糖尿病前期及2型糖尿病皮层萎缩与认知功能的相关性研究OA北大核心CSTPCD
Correlation between cortical atrophy and cognitive function in pre-diabetes and type 2 diabetes mellitus
目的 探讨糖尿病前期(pre-diabetes mellitus,PDM)和2型糖尿病(type 2 diabetes mellitus,T2DM)大脑皮层的改变模式及其与认知功能的关系,以期探寻血糖代谢异常被试早期脑损害的影像标志物.材料与方法 本研究纳入96例T2DM患者、30例PDM被试以及48名正常对照(normal control,NC),对被试进行了认知功能测试、临床生化检查及高分辨率3D-T1WI磁共振扫描.使用CAT12软件进行基于体素的形态学分析和基于表面的形态学分析得到全脑灰质体积和皮层厚度、局部回指数等皮层结构参数,并比较3组间的差异,结果均使用P<0.05的阈值和FWE校正进行多重比较校正.进一步提取组间具有差异的参数,与生化指标及认知量表得分进行相关分析.结果 与NC相比,PDM被试右侧额下回眶部及左侧中央后回灰质萎缩(P<0.05,FWE校正),T2DM患者出现更多灰质萎缩,特别是右侧颞上回、右侧额下回眶部、右侧颞中回及左侧中央后回,右侧前额叶皮层厚度减小(P<0.05,FWE校正).在血糖代谢异常被试中全脑灰质体积与胰岛素抵抗指数(r=-0.227,P=0.012,未校正)及连线测试A得分(r=-0.250,P=0.001,FDR 校正)呈负相关,与数字广度-倒背得分呈正相关(r=0.267,P=0.003,FDR校正);皮层厚度与糖化血红蛋白(r=-0.181,P=0.040,未校正)及餐后2 h血糖(r=-0.272,P=0.020,未校正)呈负相关,与餐后2 h胰岛素(r=0.236,P=0.010,未校正)及胰岛β细胞功能指数(r=0.207,P=0.022,未校正)呈正相关.结论 本研究发现PDM人群已存在脑区灰质萎缩,T2DM患者出现更多的灰质萎缩,且与注意和工作记忆功能相关,因此皮层萎缩有可能是糖尿病相关脑损伤早期的影像标志物.
Objective:To explore the change pattern of cerebral cortex in pre-diabetes(PDM)and type 2 diabetes mellitus(T2DM)and its relationship with cognitive function,and explore the early image markers of abnormal blood glucose metabolism.Materials and Methods:This study included 48 normal controls(NC),30 PDM subjects and 96 T2DM patients.Cognitive function test,clinical biochemical examination and high-resolution 3D-T1WI magnetic resonance were performed.The morphological analysis based on voxel and surface was carried out using CAT12 software,and the cortical structural parameters such as the volume of brain gray matter,cortical thickness and sulcus depth were obtained,and the differences among the three groups were compared.The threshold of P<0.05 and FWE correction were used for multiple comparison and correction.Results:Compared to NC,the gray matter volume of right frontal inferior orbital gyrus and left postcentral gyrus of PDM subjects decreased,and the brain gray matter atrophy in T2DM patients,especially the right superior temporal gyrus,right frontal inferior orbital gyrus,the right middle temporal gyrus and the left postcentral gyrus(P<0.05,FWE corrected).Thickness of right prefrontal cortex decreased in T2DM patients(P<0.05,FWE corrected).In the subjects with abnormal blood glucose metabolism,the whole brain gray matter volume is negatively correlated with HOMA-IR(r=-0.227,P=0.012,uncorrected)and Trail Making Test A(r=-0.250,P=0.001,FDR corrected),and positively correlated with the number span-backward(r= 0.267,P=0.003,FDR corrected).Cortical thickness was negatively correlated with hemoglobin A1c(r=-0.181,P=0.040,uncorrected)and postprandial blood glucose at 2 hours(r=-0.272,P=0.020,uncorrected),and positively correlated with postprandial insulin(r=0.236,P=0.010,uncorrected)and HOMA 2-B(r=0.207,P=0.022,uncorrected).Conclusions:In this study,it was found that there was gray matter atrophy in pre-diabetes and global gray matter atrophy in T2DM patients,which was related to attention and working memory function.Therefore,cortical atrophy may be an early imaging marker of diabetes-related brain injury.This suggests that prediabetes subjects should also strictly control blood sugar,and early intervention is beneficial to prevent cognitive impairment and improve prognosis.
李欣;张雯;刘佳妮;傅琳清;缪应雯;张鑫;陈玖;毕艳;张冰
南京大学医学院附属鼓楼医院医学影像科,南京 210008南京大学医学院附属鼓楼医院医学内分泌科,南京 210008
临床医学
2型糖尿病糖尿病前期磁共振成像皮层萎缩认知功能
type 2 diabetes mellituspre-diabetes mellitusmagnetic resonance imagingcortical atrophycognitive function
《磁共振成像》 2024 (004)
9-14,19 / 7
National Natural Science Foundation of China(No.82302172);National Science and Technology Innovation 2030_Major program of"Brain Science and Brain-Like Research"(No.2022ZD0211800);Clinical Trials from the Affiliated Drum Tower Hospital of Nanjing University Medical School(No.2022-LCYJ-PY-15;2022-LCYJ-MS-03). 国家自然科学基金项目(编号:82302172);科技创新 2030—"脑科学与类脑研究"重大项目(编号:2022ZD0211800);南京鼓楼医院临床研究专项资金(编号:2022-LCYJ-PY-15、2022-LCYJ-MS-03)
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