發(fā)布時(shí)間：2018-03-21 01:57

  本文選題：2型糖尿病　切入點(diǎn)：擴(kuò)散張量成像　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：采用彌散張量成像(diffusion tensor imaging, DTI)技術(shù),通過(guò)放置不同感興趣區(qū)(region of interest, ROI),測(cè)量2型糖尿病患者不同區(qū)域腦白質(zhì)DTI的主要參數(shù),探討腦白質(zhì)微結(jié)構(gòu)的改變情況,并分析各測(cè)值與臨床各指標(biāo)的變化趨勢(shì),探索2型糖尿病對(duì)腦白質(zhì)微結(jié)構(gòu)的影響及臨床危險(xiǎn)因素,從而為2型糖尿病患者的臨床診斷、療效與預(yù)后評(píng)估提供客觀的影像學(xué)依據(jù)。方法：臨床證實(shí)的25例糖尿病合并高血壓、20例單純糖尿病患者及20例健康對(duì)照組采用3OTMR進(jìn)行頭顱DTI成像。采用ROI法對(duì)雙側(cè)額葉白質(zhì)、雙側(cè)頂葉白質(zhì)、雙側(cè)顳葉白質(zhì)、雙側(cè)枕葉白質(zhì)、胼胝體膝部、胼胝體壓部、雙側(cè)內(nèi)囊后肢、雙側(cè)海馬的FA值、DCavg值和RA值進(jìn)行定量分析,并分別比較三組研究對(duì)象各感興趣區(qū)FA值、DCavg值和RA值的差異,分析有顯著性差異的FA值與糖尿病病程、糖化血紅蛋白水平(HbAlc)及體重指數(shù)(body mass index, BMI)之間的相關(guān)性。并重建幾種主要白質(zhì)纖維束。結(jié)果：T2DM合并高血壓組及單純T2DM組多發(fā)腔隙性梗塞灶、腦白質(zhì)變性及腦萎縮發(fā)生率明顯高于正常對(duì)照組。三組患者左枕葉FA值和RA值、右額葉DCavg值有顯著性差異(P0.05),表現(xiàn)為糖尿病組比對(duì)照組左枕葉FA值和RA值明顯降低,右額葉DCavg值明顯升高；T2DM合并高血壓組、單純T2DM組與正常對(duì)照組比較,右額葉、左顳葉、胼胝體壓部FA值呈逐漸降低趨勢(shì),右額葉、右枕葉、左顳葉、胼胝體壓部DCavg值呈逐漸升高趨勢(shì),右額葉、左顳葉、胼胝體壓部、右側(cè)內(nèi)囊后肢RA值呈逐漸降低趨勢(shì)。左額葉、左右頂葉、胼胝體膝部、左側(cè)內(nèi)囊后肢、左側(cè)海馬的FA值、DCavg值及RA值無(wú)顯著性差異,其大小亦無(wú)一定趨勢(shì)。右枕葉FA值、RA值,右顳葉和右側(cè)內(nèi)囊后肢FA值、DCavg值,以及右側(cè)海馬DCavg值、RA值均無(wú)顯著性差異,其大小亦無(wú)一定趨勢(shì)。相關(guān)分析顯示三組研究對(duì)象左枕葉FA值與糖尿病病程間沒(méi)有顯著相關(guān)性(r=-0.061,P=0.692),而與HbAlc水平(r=-0.301,P=0.044)呈負(fù)相關(guān),與BMI沒(méi)有顯著相關(guān)性(r=-0.117,P=0.354)。右額葉DCavg值與病程(r=0.084,P=0.584)、HbAlc水平(r=0.086,P=0.573)及BMI(r=0.035,P=0.784)間均沒(méi)有顯著相關(guān)性。彌散張量纖維束成像(Diffusion tensor tractography, DTT)顯示T2DM合并高血壓組白質(zhì)纖維束不如對(duì)照組密集、整齊,可見(jiàn)稀疏、截?cái)嗾飨蟆＝Y(jié)論：DTI可以無(wú)創(chuàng)、敏感、有效的顯示T2DM患者腦白質(zhì)微結(jié)構(gòu)的改變,對(duì)了解糖尿病患者腦內(nèi)白質(zhì)通路的變化具有重要意義,其中枕葉、額葉及顳葉白質(zhì)較易受累。與病程和BMI相比,糖化血紅蛋白水平對(duì)腦白質(zhì)DTI參數(shù)的影響最大。彌散張量纖維束成像可以直觀、形象的顯示糖尿病患者腦白質(zhì)的異常。
[Abstract]:Objective: to measure the main parameters of white matter DTI in different regions of type 2 diabetes mellitus by means of diffusion Zhang Liang diffusion tensor imaging (DTI) technique, and to investigate the changes of white matter microstructures in different regions of type 2 diabetes mellitus. The change trend of each measured value and clinical indexes were analyzed, and the effect of type 2 diabetes on the white matter microstructure and clinical risk factors were explored, so as to make the clinical diagnosis of type 2 diabetes mellitus. Methods: 25 patients with diabetes mellitus complicated with hypertension and 20 patients with simple diabetes mellitus and 20 healthy controls were examined with 3OTMR for cranial DTI imaging. Bilateral frontal white matter was examined by ROI. The FA values of bilateral parietal white matter, bilateral temporal white matter, bilateral occipital white matter, genu of corpus callosum, splenium of corpus callosum, posterior limb of bilateral internal capsule and bilateral hippocampus were quantitatively analyzed. The difference of FA value, DCavg value and RA value between the three groups were compared, and the significant difference between FA value and the course of diabetes was analyzed. The correlation between HbAlc and body mass index (BMI), and the reconstruction of several main white matter fiber bundles. Results there were multiple lacunar infarct foci in hypertension group and simple T2DM group. The incidence of white