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  • 孟凡华,孙田歌,胡绮莉,等.2型糖尿病患者血糖波动与海马体积萎缩相关性的MR研究[J].同济大学学报(医学版),2021,42(5):645-651.    [点击复制]
  • MENG Fan-hua,SUN Tian-ge,HU Qi-li,et al.Correlation between blood glucose fluctuation and hippocampus volume based on MRI in type 2 diabetes mellitus patients with mild cognitive impairment[J].同济大学学报(医学版),2021,42(5):645-651.   [点击复制]
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2型糖尿病患者血糖波动与海马体积萎缩相关性的MR研究
孟凡华,孙田歌,胡绮莉,李芸菲,赵小虎,邹彪
0
(复旦大学附属上海市第五人民医院放射科,上海200240; 复旦大学社区健康研究中心(筹),上海200240; 复旦大学附属上海市第五人民医院内分泌科,上海200240)
摘要:
目的探讨2型糖尿病(type 2 diabetes mellitus, T2DM)伴轻度认知损伤(mild cognitive impairment, MCI)患者,海马前后部体积改变与血糖波动的相关性。方法选取在复旦大学附属上海市第五人民医院内分泌科住院的92例T2DM患者,以简易精神状态检查量表(mini-mental state examination, MMSE)评分为依据,纳入12例T2DM伴MCI患者(T2DM+MCI组)和按照1:1匹配12例T2DM不伴MCI患者(T2DM组)。采用基于体素形态测量学(voxel-based morphometry, VBM)分析方法,对纳入受试者的MR T1结构像数据进行分割,使用Brainnetome atlas模板将海马分为前后部两部分。比较两组患者双侧海马前后部体积差异,确定海马灰质体积萎缩区域;进一步分析T2DM+MCI组双侧海体积萎缩区与MMSE、动态血糖指标相关性。结果T2DM+MCI组双侧海马后部较对照组明显萎缩(FWE矫正,P<0.001),而双侧海马前部无明显差异;T2DM+MCI组双侧海马后部体积与MMSE评分呈显著正相关(左: r=0.649,P=0.031;右: r=0.614,P=0.046;)。葡萄糖百分比(>13.9 mmol/L)、葡萄糖标准差、有效波动平均幅度和日间血糖平均绝对差在T2DM+MCI组均显著高于T2DM组(P<0.05);T2DM+MCI组葡萄糖标准差、有效波动平均幅度和日间血糖平均绝对差与双侧海马后部体积均呈显著负相关(P<0.05);而葡萄糖百分比(>13.9 mmol/L)仅与左侧海马后部体积呈显著负相关(P<0.05)。结论T2DM伴MCI患者在早期可能以海马后部区域选择性损伤为特点,血糖波动可能是导致其受损的重要因素之一。
关键词:  海马结构  磁共振成像  血糖波动  体素形态测量学
DOI:10.12289/j.issn.1008-0392.21071
投稿时间:2021-03-04
基金项目:上海市闵行区自然科学研究课题(2018MHZ023);上海市科委医学引导类(中、西医)科技支撑项目(18411970300);上海市卫生和计划生育委员会临床研究项目(201840018)
Correlation between blood glucose fluctuation and hippocampus volume based on MRI in type 2 diabetes mellitus patients with mild cognitive impairment
MENG Fan-hua,SUN Tian-ge,HU Qi-li,LI Yun-fei,ZHAO Xiao-hu,ZOU Biao
(Dept. of Radiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China; Center of Community-Based Health Research, Fudan University, Shanghai 200240, China;Center of Community-Based Health Research, Fudan University, Shanghai 200240, China; Dept. of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, China)
Abstract:
ObjectiveTo explore the correlation between the volume changes of anterior and posterior hippocampus and fluctuation of blood glucose in type 2 diabetes mellitus(T2DM) patients with mild cognitive impairment(MCI). MethodsNinety-two T2DM patients admitted in Department of Endocrinology, Shanghai Fifth Peoples Hospital were screened, according to MMSE score, 12 T2DM patients with MCI were recruited as T2DM+MCI group and 12 T2DM patients without were matched as T2DM group. The MRI T1 imaging of subjects were segmented by voxel-based morphometry(VBM), and the anterior and posterior hippocampus volumes were extracted by Brainnetome atlas template. The correlation of cognitive scores(MMSE) and continuous glucose monitoring index with hippocampus volume was analyzed. ResultsThe bilateral posterior hippocampus of T2DM+MCI group atrophied sgnificantly compared with T2DM group(FWE correction, P<0.001), but there were no significant differences between the bilateral anterior hippocampus. The volume of bilateral hippocampus in T2DM+MCI group was positively correlated with MMSE score(left, r=0.649, P=0.031; right, r=0.614, P<0.05). The glucose percentage(>13.9 mmol/L), standard deviation of glucose, mean amplitude of effective fluctuation and mean absolute difference of daytime blood glucose in T2DM+MCI group were significantly higher than those in T2DM group(P<0.05). In T2DM+MCI group the standard deviation of glucose, mean amplitude of effective fluctuation and mean absolute difference of daytime blood glucose were negatively correlated with the left posterior hippocampus volume(P<0.05); while the glucose percentage(>13.9 mmol/L) was negatively correlated with the left posterior hippocampus volume(P<0.05). ConclusionT2DM patients with MCI may have selective impairment of the posterior hippocampus related to memory function in the early stage, and fluctuation of blood glucose may be the primary factor for the impairment.
Key words:  hippocampus  MRI  blood glucose fluctuation  voxel-based morphometry

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