2型糖尿病患者前额叶的氢质子磁共振波谱研究

发布时间：2018-03-17 08:23

  本文选题：2型糖尿病　切入点：氢质子磁共振波谱　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景及目的： 2型糖尿病(type2diabetes mellitus, T2DM)是以慢性高血糖为特征的一种糖代谢紊乱性疾病,可导致进行性的,包括周围和中枢神经系统、心血管系统、肾脏、眼等多器官的损害。T2DM可引起脑细胞的代谢异常,产生一系列病理生理及生化改变,从而引起脑认知功能损害。氢质子磁共振波谱(proton magnetic resonance spectroscopy,'H MRS)是目前唯一无创性的评估活体脑内生化代谢活动的影像学技术。目前国内外关于T2DM患者脑代谢变化的研究多集中在海马及额顶叶白质区,并且报道结果不一,鉴于前额叶是认知功能的重要神经基础,因此本研究采用多体素1HMRS技术检测T2DM患者前额叶白质及内侧皮层的代谢变化,并分析其与认知功能及血糖水平的关系,从脑代谢的角度探讨T2DM对认知功能影响的神经机制。 对象和方法： 招募65名志愿者,其中正常对照者32名,T2DM患者33名。T2DM患者中因MRS谱线质量问题(分辨率过低,不能识别波峰)排除3名,因生化检查数据不全排除3名,认知测试数据不全排除5名。对照组中MRS谱线质量问题排除5名,因生化检查数据不全排除1名,认知数据不全排除4名,因1例被试达到抑郁程度,予以排除。最终选取22例T2DM患者(男12例,女10例,年龄41-65岁,平均54.5±8.3岁)和21名正常对照(男6例,女15例,年龄44-67岁,平均53.5±7.0岁)行临床认知功能和心理学测评,测评内容包括简易智能精神状态检查量表、数字广度测试(包括正序和倒序)、瑞文智力测试、Flanker范式实验、连线测试A、听觉词语学习测验、抑郁自评量表、焦虑自评量表。所有被试者均接受多体素1HMRS扫描,采用Functool软件对波谱数据进行处理和代谢物浓度分析,检测的感兴趣区包括双侧前额叶白质、双侧前额叶内侧皮层。统计学分析采用SPSS17.0数据软件包。首先对连续变量进行分布的正态性检验(Kolmogorov-Smirnovb),符合正态分布的变量采用独立样本t检验进行组间比较,不符合正态分布的变量采用mann-whitney U检验；计数资料采用卡方检验,采用Pearson(正态分布)或Spearman(非正态分布)相关分析检测代谢物浓度与认知功能及血糖控制水平之间的相关性。 结果： 1与对照组比较,T2DM组右侧前额叶皮层的NAA、NAA/MI减低；右侧前额叶白质Cho升高；双侧前额叶皮层的MI升高。 2.T2DM组右侧前额叶内侧皮层的NAA值与HbA1C浓度呈负相关。 结论： 1.利用多体素1H-MRS可在T2DM患者出现认知功能下降之前,即可发现相关脑区的代谢物改变,其可作为研究T2DM患者认知功能障碍的重要方法。 2.T2DM患者与正常对照比较脑内存在多个部位的神经代谢产物异常：其中前额叶内侧面皮层NAA值减低可能反映了该区神经元的早期损伤；而前额叶白质区Cho值增高、前额叶内侧皮层MI值升高可能反映了该区神经胶质细胞的增生性变化,其可间接反映该区神经元损伤的存在。 3.T2DM患者右侧前额叶内侧皮层NAA值与HbA1C浓度呈负相关,反映近期血糖水平可影响脑内代谢物的变化,合理控制血糖可有效延缓糖尿病所致的脑内神经元的损伤的速度。
[Abstract]:Background and purpose:
Type 2 diabetes mellitus (type2diabetes, mellitus, T2DM) is characterized by chronic high blood sugar is a metabolic disorder, which leads to progressive, including peripheral and central nervous system, cardiovascular system, kidney, eye and other organ damage.T2DM can cause brain cell generation Xie Yichang, produced a series of pathological and physiological biochemical changes, can cause cognitive impairment. Brain proton magnetic resonance spectroscopy (proton magnetic resonance spectroscopy,'H MRS) is the only noninvasive assessment of biochemical metabolism in brain in vivo imaging technology. The current domestic and international research about the changes of cerebral metabolism in patients with T2DM are more concentrated in the hippocampus and frontal white matter area, and reported the results of a given prefrontal is an important neural basis of cognitive function, so this research adopts multi voxel 1HMRS technique for detection of T2DM in patients with prefrontal white matter and inner cortex metabolism The relationship between the cognitive function and the level of blood glucose was analyzed and the neural mechanism of the effect of T2DM on cognitive function was discussed from the point of view of brain metabolism.
Objects and methods:
Recruited 65 volunteers, including 32 normal control subjects, line quality problems of MRS spectrum for T2DM patients 33.T2DM patients (low resolution, can not identify the peak) 3 were excluded because of incomplete data, biochemical examination excluded 3, cognitive test data not excluding the 5. In the control group MRS line quality problems 5 were excluded because of incomplete data, biochemical examination excluded 1, cognitive incomplete data excluding the 4, because 1 subjects reached the degree of depression, be excluded. The final selection of 22 T2DM patients (male 12 cases, female 10 cases, age 41-65 years, average 54.5 + 8.3 years) and 21 normal according to (male 6 cases, female 15 cases, age 44-67 years, average 53.5 + 7 years) underwent clinical cognitive function and psychological evaluation, including evaluation of MMSE, digital span test (including positive and reverse), raven intelligence test, Flanker experimental paradigm, A connection test, auditory verbal learning test, suppression Self rating depression scale, self rating anxiety scale. All the subjects underwent multi voxel 1HMRS scanning analysis and metabolite concentration on spectral data by using Functool software, the detection of region of interest including prefrontal white matter, bilateral medial prefrontal cortex. Statistical analysis using SPSS17.0 data software package first. Normality test on the distribution of continuous variables (Kolmogorov-Smirnovb), with normal distribution of variables by using independent sample t test were compared between the groups, does not meet the normal distribution of variables using Mann-Whitney U test; count data using chi square test, using Pearson (normal distribution) or Spearman (non normal distribution) correlation analysis between concentration and cognitive function and the level of blood glucose control to detect metabolites.
Result锛，

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