2型糖尿病微量白蛋白尿与相关脑组织NAA、MI及Cho水平的关系
发布时间：2019-06-15 18:54
【摘要】：目的:尿微量白蛋白检测是诊断早期糖尿病肾病较为敏感、可靠的手段。在糖尿病患者中,MAU的出现不仅提示肾小球的损害,而且是全身血管内皮细胞功能障碍的标志。氢质子磁共振波谱(1H-MRS)是一种无创性活体神经生化分析技术,可以在常规影像学出现明显异常改变之前,通过对组织代谢物浓度进行动态观察和定量分析,反映脑组织局部的代谢异常变化,对早期发现脑组织异常改变具有重要价值。本研究采用1H-MRS技术检测2型糖尿病(T2DM)患者脑组织代谢改变,探讨T2DM患者MAU与大脑额叶皮层和半卵圆中心区域内N-乙酰天门冬氨酸(NAA)、肌醇(MI)及胆碱化合物(Cho)水平的关系,推测其中的病理生理机制。方法:选取2013年12月至2014年12月于我院住院治疗的T2DM患者61例,所有入组病例经常规磁共振扫描,脑组织结构均未见异常改变。采用问卷调查及静脉血液学检测获得受试对象的一般临床资料。留取10h尿标本,用放免法测定尿白蛋白含量,根据尿白蛋白排泄率(UAER)分为单纯糖尿病组(DM组,n=29)和微量白蛋白尿组(DA组,n=32)。选取志愿者20例作为健康对照组(HC组)。采用氢质子磁共振波谱(1H-MRS)技术对大脑前额叶皮层、左侧半卵圆中心区域进行分析研究,以肌酸(Cr)为内部参考值,检测NAA/Cr、MI/Cr及Cho/Cr比值。结果:三组间年龄、性别分布、血压水平、BMI、血脂、尿素氮、肌酐均未见明显差异。DA组、DM组之间FPG、PPG、HbA1c水平无差异,均显著高于HC组。DA组UAER水平高于DM组和HC组。DA组和DM组糖尿病病程相比较有统计学差异。额叶皮层区域:DA组NAA/Cr值较DM组、HC组降低,DM组较HC组降低;Cho/Cr在三组中无显著差异;MI/Cr值DA组较HC组升高。半卵圆中心区域:DA组NAA/Cr值低于HC组;DM组Cho/Cr值较HC组升高有显著差异,DA组较DM组降低,但无统计学意义;MI/Cr值在DA组较DM组、HC组升高,DM组与HC组无显著差异。DA组在前额叶皮层区域NAA/Cr值与UAER水平呈负相关性(r=-0.686,P=0.026)。结论:T2DM患者相关脑组织区域内NAA水平较健康人群降低,MI、Cho较健康人群升高,提示脑组织代谢发生异常改变。分析数据显示合并MAU的糖尿病患者脑组织代谢异常更为明显,中枢神经系统损害更为严重,可能由于合并肾小球病变的2型糖尿病患者,糖代谢紊乱持续时间更长,个体易感因素更加敏感,血管内皮通透性增加明显。同时,外界毒素通过受损的内皮细胞入侵,进一步导致神经元功能性障碍。本研究中波普数据显示T2DM患者在额叶皮层区域NAA/Cr值下降较为明显,而在半卵圆中心区域MI/Cr值升高较为显著,推测可能与研究人群与选取的脑区域组织结构不同所致。其中的病理生理变化考虑为脑细胞因高血糖影响或炎症刺激,出现神经元功能下降、凋亡,细胞膜降解增加和神经纤维脱髓鞘及胶质细胞数目的增加等有关。
[Abstract]:Objective: the detection of urinary microalbumin is a sensitive and reliable method for the diagnosis of early diabetic nephropathy. In diabetic patients, the appearance of MAU not only indicates glomerular damage, but also is a sign of systemic vascular endothelial cell dysfunction. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive neurobiochemical analysis technique in vivo. it can reflect the local metabolic abnormalities of brain tissue by dynamic observation and quantitative analysis before the obvious abnormal changes in conventional imaging. It is of great value for the early detection of abnormal changes in brain tissue. In this study, 1H-MRS technique was used to detect the metabolic changes of brain tissue in patients with type 2 diabetes mellitus (T2DM). The relationship between MAU and the levels of N-acetylaspartate (NAA), inositol (MI) and choline compound (Cho) in the frontalis dermis and semicircular center of the brain in T2DM patients was investigated, and the pathophysiological mechanism was speculated. Methods: 61 patients with T2DM hospitalized in our hospital from December 2013 to December 2014 were selected. All the patients in the group had no abnormal changes in brain tissue structure by conventional magnetic resonance imaging (MRI). The general clinical data of the subjects were obtained by questionnaire and venous hematology. Urine albumin content was measured by radioimmunoassay. According to urinary albumin excretion rate (UAER), it was divided into simple diabetic group (DM group, n 鈮，
本文编号：2500436
[Abstract]:Objective: the detection of urinary microalbumin is a sensitive and reliable method for the diagnosis of early diabetic nephropathy. In diabetic patients, the appearance of MAU not only indicates glomerular damage, but also is a sign of systemic vascular endothelial cell dysfunction. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive neurobiochemical analysis technique in vivo. it can reflect the local metabolic abnormalities of brain tissue by dynamic observation and quantitative analysis before the obvious abnormal changes in conventional imaging. It is of great value for the early detection of abnormal changes in brain tissue. In this study, 1H-MRS technique was used to detect the metabolic changes of brain tissue in patients with type 2 diabetes mellitus (T2DM). The relationship between MAU and the levels of N-acetylaspartate (NAA), inositol (MI) and choline compound (Cho) in the frontalis dermis and semicircular center of the brain in T2DM patients was investigated, and the pathophysiological mechanism was speculated. Methods: 61 patients with T2DM hospitalized in our hospital from December 2013 to December 2014 were selected. All the patients in the group had no abnormal changes in brain tissue structure by conventional magnetic resonance imaging (MRI). The general clinical data of the subjects were obtained by questionnaire and venous hematology. Urine albumin content was measured by radioimmunoassay. According to urinary albumin excretion rate (UAER), it was divided into simple diabetic group (DM group, n 鈮，
本文编号：2500436
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