氢质子磁共振波谱技术对2型糖尿病合并急性脑梗死患者脑内代谢物变化的评估

Quantitative evaluation of brain metabolic changes in patients with acute cerebral infarction and type 2 diabetes mellitus using proton magnetic resonance spectroscopy

目的应用氢质子磁共振波谱(1H-MRS)技术检测2型糖尿病合并急性脑梗死梗塞侧及对应健侧代谢特点。方法应用1.5T MRI扫描仪对2型糖尿病合并急性脑梗死患者24例(DMCI组)、单纯急性脑梗死患者23例(CI组)与健康志愿者26例(HC组)均进行1H-MRS检测,测量大脑白质梗死侧及对应健侧的N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱化合物(Cho)/肌酸(Cr)、乳酸(Lac)/肌酸(Cr)比值。结果 DMCI组和CI组梗死灶的NAA/Cr比值较HC组降低,DMCI组梗死侧NAA/Cr比值较CI组降低,DMCI组梗死侧的NAA/Cr比值较对应健侧降低,并且该组健侧与HC组相比,NAA/Cr比值降低。NAA/Cr水平与空腹血糖(FBG)和糖化血红蛋白(HbA1c)水平呈负相关。Cho/Cr比值在3组之间无明显差异,DMCI组和CI组梗死区域可检测到Lac峰,且DMCI组Lac/Cr比值较CI组升高。结论 2型糖尿病的存在可加重急性脑梗死患者神经元的损伤。2型糖尿病患者脑组织在未出现梗塞灶之前可能已存在神经元受损。

Objective To investigate the possible cerebral metabolic changes in the infarcted side and contralateral side in patients with type 2 diabetes mellitus and acute cerebral infarction using proton magnetic resonance spectroscopy （1H-MRS）. Methods 24 patients with type 2 diabetes mellitus and acute cerebral infarction （DMCI group）, 23 patients with acute cerebral infarction （CI group） and 26 healthy controls （HC group） were scanned with a 1.5-T MRI/MRS imager. The levels of N-acetylaspartate （NAA）, Choline （Cho） and lactate （Lac） were detected and the ratios of NAA/Cr, Cho/Cr and Lac/Cr were calculated. Results Cerebral NAA/Cr ratio in the infarcted side of CI group and DMCI group was lower than that in the HC group. There was a significant decrease in NAA/Cr ratio in the infarcted side of the DMCI group as compared to CI group. Cerebral NAA/Cr ratio in the infarcted side was lower than that in the contralateral side of the DMCI group, and NAA/Cr ratio in the contralateral side of the DMCI group tended to be lower than that in the HC group. Lac/Cr ratio in the DMCI group and CI group increased in the infarcted side compared to that in the HC group, and the Lac/Cr rataio in the infarcted side of DMCI group was higher than that in the CI group. HbA1c and FBG levels were negatively correlated with NAA/Cr ratio in the DMCI group. Conclusion Type 2 diabetes may be associated with serious neuron damage in cerebral infarction, and it may cause cerebral damage in the white matter before the occurrence of infarction. 1H-MRS is useful in exploring the pathophysiologic mechanism of diabetes mellitus complicated with acute cerebral infarction.