本文選題：2型糖尿病　切入點(diǎn)：氫質(zhì)子磁共振波譜　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景及目的： 2型糖尿病(type2diabetes mellitus, T2DM)是以慢性高血糖為特征的一種糖代謝紊亂性疾病,可導(dǎo)致進(jìn)行性的,包括周?chē)椭袠猩窠?jīng)系統(tǒng)、心血管系統(tǒng)、腎臟、眼等多器官的損害。T2DM可引起腦細(xì)胞的代謝異常,產(chǎn)生一系列病理生理及生化改變,從而引起腦認(rèn)知功能損害。氫質(zhì)子磁共振波譜(proton magnetic resonance spectroscopy,'H MRS)是目前唯一無(wú)創(chuàng)性的評(píng)估活體腦內(nèi)生化代謝活動(dòng)的影像學(xué)技術(shù)。目前國(guó)內(nèi)外關(guān)于T2DM患者腦代謝變化的研究多集中在海馬及額頂葉白質(zhì)區(qū),并且報(bào)道結(jié)果不一,鑒于前額葉是認(rèn)知功能的重要神經(jīng)基礎(chǔ),因此本研究采用多體素1HMRS技術(shù)檢測(cè)T2DM患者前額葉白質(zhì)及內(nèi)側(cè)皮層的代謝變化,并分析其與認(rèn)知功能及血糖水平的關(guān)系,從腦代謝的角度探討T2DM對(duì)認(rèn)知功能影響的神經(jīng)機(jī)制。 對(duì)象和方法： 招募65名志愿者,其中正常對(duì)照者32名,T2DM患者33名。T2DM患者中因MRS譜線(xiàn)質(zhì)量問(wèn)題(分辨率過(guò)低,不能識(shí)別波峰)排除3名,因生化檢查數(shù)據(jù)不全排除3名,認(rèn)知測(cè)試數(shù)據(jù)不全排除5名。對(duì)照組中MRS譜線(xiàn)質(zhì)量問(wèn)題排除5名,因生化檢查數(shù)據(jù)不全排除1名,認(rèn)知數(shù)據(jù)不全排除4名,因1例被試達(dá)到抑郁程度,予以排除。最終選取22例T2DM患者(男12例,女10例,年齡41-65歲,平均54.5±8.3歲)和21名正常對(duì)照(男6例,女15例,年齡44-67歲,平均53.5±7.0歲)行臨床認(rèn)知功能和心理學(xué)測(cè)評(píng),測(cè)評(píng)內(nèi)容包括簡(jiǎn)易智能精神狀態(tài)檢查量表、數(shù)字廣度測(cè)試(包括正序和倒序)、瑞文智力測(cè)試、Flanker范式實(shí)驗(yàn)、連線(xiàn)測(cè)試A、聽(tīng)覺(jué)詞語(yǔ)學(xué)習(xí)測(cè)驗(yàn)、抑郁自評(píng)量表、焦慮自評(píng)量表。所有被試者均接受多體素1HMRS掃描,采用Functool軟件對(duì)波譜數(shù)據(jù)進(jìn)行處理和代謝物濃度分析,檢測(cè)的感興趣區(qū)包括雙側(cè)前額葉白質(zhì)、雙側(cè)前額葉內(nèi)側(cè)皮層。統(tǒng)計(jì)學(xué)分析采用SPSS17.0數(shù)據(jù)軟件包。首先對(duì)連續(xù)變量進(jìn)行分布的正態(tài)性檢驗(yàn)(Kolmogorov-Smirnovb),符合正態(tài)分布的變量采用獨(dú)立樣本t檢驗(yàn)進(jìn)行組間比較,不符合正態(tài)分布的變量采用mann-whitney U檢驗(yàn)；計(jì)數(shù)資料采用卡方檢驗(yàn),采用Pearson(正態(tài)分布)或Spearman(非正態(tài)分布)相關(guān)分析檢測(cè)代謝物濃度與認(rèn)知功能及血糖控制水平之間的相關(guān)性。 結(jié)果： 1與對(duì)照組比較,T2DM組右側(cè)前額葉皮層的NAA、NAA/MI減低；右側(cè)前額葉白質(zhì)Cho升高；雙側(cè)前額葉皮層的MI升高。 2.T2DM組右側(cè)前額葉內(nèi)側(cè)皮層的NAA值與HbA1C濃度呈負(fù)相關(guān)。 結(jié)論： 1.利用多體素1H-MRS可在T2DM患者出現(xiàn)認(rèn)知功能下降之前,即可發(fā)現(xiàn)相關(guān)腦區(qū)的代謝物改變,其可作為研究T2DM患者認(rèn)知功能障礙的重要方法。 2.T2DM患者與正常對(duì)照比較腦內(nèi)存在多個(gè)部位的神經(jīng)代謝產(chǎn)物異常：其中前額葉內(nèi)側(cè)面皮層NAA值減低可能反映了該區(qū)神經(jīng)元的早期損傷；而前額葉白質(zhì)區(qū)Cho值增高、前額葉內(nèi)側(cè)皮層MI值升高可能反映了該區(qū)神經(jīng)膠質(zhì)細(xì)胞的增生性變化,其可間接反映該區(qū)神經(jīng)元損傷的存在。 3.T2DM患者右側(cè)前額葉內(nèi)側(cè)皮層NAA值與HbA1C濃度呈負(fù)相關(guān),反映近期血糖水平可影響腦內(nèi)代謝物的變化,合理控制血糖可有效延緩糖尿病所致的腦內(nèi)神經(jīng)元的損傷的速度。
[Abstract]:Background and purpose:
Type 2 diabetes mellitus (type2diabetes, mellitus, T2DM) is characterized by chronic high blood sugar is a metabolic disorder, which leads to progressive, including peripheral and central nervous system, cardiovascular system, kidney, eye and other organ damage.T2DM can cause brain cell generation Xie Yichang, produced a series of pathological and physiological biochemical changes, can cause cognitive impairment. Brain proton magnetic