2型糖尿病治疗后近期骨骼肌改变的MR氢谱研究

目的探讨非消瘦2型糖尿病治疗后,MR氢谱(1H MR spectroscopy,1H-MRS)测定骨骼肌细胞内脂质(intramyocellular lipid,IMCL)及细胞外脂质(extramyocellular lipdid,EMCL)相对含量的变化特点,并分析IMCL相对含量与评估胰岛素抵抗指标(HOMA-IR指数)的关系。材料与方法搜集初发非消瘦2型糖尿病患者30例,其中胰岛素联合二甲双胍药物治疗组20例,非药物治疗组10例;健康志愿者10名作对照组。所有受检者分别于第0周(0 d)、2周(14 d)、4周(28 d)行1H-MRS扫描,测定右小腿比目鱼肌内IMCL及EMCL相对含量。期间治疗组每次1H-MRS扫描前测定HOMA-IR指数。利用SPSS17.0统计软件包,对各组IMCL及EMCL前后比较用方差分析或秩和检验,治疗组IMCL与HOMA-IR指数做线性回归分析。结果药物治疗组4周时IMCL相对含量及HOMA-IR指数变化统计学差异有显著性意义(P值分别为0.008、0.015),且对应呈降低趋势。治疗组IMCL相对含量与对应HOMA-IR指数均呈正相关关系。结论 1H-MRS测定的小腿比目鱼肌IMCL可量化、敏感地反映非消瘦2型糖尿病治疗后胰岛素抵抗状态变化,能为临床评估胰岛素抵抗提供帮助。

1H magnetic resonance spectroscopy study on the short term changes of skeletal muscle after treatment in type 2 diabetes mellitus

Objective:To evaluate the changes of intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) at the soleus of right leg by 1H magnetic resonance spectroscopy (1H-MRS) after treatment within 4 weeks and correlate to insulin resistance index (HOMA-IR) in incipient non-thin type 2 diabetes. Materials and Methods:Thirty incipience non-thin type 2 diabetes were collected, and divided into insulin with metformin treatment group (n=20), no-drug treatment group (n=10). Healthy volunteers acted as control group (n=10). All groups were underwent 1H-MRS at the soleus of right leg. IMCL and EMCL were evaluated at 0 days, 14 days (2 weeks), and 28 days (4 weeks). HOMA-IR of treatment group was measured corresponding to duration of 1H-MRS scans. Statistical analysis was performed using SPSS 17.0 package. One-way ANOVA or Kruskal-Wallis test were used to analyze the difference of IMCL and EMCL at each group. Pearson correlations were evaluated between IMCL and HOMA-IR in the treatment group. Results:IMCL and HOMA-IR were obviously reduced in drug treatment group at 4 weeks (P=0.008, 0.015). IMCL in treatment group correlated to HOMA-IR positively. Conclusions:IMCL at soleus evaluated by 1H-MRS of non-thin type 2 diabetes was sensitive and quantiifed to the changes of insulin resistance level during short term treatment.