matter degeneration and brain atrophy was significantly higher in the three groups than that in the control group. There were significant differences in FA value, RA value and DCavg value of the right frontal lobe between the three groups, which showed that the FA value and RA value of the left occipital lobe in the diabetic group were significantly lower than those in the control group. The DCavg value of right frontal lobe increased significantly in T2DM with hypertension group. Compared with normal control group, the FA values of right frontal lobe, left temporal lobe and corpus callosum decreased gradually in T2DM group, right frontal lobe, right occipital lobe, left temporal lobe, right frontal lobe, right occipital lobe, left temporal lobe, right frontal lobe, right occipital lobe and left temporal lobe. The DCavg value of corpus callosum increased gradually, and decreased gradually in right frontal lobe, left temporal lobe, splenium of corpus callosum and posterior limb of right internal capsule, left frontal lobe, left parietal lobe, genu of corpus callosum, posterior limb of left internal capsule, left frontal lobe, right parietal lobe, knee of corpus callosum, left posterior limb of internal capsule. There was no significant difference in FA value and RA value in left hippocampus, but there was no significant difference in RA value in right occipital lobe, FA value in right temporal lobe and posterior limb of right internal capsule, and DCavg value in right hippocampus. The correlation analysis showed that there was no significant correlation between the FA value of left occipital lobe and the course of diabetes in the three groups, but there was a negative correlation between FA value of left occipital lobe and the course of diabetes, but a negative correlation with HbAlc level. There was no significant correlation with BMI. There was no significant correlation between the DCavg value of right frontal lobe and the course of disease. There was no significant correlation between the DCavg value of right frontal lobe and the level of HbAlc (0. 086 P0. 573) and the BMIRV 0. 035 P0. 784). The diffuse Zhang Liang fiber bundle imaging diffused tensor tractography (DTT) showed that the white fiber bundles in T2DM complicated with hypertension group were not as dense and tidy as those in the control group, so it could be seen that the white fiber bundles in the T2DM complicated with hypertension group were not as dense and tidy as those in the control group. Conclusion the changes of white matter microstructures in brain of patients with T2DM can be demonstrated effectively and noninvasively. It is of great significance to understand the changes of the white matter pathway in the brain of patients with diabetes mellitus, including the occipital lobe. Compared with the course of disease and BMI, the level of glycosylated hemoglobin had the greatest influence on the DTI parameters of the white matter. Diffuse Zhang Liang fiber bundle imaging could visualize the abnormality of the white matter in diabetic patients.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R587.2;R747.9

【參考文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 李蕾;2型糖尿病患者的海馬體積及其磁共振波譜變化[D];新鄉(xiāng)醫(yī)學(xué)院;2012年

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本文編號(hào)：1641748