3TMR弥散张量成像在2型糖尿病患者脑白质损伤中的应用研究

发布时间：2018-03-21 01:57

本文选题：2型糖尿病　切入点：扩散张量成像　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：采用弥散张量成像(diffusion tensor imaging, DTI)技术,通过放置不同感兴趣区(region of interest, ROI),测量2型糖尿病患者不同区域脑白质DTI的主要参数,探讨脑白质微结构的改变情况,并分析各测值与临床各指标的变化趋势,探索2型糖尿病对脑白质微结构的影响及临床危险因素,从而为2型糖尿病患者的临床诊断、疗效与预后评估提供客观的影像学依据。方法：临床证实的25例糖尿病合并高血压、20例单纯糖尿病患者及20例健康对照组采用3OTMR进行头颅DTI成像。采用ROI法对双侧额叶白质、双侧顶叶白质、双侧颞叶白质、双侧枕叶白质、胼胝体膝部、胼胝体压部、双侧内囊后肢、双侧海马的FA值、DCavg值和RA值进行定量分析,并分别比较三组研究对象各感兴趣区FA值、DCavg值和RA值的差异,分析有显著性差异的FA值与糖尿病病程、糖化血红蛋白水平(HbAlc)及体重指数(body mass index, BMI)之间的相关性。并重建几种主要白质纤维束。结果：T2DM合并高血压组及单纯T2DM组多发腔隙性梗塞灶、脑白质变性及脑萎缩发生率明显高于正常对照组。三组患者左枕叶FA值和RA值、右额叶DCavg值有显著性差异(P0.05),表现为糖尿病组比对照组左枕叶FA值和RA值明显降低,右额叶DCavg值明显升高；T2DM合并高血压组、单纯T2DM组与正常对照组比较,右额叶、左颞叶、胼胝体压部FA值呈逐渐降低趋势,右额叶、右枕叶、左颞叶、胼胝体压部DCavg值呈逐渐升高趋势,右额叶、左颞叶、胼胝体压部、右侧内囊后肢RA值呈逐渐降低趋势。左额叶、左右顶叶、胼胝体膝部、左侧内囊后肢、左侧海马的FA值、DCavg值及RA值无显著性差异,其大小亦无一定趋势。右枕叶FA值、RA值,右颞叶和右侧内囊后肢FA值、DCavg值,以及右侧海马DCavg值、RA值均无显著性差异,其大小亦无一定趋势。相关分析显示三组研究对象左枕叶FA值与糖尿病病程间没有显著相关性(r=-0.061,P=0.692),而与HbAlc水平(r=-0.301,P=0.044)呈负相关,与BMI没有显著相关性(r=-0.117,P=0.354)。右额叶DCavg值与病程(r=0.084,P=0.584)、HbAlc水平(r=0.086,P=0.573)及BMI(r=0.035,P=0.784)间均没有显著相关性。弥散张量纤维束成像(Diffusion tensor tractography, DTT)显示T2DM合并高血压组白质纤维束不如对照组密集、整齐,可见稀疏、截断征象。结论：DTI可以无创、敏感、有效的显示T2DM患者脑白质微结构的改变,对了解糖尿病患者脑内白质通路的变化具有重要意义,其中枕叶、额叶及颞叶白质较易受累。与病程和BMI相比,糖化血红蛋白水平对脑白质DTI参数的影响最大。弥散张量纤维束成像可以直观、形象的显示糖尿病患者脑白质的异常。
[Abstract]:Objective: to measure the main parameters of white matter DTI in different regions of type 2 diabetes mellitus by means of diffusion Zhang Liang diffusion tensor imaging (DTI) technique, and to investigate the changes of white matter microstructures in different regions of type 2 diabetes mellitus. The change trend of each measured value and clinical indexes were analyzed, and the effect of type 2 diabetes on the white matter microstructure and clinical risk factors were explored, so as to make the clinical diagnosis of type 2 diabetes mellitus. Methods: 25 patients with diabetes mellitus complicated with hypertension and 20 patients with simple diabetes mellitus and 20 healthy controls were examined with 3OTMR for cranial DTI imaging. Bilateral frontal white matter was examined by ROI. The FA values of bilateral parietal white matter, bilateral temporal white matter, bilateral occipital white matter, genu of corpus callosum, splenium of corpus callosum, posterior limb of bilateral internal capsule and bilateral hippocampus were quantitatively analyzed. The difference of FA value, DCavg value and RA value between the three groups were compared, and the significant difference between FA value and the course of diabetes was analyzed. The correlation between HbAlc and body mass index (BMI), and the reconstruction of several main white matter fiber bundles. Results there were multiple lacunar infarct foci in hypertension group and simple T2DM group. The incidence of white matter degeneration and brain atrophy was significantly higher in the three groups than that in the control group. There were significant differences in FA value, RA value and DCavg value of the right frontal lobe between the three groups, which showed that the FA value and RA value of the left occipital lobe in the diabetic group were significantly lower than those in the control group. The DCavg value of right frontal lobe increased significantly in T2DM with hypertension group. Compared with normal control group, the FA values of right frontal lobe, left temporal lobe and corpus callosum decreased gradually in T2DM group, right frontal lobe, right occipital lobe, left temporal lobe, right frontal lobe, right occipital lobe, left temporal lobe, right frontal lobe, right occipital lobe and left temporal lobe. The DCavg value of corpus callosum increased gradually, and decreased gradually in right frontal lobe, left temporal lobe, splenium of corpus callosum and posterior limb of right internal capsule, left frontal lobe, left parietal lobe, genu of corpus callosum, posterior limb of left internal capsule, left frontal lobe, right parietal lobe, knee of corpus callosum, left posterior limb of internal capsule. There was no significant difference in FA value and RA value in left hippocampus, but there was no significant difference in RA value in right occipital lobe, FA value in right temporal lobe and posterior limb of right internal capsule, and DCavg value in right hippocampus. The correlation analysis showed that there was no significant correlation between the FA value of left occipital lobe and the course of diabetes in the three groups, but there was a negative correlation between FA value of left occipital lobe and the course of diabetes, but a negative correlation with HbAlc level. There was no significant correlation with BMI. There was no significant correlation between the DCavg value of right frontal lobe and the course of disease. There was no significant correlation between the DCavg value of right frontal lobe and the level of HbAlc (0. 086 P0. 573) and the BMIRV 0. 035 P0. 784). The diffuse Zhang Liang fiber bundle imaging diffused tensor tractography (DTT) showed that the white fiber bundles in T2DM complicated with hypertension group were not as dense and tidy as those in the control group, so it could be seen that the white fiber bundles in the T2DM complicated with hypertension group were not as dense and tidy as those in the control group. Conclusion the changes of white matter microstructures in brain of patients with T2DM can be demonstrated effectively and noninvasively. It is of great significance to understand the changes of the white matter pathway in the brain of patients with diabetes mellitus, including the occipital lobe. Compared with the course of disease and BMI, the level of glycosylated hemoglobin had the greatest influence on the DTI parameters of the white matter. Diffuse Zhang Liang fiber bundle imaging could visualize the abnormality of the white matter in diabetic patients.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R587.2;R747.9

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