合并CMBs的T2DM患者相关记忆功能及静息态脑功能改变的研究

发布时间：2018-02-27 10:16

本文关键词： 2型糖尿病静息态功能磁共振脑微出血认知功能　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：2型糖尿病(Type2diabetes mellitus, T2DM)会导致认知功能下降并增加痴呆发生风险,并认为糖尿病本身代谢紊乱及微血管病变是其认知功能受损的主要原因。目前对其微血管病变的研究主要集中在白质高信号与腔梗这两方面,对于同属于脑微血管病变之一的脑微出血(Cerebral Microbleeds, CMBs)的研究却鲜有报道。本研究通过利用记忆量表及功能磁共振成像方法,对2型糖尿病合并脑微出血灶与不合并脑微出血灶的两组患者进行分析,拟从认知功能改变及静息状态下的脑功能改变两方面评估脑微出血对T2DM认知功能的影响及相关的神经生理改变,为2型糖尿病患者认知功能及脑功能损害提供血管方面的依据,为临床早期识别血管性危险因素并及早给予临床干预、改善认知功能以预防向血管性痴呆发展提供参考。方法：2012年8月至2013年8月在本院糖尿病门诊序贯招募2型糖尿病患者92例,均符合2009年美国糖尿病协会(ADA)2型糖尿病诊断标准,排除5例头动大于3mm者,最终入组87例,其中2型糖尿病合并有脑微出血者32例(CMBs阳性组),男性17例、女性15例,2型糖尿病不合并脑微出血者55例(CMBs阴性组),其中男性29例、女性26例。对两组人群行认知量表测试,贝克抑郁量表用于初步筛查,排除抑郁症患者；蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)用于比较两组患者总体认知功能；韦氏记忆量表用于总体记忆及各分支记忆领域的评估。并对两组人群行临床资料检查,详细记录患者人口基本信息(年龄、身高、体重)及高血压等相关因素,以及血脂、血糖、胰岛素、C肽等临床生化指标。所有符合入组标准的受试者均行常规序列头颅核磁共振成像(Magnetic Resonance Imaging, MRI)、静息态功能磁共振成像(resting-state Functional Magnetic Resonance Imaging, rs-fMRI)及磁敏感加权成像(susceptibility weighted imaging, SWI)检查。通过常规磁共振观察白质高信号及腔隙性脑梗死,通过SWI序列观察脑微出血灶。计算两组被试的全脑与双侧海马种子点间功能连接值及低频振幅值(amplitude of low-frequency fluctuation, ALFF)。并采用双样本t检验,比较两组被试间功能连接值和ALFF值的差异,获得合并微出血的2型糖尿病被试在脑活动、与海马功能连接的异常改变。最后将2型糖尿病患者静息态下异常连接值、异常脑区的ALFF值与记忆功能受损指标进行相关性分析。结果：192名受试者中CMBs日性者34例,CMBs阴性者58例,CMBs的发生率为36.96%。2认知功能：2型糖尿病合并脑微出血组在总体记忆(韦氏记忆量表记忆商数)、工作记忆(韦氏记忆1-100)、短时记忆(联想、背数)方面得分均低于无脑微出血组,且差异有统计学意义(P0.05)。3功能连接：以双侧海马为种子区域,计算其与其他脑区的功能连接,并比较两组之间功能连接的差异。脑微出血组较对照组左侧海马与左侧颞极、左侧颞上回、右侧海马与右侧前扣带回、右侧中央前回功能连接强度显著减低(p0.05),且脑微出血组左侧海马与左侧颞上回间的功能连接值与短时记忆(联想)得分、右侧海马与右侧前扣带回间的功能连接值与工作记忆(韦氏记忆1-100)得分呈正相关(r=0.29,p=0.034; r=0.25, p=0.039)。4低频振幅：2型糖尿病合并脑微出血组与不合并脑微出血组相比,ALFF增强的脑区是左侧颞下回、双侧小脑后叶及右侧岛叶,减低的脑区是左侧额上回。且左侧额上回低频振幅值与总体记忆(韦氏记忆量表记忆商数)得分呈正相关(r=0.26,p=0.045)。结论：12型糖尿病合并CMBs组患者在总体记忆及短时记忆方面得分减低,说明微出血的发生加重了2型糖尿病患者认知功能障碍程度。2静息状态下,2型糖尿病合并CMBs组患者海马与其他脑区的功能连接及部分脑区的低频振幅值发生了改变,说明这些受累的脑区神经元活动异常及代谢减低,反映了CMBs对2型糖尿病患者脑功能有负面影响。3上述脑微出血组2型糖尿病患者静息状态下脑功能的改变,从血管因素方面部分解释了2型糖尿病患者认知功能障碍的发生机制,也为临床判断2型糖尿病患者认知功能受损情况提供了一定的依据,为临床早期识别血管性危险因素并及早给予临床干预、改善认知功能以预防向血管性痴呆发展提供参考。
[Abstract]:Objective : Type 2 diabetes mellitus ( T2DM ) can decrease cognitive function and increase the risk of dementia . In order to study the effect of brain microbleeds on the cognitive function of patients with type 2 diabetes mellitus and the changes of brain function , it is proposed to assess the effect of cerebral microbleeds on the cognitive function of patients with type 2 diabetes mellitus and the changes of neurophysiological changes in patients with type 2 diabetes mellitus and to provide clinical intervention for early clinical identification of vascular risk factors and to improve cognitive function to prevent the development of vascular dementia . Methods : Ninety - two patients with type 2 diabetes mellitus were recruited from August 2012 to August 2013 . All of them were diagnosed with diabetes mellitus ( ADA ) type 2 diabetes mellitus ( ADA ) type 2 diabetes mellitus in 2009 . Among them , there were 32 cases of type 2 diabetes mellitus ( CMBs positive group ) , male 17 cases , female 15 cases , type 2 diabetes mellitus without brain microbleeds in 55 cases ( CMBs negative group ) . All subjects who met the criteria of enrollment were examined by magnetic resonance imaging ( MRI ) , resting - state functional magnetic resonance imaging ( ESR ) , resting - state functional magnetic resonance imaging ( rs - fmri ) and magnetic sensitive weighted imaging ( SWI ) . In the end , the abnormal connection value in resting state , ALFF value of abnormal brain area and impairment index of memory function were analyzed . Results : There were 34 cases of CMBs in 192 subjects , 58 cases of CMBs negative , and 36.96 % of CMBs . Cognitive function : The functional connection between the left hippocampus and the left temporal pole , the left temporal gyrus , the right anterior gyrus and the right central gyrus were significantly lower than those in the control group ( P = 0 . 29 , p = 0.034 ; r = 0.25 , p = 0.039 ) . Conclusion : Patients with type 2 diabetes mellitus complicated with CMBs had a lower score in overall memory and short term memory , which indicated that the occurrence of microbleeds aggravated the degree of cognitive impairment in patients with type 2 diabetes mellitus .

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R445.2

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