早期胰岛素强化治疗对2型糖尿病患者海马N-乙酰天门冬氨酸复合物、胆碱复合物表达的影响  

Effects of early intensive insulin therapy on hippocampal N-acetylaspartate and choline compound expression in patients with type 2 diabetes mellitus

作　　者：张苏皖[1] 戴武[1] 张继[2] 王松[2] 廖芳芳[3] 叶军[1] 曹永红[1] 刘燕[1] 汪运生[1] 章容[1] 匡蕾[1] 邹玲玲[1] 

机构地区：[1]安徽医科大学附属合肥医院合肥市第二人民医院内分泌科,安徽合肥230011 [2]安徽医科大学附属合肥医院合肥市第二人民医院磁共振室,安徽合肥230011 [3]安徽医科大学附属合肥医院合肥市第二人民医院院感科,安徽合肥230011

出　　处：《中国医学影像技术》2015年第11期1625-1629,共5页Chinese Journal of Medical Imaging Technology

基　　金：安徽省2012年度科技厅重点科研项目(12070403043)

摘　　要：目的探讨对初诊2型糖尿病患者行胰岛素强化治疗对海马N-乙酰天门冬氨酸复合物(NAA)/肌酸(Cr)、胆碱复合物(Cho)/肌酸(Cr)的长期影响。方法将58例初诊2型糖尿病患者随机分为2组,实验组29例予以早期胰岛素强化治疗,对照组29例予以常规口服降糖药物。于治疗前和1年后分别检测空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbAlc),并行胰岛素、C肽释放试验,计算C肽曲线下面积(AUCc-p)、HOMA-β细胞功能指数(HOMA-β)和HOMA-胰岛素抵抗指数(HOMA-IR),应用1 H-MRS检测左、右海马区NAA/Cr、Cho/Cr。结果治疗前实验组与对照组比较,FPG、2hPG、HbAlc,AUCc-p、HOMA-β、HOMA-IR,双侧海马NAA/Cr、Cho/Cr,差异均无统计学意义(P均>0.05)。治疗后1年实验组与对照组比较,FPG、2hPG、HbAlc差异均无统计学意义(P均>0.05);AUCc-p升高(P<0.05),HOMA-IR降低(P<0.05),HOMA-β差异无统计学意义(P>0.05);双侧海马NAA/Cr均升高(P均<0.05),Cho/Cr均降低(P均<0.05)。结论对2型糖尿病患者早期胰岛素强化治疗可影响海马NAA、Cho表达,并有一定的长期缓解作用,其机制可能与胰岛素抵抗改善有关。Objective To explore the long-term effects of early intensive insulin therapy to hippocampal spectroscopy parameters,such as the ratios between N-acetylaspartate（NAA）or choline compound（Cho）and creatine（Cr,NAA/Cho and NAA/Cr）in newly diagnosed type 2diabetic patients.Methods Totally 58 patients of newly diagnosed type 2diabetes were randomly divided into 2groups,including 29 cases in experiment group underwent early intensive insulin therapy and29 cases in control group underwent conventional therapy of oral hypoglycemic drugs.The glucose parameters included fasting plasma glucose（FPG）,2-hour postprandial glucose（2hPG）and glycosylated hemoglobin（HbAlc）,as well as the indexes of insulin and C-peptide release test included area under the curve of C-peptide（AUCc-p）,HOMA-beta cell function index（HOMA-β）and HOMA-insulin resistance index（HOMA-IR）were obtained before treatment and 1year after treatment,respectively.MR spectroscopy was also performed at the same time.The parameters of NAA/Cr and Cho/Cr in bilateral hippocampus were detected.Results Before treatment,there was no statistical difference of FPG,2h PG,HbAlc,AUCc-p,HOMA-β,HOMA-IR,bilateral NAA/Cr and Cho/Cr between experiment group and control group（all P〈0.05）.One year after treatment,the AUCc-p of experiment group was higher than that of control groups（P〈0.05）,while the HOMA-IR of experiment group was lower than that of control groups（P〈0.05）.No statistical difference of FPG,2hPG,HbAlc and HOMA-βwas found between the two groups（all P〉0.05）.NAA/Cr in bilateral hippocampus of experiment group was higher than that of control groups（both P〈0.05）,while the Cho/Cr of experiment group was lower than that of control groups（both P〈0.05）.Conclusion Early intensive insulin therapy can affect the expression of hippocampal NAA and Cho in patients with type 2diabetes mellitus for long term.The mechanism may be related with the recovery from insulin resistance.

关 键 词：糖尿病 2型 胰岛素强化 海马 胰岛素抵抗 磁共振波谱 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]