本文關(guān)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(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:聯(lián)合運(yùn)用DTI和~1H-MRS技術(shù)檢測(cè)和評(píng)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(zhì)微結(jié)構(gòu)損傷及腦代謝物異常改變,并探討其可能的機(jī)制以及與患者認(rèn)知障礙的相關(guān)性及其臨床意義。研究對(duì)象與方法:收集2016年4月-2017年1月期間在大連大學(xué)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(rèn)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(jīng)倫理委員會(huì)批準(zhǔn),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(dòng)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(fù)合物(glutamate+glutamine,Glu+Gln)及磷酸肌酸(phosphocreatine,PCr)的含量。DTI數(shù)據(jù)分析采用PANDA軟件,讀取全腦各向異性分?jǐn)?shù)(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(jì)學(xué)分析采用SPSS 21.0軟件,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.T2DM+CD、T2DM與HC組PCC腦區(qū)~1H-MRS代謝物指標(biāo)比較:三組間mI/Cr(P0.001)、Glx/Cr(P=0.001)差異具有統(tǒng)計(jì)學(xué)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(jì)學(xué)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(jì)學(xué)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(jì)學(xué)意義(P=0.017)。2.T2DM+CD患者PCC區(qū)~1H-MRS代謝物指標(biāo)與認(rèn)知評(píng)分及實(shí)驗(yàn)室指標(biāo)相關(guān)性分析:Glx/Cr與Mo CA評(píng)分呈顯著正相關(guān)(r=0.591,P=0.004),Cr+PCr與AVLT20min呈明顯正相關(guān)(r=0.483,P=0.027),其余代謝物比值及其組合與各組的認(rèn)知評(píng)分之間均無(wú)顯著相關(guān)性;PCC區(qū)~1H-MRS代謝物指標(biāo)與臨床上各項(xiàng)實(shí)驗(yàn)室指標(biāo)之間亦均無(wú)顯著相關(guān)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(jì)學(xué)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(jì)學(xué)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(jì)學(xué)意義(P0.05)。4.T2DM+CD患者PCC區(qū)FA、MD值與認(rèn)知評(píng)分、實(shí)驗(yàn)室指標(biāo)及~1H-MRS代謝物指標(biāo)相關(guān)性分析:FA值與Mo CA評(píng)分呈顯著正相關(guān)(r=0.572,P=0.007);FA值與Glx/Cr呈負(fù)相關(guān)(r=-0.471,P=0.031)。結(jié)論:1.PCC區(qū)FA值降低、MD值升高及mI/Cr升高、Glx/Cr降低對(duì)T2DM認(rèn)知損傷的預(yù)測(cè)與診斷較敏感,具有早期預(yù)警作用,且能評(píng)估T2DM患者PCC區(qū)腦損傷的程度;此外,Cr+PCr降低對(duì)T2DM認(rèn)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(biāo)的改變從兩種不同模態(tài)同時(shí)反映和印證了T2DM早期認(rèn)知功能損傷的影像學(xué)表現(xiàn);并推測(cè)引起T2DM患者認(rèn)知功能損傷的原因或機(jī)制可能系PCC區(qū)神經(jīng)元代謝障礙及白質(zhì)纖維束損傷引起的皮層、皮層下功能失聯(lián)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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