糖尿病视网膜病变对2型糖尿病患者脑损伤的预测价值

Predictive value of diabetic retinopathy to brain damage in patients with type 2 diabetes mellitus

目的研究糖尿病视网膜病变(DR)患者的脑组织损伤。方法选取合并视网膜病变的2型糖尿病患者27例(DM组)以及健康对照组24例(HC组),所有研究对象行氢质子磁共振波谱(1H-MRS)以及扩散加权成像(DWI)检查。感兴趣区域(ROIs)定位于颅脑左侧额叶白质、左侧豆状核以及左侧视辐射区。计算ROIs内N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱化合物(Cho)/肌酸(Cr)、肌醇(MI)/Cr以及NAA/Cho值,并测量表观扩散系数(ADC)。结果 DM组额叶白质NAA/Cr、NAA/Cho值均低于HC组(P<0.05),豆状核NAA/Cr值低于HC组(P<0.05);视辐射区NAA/Cho值低于HC组,MI/Cr值高于HC组(P<0.05)。DM组额叶白质NAA/Cr值与糖化血红蛋白(HbA1c)水平呈负相关(r=-0.652,P<0.05),视辐射区MI/Cr与Cho/Cr值呈正相关(r=0.520,P<0.05)。DM组所有ROIs内ADC值均高于HC组(P<0.05)。结论糖尿病视网膜病变患者存在早期脑组织损伤,临床医师应采取干预措施,预防严重的脑血管疾病的发生。

Objective To investigate the brain damage in patients with diabetic retinopathy （ DR） .Methods Twenty-seven type 2 diabetes mellitus （ T2DM） patients with retinopathy （ DM group） and twenty-four healthy controls （ HC group） were selected.Proton magnetic resonance spectroscopy （1H-MRS） and diffusion-weighted imaging （DWI） were performed on all the participants.Regions of interest （ ROIs） were located in the left frontal white matter, left len-ticular nucleus, and left optic radiation.N-acetylaspartate （ NAA）/creatine （ Cr）, Choline （ Cho）/creatine （ Cr）, myo-inositol （ MI）/Cr, and NAA/Cho ratios and ADC values of all the ROIs were obtained.Results In the frontal white matter, NAA/Cr and NAA/Cho ratios were lower in the DM group than in the HC group （P〈0.05）.In the len-ticular nucleus, NAA/Cr ratios were lower in the DM group than in the HC group （P〈0.05）.In the optic radiation, NAA/Cho ratios in the DM group were decreased, while MI/Cr values were increased compared with those in the HC group （P〈0.05）.In the DM group, NAA/Cr ratios in the frontal white matter were negatively correlated with glycosy-lated hemoglobin （HbA1C） levels （r=-0.652, P〈0.05）.In the optic radiation, MI/Cr ratios were positively correlated＆nbsp;with Cho/Cr values （r=0.520, P〈0.05） in the DM group.ADC values in the DM group were significantly higher than those in the HC group （P〈0.05）.Conclusion Patients with DR are accompanied with early brain injury and cli-nicians should take measures to prevent the occurrence of severe cerebrovascular diseases.