2型糖尿病患者脑功能连接强度的静息态fMRI研究

发布时间：2018-04-02 19:40

  本文选题：2型糖尿病　切入点：认知功能　出处：《天津医科大学》2017年硕士论文

【摘要】：目的:2型糖尿病(type 2 diabetes mellitus,T2DM)与认知功能障碍密切相关,T2DM是痴呆的风险因素。本研究采用静息态功能磁共振成像(resting-state functional MRI,rs-fMRI)的方法,研究认知功能正常的T2DM患者脑功能连接强度(functional connectivity strength,FCS)的改变情况,并探究全脑FCS改变与认知功能表现之间的关系。材料和方法:招募T2DM患者59例(男性28人,女性31人),另选择年龄、性别及教育程度与T2DM患者相匹配的健康志愿者59名(男性30人,女性29人)作为对照组(healthy controls,HCs)。T2DM患者无任何糖尿病相关并发症,且近两年内无低血糖发作。对所有受试者进行临床认知功能测评及实验室检查。采用GE公司3.0T磁共振扫描仪进行数据采集。采用统计参数图软件(statistical parametric mapping,SPM)和DPARSF软件进行rs-fMRI数据预处理,包括:时间校正、头动校正、回归协变量、带通滤波(0.01~0.08Hz)和空间标准化。然后进行全脑功能连接(functional connectivity,FC)分析,每一个体素的静息态FCS为该体素与其他所有体素连接强度的总和;并基于解剖距离,将静息态FCS分为长程和短程。利用SPM软件中的双样本t检验,在控制年龄、性别及教育程度后,分别对长程和短程的FCS进行组间比较。进一步采用种子点的方法,分析具有明显FCS组间差异的区域的FC,并进行组间比较。利用SPM8的VBM8工具对3DT1加权图像(T1WI)进行预处理,并对灰质体积进行组间比较。以上所有组间比较采用AlphaSim方法对结果进行多重比较校正。采用SPSS 21.0软件对两组受试者的人口统计学资料和临床变量进行组间比较分析。并将FCS/FC与临床变量及认知测评结果进行相关分析。结果:两组受试者的人口统计学资料和认知功能均无明显组间差异(P�e0.05)。相较于正常对照组,T2DM患者的空腹血糖水平(P0.001)和糖化血红蛋白明显增高(P0.001)。与HCs相比,T2DM患者右侧岛叶的长程FCS和右侧缘上回的短程FCS均减弱(P0.05,AlphaSim校正)。与HCs相比,T2DM患者右侧岛叶与左侧中央后回/前回、左侧顶上小叶及右侧中央后回/顶上小叶之间的FC减弱。此外,T2DM患者的右侧缘上回和双侧辅助运动区、右侧中央后回/顶上小叶之间的FC减弱(P0.05,AlphaSim校正)。两组受试者的灰质体积无明显组间差异(P0.05,Alpha Sim校正)。T2DM组右侧岛叶的长程FCS与糖化血红蛋白水平呈明显负相关(r=-0.361,P=0.046),右侧缘上回和双侧辅助运动区的FC与连线测试-A(TMT-A)呈显著的负相关(r=-0.436,P=0.014)。结论:认知功能正常的T2DM患者表现出右侧岛叶的长程FCS及右侧缘上回的短程FCS均减弱,提示患者静息态FCS的改变早于认知功能障碍的出现。FCS有可能作为预测T2DM患者早期认知功能下降的神经影像学指标。
[Abstract]:Objective to investigate the association between type 2 diabetes mellitusus T2DM and cognitive impairment. T2DM is a risk factor for dementia.In this study, resting-state functional MRI rs-fMRI was used to study the changes of brain functional junction intensity (FCS) in T2DM patients with normal cognitive function, and to explore the relationship between the changes of FCS in the whole brain and the manifestations of cognitive function.Materials and methods: 59 T2DM patients (28 males, 31 females) were recruited, and 59 healthy volunteers (30 males, 30 males) matched age, sex and education level with T2DM patients were selected.There were no diabetic related complications and no hypoglycemia in healthy control group (29 females).All subjects were evaluated for clinical cognitive function and laboratory examination.GE 3.0T magnetic resonance scanner was used to collect data.Statistical parametric mapping software (SPM) and DPARSF software were used to preprocess rs-fMRI data, including time correction, head-moving correction, regression covariable, bandpass filtering (0.01Hz0.08Hz) and spatial standardization.Then the functional connectivity of the whole brain was analyzed. The resting FCS of each individual was the sum of the connection strength between the voxel and all other voxels, and the resting FCS was divided into long range and short range based on the anatomical distance.Using the double sample t test in SPM software, after controlling age, sex and education level, the FCS of long range and short range were compared respectively.Furthermore, the seed point method was used to analyze the regions with obvious differences between FCS groups, and to compare them among groups.The VBM8 tool of SPM8 was used to preprocess the weighted 3DT1 images and the volume of gray matter was compared among groups.All the above groups were compared and corrected by AlphaSim method.The demographic data and clinical variables of the two groups were compared and analyzed by SPSS 21. 0 software.The correlation between FCS/FC and clinical variables and cognitive evaluation results was analyzed.Results: there was no significant difference in demographic data and cognitive function between the two groups.Compared with normal control group, fasting blood glucose level and glycosylated hemoglobin were significantly higher in T2DM patients (P 0.001).Compared with HCs, the long range FCS in the right insular lobe and the short range FCS in the right superior marginal gyrus were all decreased in T2DM patients with P0.05 AlphaSim correction.Compared with HCs, the FC between the right insular lobe and the left posterior / anterior gyrus, the left superior parietal lobe and the right posterior central gyrus / superior parietal lobe was decreased.In addition, the right superior marginal gyrus and bilateral auxiliary motor area in patients with T2DM and FC between the right posterior central gyrus and superior parietal lobules decreased P0.05 AlphaSim correction.涓ょ粍鍙楄瘯鑰呯殑鐏拌川浣撶Н鏃犳槑鏄剧粍闂村樊寮，

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