氨酸(N-acetylaspartate,NAA)、肌酸(creatine,Cr)、肌醇(myo-inositol,mI)、谷氨酸复合物(glutamate+glutamine,Glu+Gln)及磷酸肌酸(phosphocreatine,PCr)的含量。DTI数据分析采用PANDA软件,读取全脑各向异性分数(fractional anisotropy,FA)、平均弥散率(mean diffusivity,MD),并提取与MRS形态、大小相匹配区域的FA值、MD值。统计学分析采用SPSS 21.0软件,P0.05表示差异有统计学意义。结果:1.T2DM+CD、T2DM与HC组PCC脑区~1H-MRS代谢物指标比较:三组间mI/Cr(P0.001)、Glx/Cr(P=0.001)差异具有统计学意义。多重比较显示:PCC区mI/Cr在T2DM+CD与T2DM组、T2DM+CD与HC组、T2DM与HC组三组之间的差异也均具有统计学意义(P0.05)。PCC区Glx/Cr比值在T2DM+CD与T2DM组、T2DM+CD与HC组之间的差异也具有统计学意义(P0.05)。PCC区Cr+PCr组合仅在T2DM+CD与HC组间差异有统计学意义(P=0.017)。2.T2DM+CD患者PCC区~1H-MRS代谢物指标与认知评分及实验室指标相关性分析:Glx/Cr与Mo CA评分呈显著正相关(r=0.591,P=0.004),Cr+PCr与AVLT20min呈明显正相关(r=0.483,P=0.027),其余代谢物比值及其组合与各组的认知评分之间均无显著相关性;PCC区~1H-MRS代谢物指标与临床上各项实验室指标之间亦均无显著相关性。3.T2DM+CD、T2DM与HC组全脑及PCC区FA、MD值比较:全脑及PCC区FA、MD值在三组之间的差异性具有统计学意义(P0.05);多重比较显示:全脑FA、MD值及PCC区MD值在T2DM+CD与T2DM组、T2DM+CD与HC组间差异具有统计学意义(P0.05)。PCC区FA值在T2DM+CD与T2DM组、T2DM+CD与HC组、T2DM与HC三组之间的差异均有统计学意义(P0.05)。4.T2DM+CD患者PCC区FA、MD值与认知评分、实验室指标及~1H-MRS代谢物指标相关性分析:FA值与Mo CA评分呈显著正相关(r=0.572,P=0.007);FA值与Glx/Cr呈负相关(r=-0.471,P=0.031)。结论:1.PCC区FA值降低、MD值升高及mI/Cr升高、Glx/Cr降低对T2DM认知损伤的预测与诊断较敏感,具有早期预警作用,且能评估T2DM患者PCC区脑损伤的程度;此外,Cr+PCr降低对T2DM认知损伤也具有一定提示作用。2.PCC区FA与MD值、Glx/Cr及mI/Cr指标的改变从两种不同模态同时反映和印证了T2DM早期认知功能损伤的影像学表现;并推测引起T2DM患者认知功能损伤的原因或机制可能系PCC区神经元代谢障碍及白质纤维束损伤引起的皮层、皮层下功能失联所致。
[Abstract]:Objective: combined detection of DTI and ~1H-MRS technology and evaluation of type 2 diabetes (type diabetes 2 mellitus, T2DM) in patients with posterior cingulate (posterior cingulate, cortex, PCC) abnormal changes of brain damage and whitematter metabolites, correlation and investigate the possible mechanism of cognitive dysfunction in patients with clinical significance and research object. Methods: collected from April 2016 -2017 year in January in Dalian University affiliated Zhongshan hospital 43 T2DM patients treated and diagnosed cases, age range 45-70 (average age: 60.53 + 5.56 years), including T2DM+CD (congitive dysfunction CD) group of 21 cases (8 cases, male 13 cases of female), 22 T2DM patients without cognitive cases of injury group (14 males, 8 females); recruitment age in outpatients, sex and education matched healthy volunteers in 23 cases (8 cases, male 15 cases of female). The study by the ethics committee approved by There were signed the consent of parallel 3.0T MRI scanning, the main scanning sequence is DTI and ~1H-MRS, the software automatically reads the PCC metabolites (cho-line, Cho), choline N- acetylaspartate (N-acetylaspartate, NAA), creatine (creatine, Cr) (myo-inositol, mI), inositol, glutamate complex (glutamate+glutamine, Glu+Gln) and creatine phosphate (phosphocreatine, PCr) the content of.DTI data were analyzed by PANDA software, read the whole brain fractional anisotropy (fractional anisotropy, FA), mean diffusivity (mean diffusivity, MD), and the MRS extraction and morphology, match the size of the FA values, MD values were used for statistical analysis. SPSS 21 software, P0.05 said the difference was statistically significant. Results: 1.T2DM+CD, T2DM and ~1H-MRS compared with brain PCC group HC: metabolic indexes between the three groups mI/Cr (P0.001) Glx/Cr (P=0.001), the difference was statistically significant. Multiple comparisons showed that: PCC mI/Cr 鍦═2DM+CD涓嶵2DM缁，

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