2型糖尿病患者认知功能与脑磁共振质子波谱研究

目的 探讨2型糖尿病患者认知功能改变特点及与脑磁共振质子波谱的相关性.方法 对2007年10月至2008年10月就诊于同济大学附属上海东方医院及上海浦东新区周家渡社区、北蔡社区所有志愿者进行一般资料及既往史资料收集,空腹10 h后行血糖、糖化血红蛋白及血脂检测,并进行尿常规及血压检查,日常生活能力量表、全面衰退量表及汉密尔顿抑郁量表评分,对其中的84例2型糖尿病患者及对照者进行1∶1配对研究.运用简易智能精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MOCA)进行认知功能测查.3.0 TMR成像系统分别行左侧海马及左侧基底节单体素质子波谱(STEAM序列)采集.分析N-乙酰天冬氨酸(NAA)、含胆碱复合物(Cho)、肌酸复合物(Cr)、肌醇(mI)及谷氨酸复合物-α(Glx-α)代谢物峰下面积变化,并将代谢物峰下面积与2型糖尿病患者MOCA量表中的分项指标评分进行Spearman's相关性分析,组间比较采用Wilcoxon符号秩和检验.两组分析采用配对t检验.结果 2型糖尿病组MMSE和MOCA的中位数(四分位数间距)分别为26.00(5.00)和19.50(7.00),低于对照组的29.00(3.00)和23.50(5.00),组间差异均有统计学意义(均P＜0.05).2型糖尿病组左侧海马Cr、mI、Glx-α峰下面积[分别为96.40(201.00)、71.25(98.90)、57.40(108.10)]高于对照组[分别为53.20(51.50)、40.15(62.25)、45.20(40.50)],组间差异均有统计学意义(P均＜0.05).左侧海马NAA、Cho峰下面积[分别为85.20(113.78)、62.90(111.28)]与对照组左侧海马[分别为62.00(69.45)、53.95(42.08)]比较,差异均无统计学意义(P均＜0.05).2型糖尿病组中,左侧海马Cr峰下面积绝对值与视觉执行能力(r=-0.219,P=0.031)、语言功能(r=-0.239,P=0.018)及记忆(r=-0.268,P=0.009)的评分呈负相关.结论 2型糖尿病可损害认知功能.运用1H-MRS检测发现2型糖尿病患者左侧海马存在代谢物质的改变,表现为Cr、mI及Glx-α值的升高.其中Cr峰值的?

Study of cognitive function and 1H-MRS in patients with type 2 diabetes mellitus

Objective To investigate the relationship between cognitive function and cerebral metabolic changes measured by proton magnetic resonance spectroscopy in patients with type 2 diabetes.Mini-mental state examination (MMSE) and the Montreal Cognitive Assessment Scale (MOCA) were used for assessment. STEAM 1H-MRS was performed in the left hippocampus and left basal ganglia on 3.0 T MR.Metabolic peaks of N-acetylasparte (NAA), creatine (Cr), choline-containing compounds (Cho), myoinositol (mI)and glutamate complex-α (Glx-α) were analyzed. We studied the correlation between the metabolic peak areas and the sub-scale indicators of MOCA in those patients. Enumeration data between the type 2 diabetes group and the control group were assessed by Wilcoxon test. Results In both MMSE and MOCA, the scores in type 2 diabetes group (median (interquartile range) are 26.00 (5.00) and 19. 50(7.00)) were significant lower than those in control group (29.00(3. 00) and 23.50(5.00), P ＜0. 05).In the left hippocampus, the peak areas of Cr, mI and Glx-α in type 2 diabetes group (median(interquartile range) were 96. 40(201.00), 71.25 (98.90) and 57.40 (108. 10)) were significant higher than those in control group (53.20(51.50) ,40. 15(62.25) and 45.20(40.50, P＜0.05). The reruas no significant differences in peak areas of NAA and Cho statistic different between the two groups (P ＞ 0. 05). The following parameters demonstrated close relationship with the peak area of Cr in the left hippocampus of patients with type 2 diabetes: execute and vision score (r = -0. 219, P =0. 031), language score (r = -0.239,P=0.018) and memory score (r= -0.268,P=0.009). Conclusions Type 2 diabetes mellitus may damage the cognitive function. The metabolic abnormalities exist in the left hippocampus of patients with type 2 diabetes. The close relationships exist between the peak area of Cr and the cognitive dysfunction in patients with type 2 diabetes.