resonance spectroscopy (proton magnetic resonance spectroscopy,'H MRS) is the only noninvasive assessment of biochemical metabolism in brain in vivo imaging technology. The current domestic and international research about the changes of cerebral metabolism in patients with T2DM are more concentrated in the hippocampus and frontal white matter area, and reported the results of a given prefrontal is an important neural basis of cognitive function, so this research adopts multi voxel 1HMRS technique for detection of T2DM in patients with prefrontal white matter and inner cortex metabolism The relationship between the cognitive function and the level of blood glucose was analyzed and the neural mechanism of the effect of T2DM on cognitive function was discussed from the point of view of brain metabolism.
Objects and methods:
Recruited 65 volunteers, including 32 normal control subjects, line quality problems of MRS spectrum for T2DM patients 33.T2DM patients (low resolution, can not identify the peak) 3 were excluded because of incomplete data, biochemical examination excluded 3, cognitive test data not excluding the 5. In the control group MRS line quality problems 5 were excluded because of incomplete data, biochemical examination excluded 1, cognitive incomplete data excluding the 4, because 1 subjects reached the degree of depression, be excluded. The final selection of 22 T2DM patients (male 12 cases, female 10 cases, age 41-65 years, average 54.5 + 8.3 years) and 21 normal according to (male 6 cases, female 15 cases, age 44-67 years, average 53.5 + 7 years) underwent clinical cognitive function and psychological evaluation, including evaluation of MMSE, digital span test (including positive and reverse), raven intelligence test, Flanker experimental paradigm, A connection test, auditory verbal learning test, suppression Self rating depression scale, self rating anxiety scale. All the subjects underwent multi voxel 1HMRS scanning analysis and metabolite concentration on spectral data by using Functool software, the detection of region of interest including prefrontal white matter, bilateral medial prefrontal cortex. Statistical analysis using SPSS17.0 data software package first. Normality test on the distribution of continuous variables (Kolmogorov-Smirnovb), with normal distribution of variables by using independent sample t test were compared between the groups, does not meet the normal distribution of variables using Mann-Whitney U test; count data using chi square test, using Pearson (normal distribution) or Spearman (non normal distribution) correlation analysis between concentration and cognitive function and the level of blood glucose control to detect metabolites.
Result錛，

本文編號(hào)：1623924