基于静息态功能磁共振成像探索早期糖尿病肾病对脑功能和认知能力的影响  

Analysis of the Impact of Early Diabetic Kidney Disease on Brain Function and Cognitive Abilities via Resting-state Functional Magnetic Resonance Imaging

作　　者：何淼 季冰 程立庆 欧兰 谢蕤 王健 HE Miao;JI Bing;CHENG Liqing;OU Lan;XIE Rui;WANG Jian(7T Magnetic Resonance Translational Medicine Research Center,Department of Radiology,Southwest Hospital,Army Medical University(third Military Medical University),Chongqing 400038,China;不详)

机构地区：[1]陆军军医大学第一附属医院7T磁共振转化医学研究中心/放射科,重庆400038 [2]陆军军医大学第一附属医院内分泌科,重庆400038

出　　处：《中国医学影像学杂志》2025年第2期133-140,共8页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81971587)。

摘　　要：目的 通过低频振幅(ALFF)联合功能连接(FC)的方法,分析早期肾病并发症对糖尿病患者脑功能的影响。资料与方法 前瞻性纳入陆军军医大学第一附属医院2023年9月—2024年6月39例早期糖尿病肾病患者和49例糖尿病不伴肾病患者,使用蒙特利尔认知评估量表(MoCA)和简易智力状态检查量表(MMSE)行行认知测试。采集静息态功能磁共振成像数据,通过ALFF和FC的方法,分析两组间脑功能的差异。在早期糖尿病肾病组中,对影像差异指标和临床变量进行相关和多元线性逐步回归分析。结果 与糖尿病不伴肾病患者相比,早期糖尿病肾病患者左侧距状裂周围皮质ALFF降低(P<0.05,FWE校正),左侧距状裂周围皮质与左侧豆状壳核FC增强(P<0.05,FWE校正)。在早期糖尿病肾病组中,左侧距状裂周围皮质ALFF值与尿白蛋白/肌酐、总胆固醇呈负相关(r=-0.595、-0.351,P均<0.05),与MoCA、MMSE得分呈正相关(r=0.596、0.591,P均<0.001);左侧距状裂周围皮质与左侧豆状壳核FC,与尿白蛋白/肌酐呈正相关(r=0.552,P<0.001),与MoCA、MMSE得分呈负相关(r=-0.497,P=0.011;r=-0.529,P<0.001)。结论 早期肾病并发症会影响糖尿病患者脑功能及认知能力的改变;左侧距状裂周围皮质ALFF及左侧豆状壳核FC的改变,可能是监测糖尿病肾病患者认知障碍和脑损伤的影像标志物。Purpose To analyze the impact of early renal complication on brain function in diabetes using the amplitude of low frequency fluctuations(ALFF)and functional connectivity(FC).Materials and Methods A total of 39 early diabetic kidney disease patients and 49 diabetic patients without kidney disease were included at the First Affiliated Hospital of Army Medical University from September 2023 to June 2024.Cognitive assessments were conducted using the Montreal cognitive assessment(MoCA)and mini-mental state examination(MMSE).All subjects underwent resting-state functional magnetic resonance imaging.Differences in brain function between the two groups were analyzed by ALFF and FC.In the early diabetic kidney disease group,the correlation and stepwise multiple linear regression analysis were performed between imaging difference indicators and clinical variables.Results In the early diabetic kidney disease patients,there was a decrease in ALFF values in the left calcarine(P<0.05,corrected for FWE),but an increase in FC with the left putamen(P<0.05,corrected for FWE).The ALFF values showed a negative correlation with urinary albumin-to-creatinine ratio and total cholesterol(r=-0.595,-0.351,both P<0.05)and a positive correlation with MoCA and MMSE scores(r=0.596,0.591,both P<0.001).The FC values were positively correlated with urinary albumin-to-creatinine ratio(r=0.552,P<0.001),while negatively correlated with MoCA and MMSE scores(r=-0.497,P=0.011;r=-0.529,P<0.001).Conclusion Early renal complications can affect changes in brain function and cognitive abilities in diabetic patients;alterations in the ALFF of the left calcarine and its FC with left putamen may serve as imaging biomarkers for monitoring cognitive impairment and brain injury in early diabetic kidney disease.

关 键 词：早期糖尿病肾病 静息态功能磁共振成像 低频振幅 功能连接 认知能力 

分 类 号：R587.24[医药卫生—内分泌] R445.2[医药卫生—内科学]