2型糖尿病PET/CT脑葡萄糖代谢统计参数图分析

SPM analysis of cerebral glucose metabolism with PET/CT in type 2 diabetes mellitus

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者脑葡萄糖代谢的分布特点。方法:回顾性分析47例已被临床确诊且无明显脑损伤的T2DM患者,选取健康体检者62例作为健康对照(healthy control,HC)组,运用统计参数图(statistical parametric mapping,SPM)对两组脑部18氟-脱氧葡萄糖(18Fluoro-2-deoxyglucosel,18F-FDG)正电子发射断层显像/计算机断层扫描(positron emission tomography/computed tomography,PET/CT)显像资料进行基于体素水平的两独立样本t检验,获得有脑葡萄糖代谢差异区域的Talairach坐标值及相对应的脑区。结果:T2DM患者脑PET/CT成像显示区域性脑葡萄糖代谢异常模式,大脑额顶叶认知皮层葡萄糖代谢减低,而广泛的脑白质区域葡萄糖代谢增高,与HC组相比,差异均有统计学意义(P<0.001)。结论:与炎症反应有关的脑白质代谢增高加重T2DM患者脑白质损伤,同时小脑后叶认知皮层局部葡萄糖代谢增高,可能对大脑认知皮层有负反馈作用。这一特定区域脑葡萄糖代谢差异模式,为T2DM认知障碍的研究提供物质基础。

Objective:To investigate the distribution of glucose metabolism in the brain of type 2 diabetes mellitus(T2 DM).Methods:Retrospective analysis was performed on 47 patients with T2 DM who had been clinically confirmed and had no significant brain injury,62 healthy persons were selected as healthy control(HC)group.Statistical parametric mapping(SPM)was used to analyze18 Fluoro-2-deoxyglucosel(18 F-FDG)positron emission tomography/computed tomography(PET/CT)imaging data in the brain of two groups,two independent sample t-test based on voxel level was performed.Talairach coordinate values and corresponding brain regions with different cerebral glucose metabolism were obtained.Results:Brain PET/CT imaging of T2 DM patients showed regional abnormal patterns of cerebral glucose metabolism,decreased glucose metabolism in the cognitive cortex of the frontal and parietal lobes of the brain,and increased glucose metabolism in the extensive white matter region,all of which showed statistically significant differences compared with HC group(P<0.001).Conclusion:Increased white matter metabolism related to inflammatory response may aggravate white matter damage in T2 DM patients,while hypermetabolism in the cognitive gray matters of the posterior cerebellum may have a negative feedback effect on the cerebral cognitive cortex.This specific regional differential pattern of cerebral glucose metabolism provides a material basis for the study of cognitive impairment in T2 DM.