2型糖尿病血糖水平致慢性脑损害脑区差异的磁共振波谱研究  

Proton MR spectroscopy of chronic brain damage induced by blood-glucose control in type 2 diabetes mellitus

作　　者：梁晓莹 肖叶玉 张萍 陈杰 侯卫武 LIANG Xiao-ying;XIAO Ye-yu;ZHANG Ping;CHEN Jie;HOU Wei-wu(Department of Medical Imaging,The Second Affiliated Hospital of Shantou University Medical College,Guangdong 515041,China)

机构地区：[1]汕头大学医学院第二附属医院医学影像科,广东汕头515041 [2]广州市中西医结合医院医学影像科,广东广州510800 [3]高州市人民医院超声科,广东茂名525200

出　　处：《影像诊断与介入放射学》2022年第1期14-19,共6页Diagnostic Imaging & Interventional Radiology

基　　金：广东省自然科学基金(2018A0303070002);广东省中医药局科研项目(20202141);广州市科技计划项目(202102080665)。

摘　　要：目的采用多体素氢质子磁共振波谱(;H-MRS)定量技术探讨2型糖尿病(T2DM)患者不同脑区代谢物变化与糖化血红蛋白(HbAlc)水平的关系。方法 T2DM患者45例(HbAlc<6.5%组15例、HbAlc 6.5%~7.5%组15例、HbAlc>7.5%组15例)与正常对照34例行多体素;H-MRS扫描后用SAGE与LC-Model软件测定左额叶皮质及左顶叶白质N-乙酰基天门冬氨酸(NAA)/肌酸(Cr)、胆碱复合物(Cho)/Cr与肌醇(mI)/Cr的相对浓度比值,T2DM组与正常组(HC)间各代谢物相对浓度用单因素方差分析及两两比较,T2DM组各代谢物与HbA1c水平作相关分析。结果 (1)T2DM组与HC组间左额叶皮质Cho/Cr及mI/Cr差异有统计学意义(P<0.05,P<0.05)。随着HbAlc水平的升高,T2DM组Cho/Cr较HC组逐渐降低,B、C两组较HC组具有统计学意义(P=0.047,P=0.001)。(2)T2DM组与HC组间左顶叶白质Cho/Cr及mI/Cr差异有统计学意义(P<0.01,P<0.05)。与HC组比较,A~C组Cho/Cr均显著降低(P=0.008,P=0.005,P=0.002)。(3)相关性分析示T2DM患者左额叶皮质Cho/Cr与HbA1c水平呈中度线性负相关(r=-0.453,P<0.01)。结论 HbAlc水平越高,T2DM患者左额叶皮质及顶叶白质多种代谢物变化越明显,且以左额叶皮质Cho/Cr最为明显。Objective To explore the relationship between changes of neural metabolites of different brain regions and hemoglobin A1c(HbA1c) levels in patients with type 2 diabetes mellitus(T2DM) by multi-voxel;H magnetic resonance spectroscopy(;H-MRS).Methods Thirty-four healthy control subjects and 45 patients with T2DM and HbAlc levels of <6.5%(15), 6.5%-7.5%(15), and >7.5%(15)underwent;H-MRS. The relative concentration ratios of n-acetylaspartate(NAA)/creatine(Cr), choline(Cho)/Cr and myoinositol(mI)/Cr in the left frontal cortex and left parietal white matter were determined by SAGE and LC-Model software. One-way ANOVA and pairwise Bonferroni methods were used to compare the relative concentration of metabolites among T2DM groups with different HbAlc levels and healthy control. Spearman correlation analysis was performed among NAA/Cr, Cho/Cr, MI/Cr and levels of HbA1c in T2DM group.Results There were statistically significant differences in Cho/Cr(P<0.05) and mI/Cr(P<0.05) in the left frontal cortex among T2DM groups with different HbA1c levels and healthy control. With increasing HbAlc level, Cho/Cr of the left frontal cortex in T2DM groups gradually decreased(P=0.047) whereas Cho/Cr of patients with HbAlc levels of 6.5%-7.5% and >7.5% decreased more significantly(P=0.001) compared with healthy control. There were statistically significant differences in Cho/Cr( P<0.01) and mI/Cr(P<0.05) in the left parietal white matter among T2DM groups with different HbA1c levels compared with healthy control. Cho/Cr was progressively lower than normal at HbAlc levels of <6.5%(P=0.008), 6.5%-7.5%(P=0.005), and >7.5%(P=0.002). The Cho/Cr in the left frontal cortex was moderately inversely correlated with HbA1c levels(r=-0.453, P<0.01). Conclusion Various metabolites in the left frontal cortex and left parietal white matter change progressively in patients with T2DM and higher HbA1c levels.

关 键 词：2型糖尿病 磁共振频谱 脑部代谢物 糖化血红蛋白 

分 类 号：R587.2[医药卫生—内分泌] R742[医药卫生—内科学]