中国神经再生研究(英文版) ›› 2014, Vol. 9 ›› Issue (16): 1548-1556.doi: 10.4103/1673-5374.139482

• 原著:颅神经损伤修复保护与再生 • 上一篇    下一篇

体素形态学揭示2型糖尿病患者脑结构及血管变化:为脑神经保护提供依据

  

  • 收稿日期:2014-05-24 出版日期:2014-08-22 发布日期:2014-08-22

Brain structural changes and their correlation with vascular disease in type 2 diabetes mellitus patients: a voxel-based morphometric study

Chunxia Wang 1, Kailiang Fu 1, Huaijun Liu 1, Fei Xing 1, Songyun Zhang 2   

  1. 1 Department of Medical Imaging, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
    2 Department of Endocrinology, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
  • Received:2014-05-24 Online:2014-08-22 Published:2014-08-22
  • Contact: Huaijun Liu, Department of Medical Imaging, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China, huaijunliu2@126.com.

摘要:

体素形态学方法已用于研究1型糖尿病脑结构的变化,且发现其结构变化与临床指标有相关性。但由于1型糖尿病与2型糖尿病在发病年龄、发病机制及治疗方面均有所不同,因此两者对脑结构的影响也会有所不同,而体素形态学技术用于2型糖尿病脑结构变化的研究还甚少,且研究结果存在差异。因此,我们以体素形态学检测23例2型糖尿病者脑微小结构变化,发现2型糖尿病者全脑总的灰白质体积无明显变化,而局域性的灰、白质萎缩主要位于右颞叶、左枕叶皮质、右颞叶、右小脑半球白质,且2型糖尿病患者周围血管病变与主要位于默认网络的脑区的体积密切相关,其中与右颞叶灰质体积相关性最强的是大血管病变,其次为糖化血红蛋白。以上结果表明,体素形态学可以检测出2型糖尿病者脑微小的结构变化,大血管病变可能在与2型糖尿病相关的脑萎缩中起主要作用,其次是慢性高血糖状态,这些信息可为临床制定干预措施实施神经保护提供依据。

关键词: 神经再生, 糖尿病, 体素形态学, 脑体积, 脑萎缩, 灰质丢失, 大血管病变, 踝肱比值, 微血管病变, 微白蛋白尿, 尿白蛋白肌酐比

Abstract:

Voxel-based morphometry has been used in the study of alterations in brain structure in type 1 diabetes mellitus patients. These changes are associated with clinical indices. The age at onset, pathogenesis, and treatment of type 1 diabetes mellitus are different from those for type 2 diabetes mellitus. Thus, type 1 and type 2 diabetes mellitus may have different impacts on brain structure. Only a few studies of the alterations in brain structure in type 2 diabetes mellitus patients using voxel-based morphometry have been conducted, with inconsistent results. We detected subtle changes in the brain structure of 23 cases of type 2 diabetes mellitus, and demonstrated that there was no significant difference between the total volume of gray and white matter of the brain of type 2 diabetes mellitus patients and that in controls. Regional atrophy of gray matter mainly occurred in the right temporal and left occipital cortex, while regional atrophy of white matter involved the right temporal lobe and the right cerebellar hemisphere. The ankle-brachial index in patients with type 2 diabetes mellitus strongly correlated with the volume of brain regions in the default mode network. The ankle-brachial index, followed by the level of glycosylated hemoglobin, most strongly correlated with the volume of gray matter in the right temporal lobe. These data suggest that voxel-based morphometry could detect small structural changes in patients with type 2 diabetes mellitus. Early macrovascular atherosclerosis may play a crucial role in subtle brain atrophy in type 2 diabetes mellitus patients, with chronic hyperglycemia playing a lesser role.

Key words: nerve regeneration, diabetes mellitus, ankle-brachial index, albuminuria, neural regeneration