本文關鍵詞： 2型糖尿病 后扣帶回 彌散張量成像 磁共振波譜　出處：《遵義醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:聯合運用DTI和~1H-MRS技術檢測和評估2型糖尿病(type 2 diabetes mellitus,T2DM)患者后扣帶回(posterior cingulate cortex,PCC)區(qū)腦白質微結構損傷及腦代謝物異常改變,并探討其可能的機制以及與患者認知障礙的相關性及其臨床意義。研究對象與方法:收集2016年4月-2017年1月期間在大連大學附屬中山醫(yī)院住院治療并確診的T2DM患者43例,年齡范圍45-70歲(平均年齡:60.53±5.56歲),其中T2DM+CD(congitive dysfunction,CD)組21例(男性8例,女性13例),T2DM不伴認知損傷組22例(男性14例,女性8例);在門診體檢人群中招募年齡、性別及受教育年限相匹配的健康自愿者23例(男性8例,女性15例)。本研究經倫理委員會批準,所有被試均簽署之情同意書,并行3.0T MRI掃描,主要掃描序列為DTI及~1H-MRS,軟件自動讀取PCC區(qū)代謝物膽堿(cho-line,Cho)、N-乙酰天門冬氨酸(N-acetylaspartate,NAA)、肌酸(creatine,Cr)、肌醇(myo-inositol,mI)、谷氨酸復合物(glutamate+glutamine,Glu+Gln)及磷酸肌酸(phosphocreatine,PCr)的含量。DTI數據分析采用PANDA軟件,讀取全腦各向異性分數(fractional anisotropy,FA)、平均彌散率(mean diffusivity,MD),并提取與MRS形態(tài)、大小相匹配區(qū)域的FA值、MD值。統(tǒng)計學分析采用SPSS 21.0軟件,P0.05表示差異有統(tǒng)計學意義。結果:1.T2DM+CD、T2DM與HC組PCC腦區(qū)~1H-MRS代謝物指標比較:三組間mI/Cr(P0.001)、Glx/Cr(P=0.001)差異具有統(tǒng)計學意義。多重比較顯示:PCC區(qū)mI/Cr在T2DM+CD與T2DM組、T2DM+CD與HC組、T2DM與HC組三組之間的差異也均具有統(tǒng)計學意義(P0.05)。PCC區(qū)Glx/Cr比值在T2DM+CD與T2DM組、T2DM+CD與HC組之間的差異也具有統(tǒng)計學意義(P0.05)。PCC區(qū)Cr+PCr組合僅在T2DM+CD與HC組間差異有統(tǒng)計學意義(P=0.017)。2.T2DM+CD患者PCC區(qū)~1H-MRS代謝物指標與認知評分及實驗室指標相關性分析:Glx/Cr與Mo CA評分呈顯著正相關(r=0.591,P=0.004),Cr+PCr與AVLT20min呈明顯正相關(r=0.483,P=0.027),其余代謝物比值及其組合與各組的認知評分之間均無顯著相關性;PCC區(qū)~1H-MRS代謝物指標與臨床上各項實驗室指標之間亦均無顯著相關性。3.T2DM+CD、T2DM與HC組全腦及PCC區(qū)FA、MD值比較:全腦及PCC區(qū)FA、MD值在三組之間的差異性具有統(tǒng)計學意義(P0.05);多重比較顯示:全腦FA、MD值及PCC區(qū)MD值在T2DM+CD與T2DM組、T2DM+CD與HC組間差異具有統(tǒng)計學意義(P0.05)。PCC區(qū)FA值在T2DM+CD與T2DM組、T2DM+CD與HC組、T2DM與HC三組之間的差異均有統(tǒng)計學意義(P0.05)。4.T2DM+CD患者PCC區(qū)FA、MD值與認知評分、實驗室指標及~1H-MRS代謝物指標相關性分析:FA值與Mo CA評分呈顯著正相關(r=0.572,P=0.007);FA值與Glx/Cr呈負相關(r=-0.471,P=0.031)。結論:1.PCC區(qū)FA值降低、MD值升高及mI/Cr升高、Glx/Cr降低對T2DM認知損傷的預測與診斷較敏感,具有早期預警作用,且能評估T2DM患者PCC區(qū)腦損傷的程度;此外,Cr+PCr降低對T2DM認知損傷也具有一定提示作用。2.PCC區(qū)FA與MD值、Glx/Cr及mI/Cr指標的改變從兩種不同模態(tài)同時反映和印證了T2DM早期認知功能損傷的影像學表現;并推測引起T2DM患者認知功能損傷的原因或機制可能系PCC區(qū)神經元代謝障礙及白質纖維束損傷引起的皮層、皮層下功能失聯所致。
[Abstract]:Objective: combined detection of DTI and ~1H-MRS technology and evaluation of type 2 diabetes (type diabetes 2 mellitus, T2DM) in patients with posterior cingulate (posterior cingulate, cortex, PCC) abnormal changes of brain damage and whitematter metabolites, correlation and investigate the possible mechanism of cognitive dysfunction in patients with clinical significance and research object. Methods: collected from April 2016 -2017 year in January in Dalian University affiliated Zhongshan hospital 43 T2DM patients treated and diagnosed cases, age range 45-70 (average age: 60.53 + 5.56 years), including T2DM+CD (congitive dysfunction CD) group of 21 cases (8 cases, male 13 cases of female), 22 T2DM patients without cognitive cases of injury group (14 males, 8 females); recruitment age in outpatients, sex and education matched healthy volunteers in 23 cases (8 cases, male 15 cases of female). The study by the ethics committee approved by There were signed the consent of parallel 3.0T MRI scanning, the main scanning sequence is DTI and ~1H-MRS, the software automatically reads the PCC metabolites (cho-line, Cho), choline N- acetylaspartate (N-acetylaspartate, NAA), creatine (creatine, Cr) (myo-inositol, mI), inositol, glutamate complex (glutamate+glutamine, Glu+Gln) and creatine phosphate (phosphocreatine, PCr) the content of.DTI data were analyzed by PANDA software, read the whole brain fractional anisotropy (fractional anisotropy, FA), mean diffusivity (mean diffusivity, MD), and the MRS extraction and morphology, match the size of the FA values, MD values were used for statistical analysis. SPSS 21 software, P0.05 said the difference was statistically significant. Results: 1.T2DM+CD, T2DM and ~1H-MRS compared with brain PCC group HC: metabolic indexes between the three groups mI/Cr (P0.001) Glx/Cr (P=0.001), the difference was statistically significant. Multiple comparisons showed that: PCC mI/Cr 鍦═2DM+CD涓嶵2DM緇，

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