本文選題：2型糖尿病　切入點(diǎn)：認(rèn)知功能　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:2型糖尿病(type 2 diabetes mellitus,T2DM)與認(rèn)知功能障礙密切相關(guān),T2DM是癡呆的風(fēng)險(xiǎn)因素。本研究采用靜息態(tài)功能磁共振成像(resting-state functional MRI,rs-fMRI)的方法,研究認(rèn)知功能正常的T2DM患者腦功能連接強(qiáng)度(functional connectivity strength,FCS)的改變情況,并探究全腦FCS改變與認(rèn)知功能表現(xiàn)之間的關(guān)系。材料和方法:招募T2DM患者59例(男性28人,女性31人),另選擇年齡、性別及教育程度與T2DM患者相匹配的健康志愿者59名(男性30人,女性29人)作為對(duì)照組(healthy controls,HCs)。T2DM患者無任何糖尿病相關(guān)并發(fā)癥,且近兩年內(nèi)無低血糖發(fā)作。對(duì)所有受試者進(jìn)行臨床認(rèn)知功能測(cè)評(píng)及實(shí)驗(yàn)室檢查。采用GE公司3.0T磁共振掃描儀進(jìn)行數(shù)據(jù)采集。采用統(tǒng)計(jì)參數(shù)圖軟件(statistical parametric mapping,SPM)和DPARSF軟件進(jìn)行rs-fMRI數(shù)據(jù)預(yù)處理,包括:時(shí)間校正、頭動(dòng)校正、回歸協(xié)變量、帶通濾波(0.01~0.08Hz)和空間標(biāo)準(zhǔn)化。然后進(jìn)行全腦功能連接(functional connectivity,FC)分析,每一個(gè)體素的靜息態(tài)FCS為該體素與其他所有體素連接強(qiáng)度的總和;并基于解剖距離,將靜息態(tài)FCS分為長程和短程。利用SPM軟件中的雙樣本t檢驗(yàn),在控制年齡、性別及教育程度后,分別對(duì)長程和短程的FCS進(jìn)行組間比較。進(jìn)一步采用種子點(diǎn)的方法,分析具有明顯FCS組間差異的區(qū)域的FC,并進(jìn)行組間比較。利用SPM8的VBM8工具對(duì)3DT1加權(quán)圖像(T1WI)進(jìn)行預(yù)處理,并對(duì)灰質(zhì)體積進(jìn)行組間比較。以上所有組間比較采用AlphaSim方法對(duì)結(jié)果進(jìn)行多重比較校正。采用SPSS 21.0軟件對(duì)兩組受試者的人口統(tǒng)計(jì)學(xué)資料和臨床變量進(jìn)行組間比較分析。并將FCS/FC與臨床變量及認(rèn)知測(cè)評(píng)結(jié)果進(jìn)行相關(guān)分析。結(jié)果:兩組受試者的人口統(tǒng)計(jì)學(xué)資料和認(rèn)知功能均無明顯組間差異(P㧐0.05)。相較于正常對(duì)照組,T2DM患者的空腹血糖水平(P0.001)和糖化血紅蛋白明顯增高(P0.001)。與HCs相比,T2DM患者右側(cè)島葉的長程FCS和右側(cè)緣上回的短程FCS均減弱(P0.05,AlphaSim校正)。與HCs相比,T2DM患者右側(cè)島葉與左側(cè)中央后回/前回、左側(cè)頂上小葉及右側(cè)中央后回/頂上小葉之間的FC減弱。此外,T2DM患者的右側(cè)緣上回和雙側(cè)輔助運(yùn)動(dòng)區(qū)、右側(cè)中央后回/頂上小葉之間的FC減弱(P0.05,AlphaSim校正)。兩組受試者的灰質(zhì)體積無明顯組間差異(P0.05,Alpha Sim校正)。T2DM組右側(cè)島葉的長程FCS與糖化血紅蛋白水平呈明顯負(fù)相關(guān)(r=-0.361,P=0.046),右側(cè)緣上回和雙側(cè)輔助運(yùn)動(dòng)區(qū)的FC與連線測(cè)試-A(TMT-A)呈顯著的負(fù)相關(guān)(r=-0.436,P=0.014)。結(jié)論:認(rèn)知功能正常的T2DM患者表現(xiàn)出右側(cè)島葉的長程FCS及右側(cè)緣上回的短程FCS均減弱,提示患者靜息態(tài)FCS的改變?cè)缬谡J(rèn)知功能障礙的出現(xiàn)。FCS有可能作為預(yù)測(cè)T2DM患者早期認(rèn)知功能下降的神經(jīng)影像學(xué)指標(biāo)。
[Abstract]:Objective to investigate the association between type 2 diabetes mellitusus T2DM and cognitive impairment. T2DM is a risk factor for dementia.In this study, resting-state functional MRI rs-fMRI was used to study the changes of brain functional junction intensity (FCS) in T2DM patients with normal cognitive function, and to explore the relationship between the changes of FCS in the whole brain and the manifestations of cognitive function.Materials and methods: 59 T2DM patients (28 males, 31 females) were recruited, and 59 healthy volunteers (30 males, 30 males) matched age, sex and education level with T2DM patients were selected.There were no diabetic related complications and no hypoglycemia in healthy control group (29 females).All subjects were evaluated for clinical cognitive function and laboratory examination.GE 3.0T magnetic resonance scanner was used to collect data.Statistical parametric mapping software (SPM) and DPARSF software were used to preprocess rs-fMRI data, including time correction, head-moving correction, regression covariable, bandpass filtering (0.01Hz0.08Hz) and spatial standardization.Then the functional connectivity of the whole brain was analyzed. The resting FCS of each individual was the sum of the connection strength between the voxel and all other voxels, and the resting FCS was divided into long range and short range based on the anatomical distance.Using the double sample t test in SPM software, after controlling age, sex and education level, the FCS of long range and short range were compared respectively.Furthermore, the seed point method was used to analyze the regions with obvious differences between FCS groups, and to compare them among groups.The VBM8 tool of SPM8 was used to preprocess the weighted 3DT1 images and the volume of gray matter was compared among groups.All the above groups were compared and corrected by AlphaSim method.The demographic data and clinical variables of the two groups were compared and analyzed by SPSS 21. 0 software.The correlation between FCS/FC and clinical variables and cognitive evaluation results was analyzed.Results: there was no significant difference in demographic data and cognitive function between the two groups.Compared with normal control group, fasting blood glucose level and glycosylated hemoglobin were significantly higher in T2DM patients (P 0.001).Compared with HCs, the long range FCS in the right insular lobe and the short range FCS in the right superior marginal gyrus were all decreased in T2DM patients with P0.05 AlphaSim correction.Compared with HCs, the FC between the right insular lobe and the left posterior / anterior gyrus, the left superior parietal lobe and the right posterior central gyrus / superior parietal lobe was decreased.In addition, the right superior marginal gyrus and bilateral auxiliary motor area in patients with T2DM and FC between the right posterior central gyrus and superior parietal lobules decreased P0.05 AlphaSim correction.涓ょ粍鍙楄瘯鑰呯殑鐏拌川浣撶Н鏃犳槑鏄劇粍闂村樊寮，

本文編號(hào)：1701823