【摘要】：目的:尿微量白蛋白檢測(cè)是診斷早期糖尿病腎病較為敏感、可靠的手段。在糖尿病患者中,MAU的出現(xiàn)不僅提示腎小球的損害,而且是全身血管內(nèi)皮細(xì)胞功能障礙的標(biāo)志。氫質(zhì)子磁共振波譜(1H-MRS)是一種無(wú)創(chuàng)性活體神經(jīng)生化分析技術(shù),可以在常規(guī)影像學(xué)出現(xiàn)明顯異常改變之前,通過(guò)對(duì)組織代謝物濃度進(jìn)行動(dòng)態(tài)觀察和定量分析,反映腦組織局部的代謝異常變化,對(duì)早期發(fā)現(xiàn)腦組織異常改變具有重要價(jià)值。本研究采用1H-MRS技術(shù)檢測(cè)2型糖尿病(T2DM)患者腦組織代謝改變,探討T2DM患者M(jìn)AU與大腦額葉皮層和半卵圓中心區(qū)域內(nèi)N-乙酰天門(mén)冬氨酸(NAA)、肌醇(MI)及膽堿化合物(Cho)水平的關(guān)系,推測(cè)其中的病理生理機(jī)制。方法:選取2013年12月至2014年12月于我院住院治療的T2DM患者61例,所有入組病例經(jīng)常規(guī)磁共振掃描,腦組織結(jié)構(gòu)均未見(jiàn)異常改變。采用問(wèn)卷調(diào)查及靜脈血液學(xué)檢測(cè)獲得受試對(duì)象的一般臨床資料。留取10h尿標(biāo)本,用放免法測(cè)定尿白蛋白含量,根據(jù)尿白蛋白排泄率(UAER)分為單純糖尿病組(DM組,n=29)和微量白蛋白尿組(DA組,n=32)。選取志愿者20例作為健康對(duì)照組(HC組)。采用氫質(zhì)子磁共振波譜(1H-MRS)技術(shù)對(duì)大腦前額葉皮層、左側(cè)半卵圓中心區(qū)域進(jìn)行分析研究,以肌酸(Cr)為內(nèi)部參考值,檢測(cè)NAA/Cr、MI/Cr及Cho/Cr比值。結(jié)果:三組間年齡、性別分布、血壓水平、BMI、血脂、尿素氮、肌酐均未見(jiàn)明顯差異。DA組、DM組之間FPG、PPG、HbA1c水平無(wú)差異,均顯著高于HC組。DA組UAER水平高于DM組和HC組。DA組和DM組糖尿病病程相比較有統(tǒng)計(jì)學(xué)差異。額葉皮層區(qū)域:DA組NAA/Cr值較DM組、HC組降低,DM組較HC組降低;Cho/Cr在三組中無(wú)顯著差異;MI/Cr值DA組較HC組升高。半卵圓中心區(qū)域:DA組NAA/Cr值低于HC組;DM組Cho/Cr值較HC組升高有顯著差異,DA組較DM組降低,但無(wú)統(tǒng)計(jì)學(xué)意義;MI/Cr值在DA組較DM組、HC組升高,DM組與HC組無(wú)顯著差異。DA組在前額葉皮層區(qū)域NAA/Cr值與UAER水平呈負(fù)相關(guān)性(r=-0.686,P=0.026)。結(jié)論:T2DM患者相關(guān)腦組織區(qū)域內(nèi)NAA水平較健康人群降低,MI、Cho較健康人群升高,提示腦組織代謝發(fā)生異常改變。分析數(shù)據(jù)顯示合并MAU的糖尿病患者腦組織代謝異常更為明顯,中樞神經(jīng)系統(tǒng)損害更為嚴(yán)重,可能由于合并腎小球病變的2型糖尿病患者,糖代謝紊亂持續(xù)時(shí)間更長(zhǎng),個(gè)體易感因素更加敏感,血管內(nèi)皮通透性增加明顯。同時(shí),外界毒素通過(guò)受損的內(nèi)皮細(xì)胞入侵,進(jìn)一步導(dǎo)致神經(jīng)元功能性障礙。本研究中波普數(shù)據(jù)顯示T2DM患者在額葉皮層區(qū)域NAA/Cr值下降較為明顯,而在半卵圓中心區(qū)域MI/Cr值升高較為顯著,推測(cè)可能與研究人群與選取的腦區(qū)域組織結(jié)構(gòu)不同所致。其中的病理生理變化考慮為腦細(xì)胞因高血糖影響或炎癥刺激,出現(xiàn)神經(jīng)元功能下降、凋亡,細(xì)胞膜降解增加和神經(jīng)纖維脫髓鞘及膠質(zhì)細(xì)胞數(shù)目的增加等有關(guān)。
[Abstract]:Objective: the detection of urinary microalbumin is a sensitive and reliable method for the diagnosis of early diabetic nephropathy. In diabetic patients, the appearance of MAU not only indicates glomerular damage, but also is a sign of systemic vascular endothelial cell dysfunction. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive neurobiochemical analysis technique in vivo. it can reflect the local metabolic abnormalities of brain tissue by dynamic observation and quantitative analysis before the obvious abnormal changes in conventional imaging. It is of great value for the early detection of abnormal changes in brain tissue. In this study, 1H-MRS technique was used to detect the metabolic changes of brain tissue in patients with type 2 diabetes mellitus (T2DM). The relationship between MAU and the levels of N-acetylaspartate (NAA), inositol (MI) and choline compound (Cho) in the frontalis dermis and semicircular center of the brain in T2DM patients was investigated, and the pathophysiological mechanism was speculated. Methods: 61 patients with T2DM hospitalized in our hospital from December 2013 to December 2014 were selected. All the patients in the group had no abnormal changes in brain tissue structure by conventional magnetic resonance imaging (MRI). The general clinical data of the subjects were obtained by questionnaire and venous hematology. Urine albumin content was measured by radioimmunoassay. According to urinary albumin excretion rate (UAER), it was divided into simple diabetic group (DM group, n 鈮，

本文編號(hào)：2500436