DWI技术对2型糖尿病视网膜病变脑部功能损伤的评估价值

Value of DWI in evaluating brain functional damage in type 2 diabetic patients with retinopathy

目的探讨磁共振弥散加权成像(DWI)技术对2型糖尿病(T2DM)视网膜病变脑部功能区域损伤的评估价值。方法 T2DM患者54例分为增殖期糖尿病视网膜病变(A)组、非增殖期糖尿病视网膜病变(B)组和糖尿病无视网膜病变(C)组,每组均为18例;另选择18例健康志愿者作为对照(D)组。运用3.0T磁共振成像系统行脑部DWI,分别测量7个脑相关功能区域的表观扩散系数(ADC)值。结果 A、B组眶额叶皮层、扣带回及视皮层区域ADC值均高于C、D组(P<0.01),A组上述区域ADC值亦高于B组(P<0.01)。A组病程长于C组,A组HbA1c高于C组(P<0.01)。T2DM患者中,HbA1c、病程与眶额叶皮层(r_s=0.408、0.592,P<0.01)、扣带回(r_s=0.384、0.514,P<0.01)及视皮层(r_s=0.292、0.506,P<0.05)的ADC值呈正相关。糖尿病视网膜病变分期与视皮层的ADC值呈正相关(r_s=0.632,P<0.01)。结论脑部视觉中枢ADC值升高提示糖尿病视网膜病变与脑部功能损伤具有一定关联性。DWI技术对评估亚临床阶段糖尿病视网膜病变的脑部相关功能损伤具有一定价值。

Objective To evaluate the role of magnetic resonance diffusion-weighted imaging（DWI）in assessing brain injury in type 2 diabetic patients with diabetic retinopathy.Methods Fifty-four patients with type 2 diabetis mellitus were divided into three groups of A（with proliferative diabetic retinopathy）,B（with non-proliferative diabetic retinopathy）and C（without diabetic retinopathy）with 18 cases each.Eighteen healthy volunteers were taken as the controls（group D）.The apparent diffusion coefficient（ADC）of seven brain-related functional regions was measured by DWI of 3.0 T magnetic resonance imaging system.Results The ADC values of orbitofrontal cortex,cingulated gyrus and visual cortex were higher in groups of A and B than those in groups of C and D（P〈0.01）,which were higher in group A than those in group B（P〈0.01）.The course of disease was longer and HbA1c level was higher significantly in group A than those in group C（P〈0.01）.The course of disease and HbA1c level in diabetic patients were positively correlated to ADC values of the orbitofrontal cortex（rs=0.408 and 0.592,P〈0.01）,cingulated gyrus（rs=0.384 and 0.514,P〈0.01）and visual cortex（rs=0.292 and 0.506,P〈0.05）.Diabetic retinopathy was positively correlated with ADC value of the visual cortex（rs=0.632,P〈0.01）.Conclusion An increase of ADC in the visual center indicates that diabetic retinopathy has a certain relation with brain function damage.DWI technique is valuable in assessing brain-related functional impairments of diabetic retinopathy in subclinical stage.