内嗅皮质萎缩评价糖尿病患者认知功能

Atrophy of entorhinal cortex in evaluation of cognitive performance in patients with diabetes mellitus

目的探讨2型糖尿病(T2DM)伴轻度认知功能损害(MCI)患者与单纯T2DM患者、健康对照者间各脑区皮质体积的差异,并分析其与认知下降的关联程度。方法收集30例单纯T2DM患者、30例T2DM伴MCI患者和30名健康对照者,通过高分辨率MR T1WI采集大脑结构像数据,应用FreeSurfer软件处理获得各脑区体积参数。3组间各脑区体积的比较采用方差分析,对差异有统计学意义的脑区与心理学量表进行相关分析。结果 T2DM与T2DM伴MCI患者的听觉词语学习测验、复杂图形20min回忆测验、数字符号编码测验、连线测验A、连线测验B、蒙特利尔认知评估量表分数差异有统计学意义(P均<0.05)。与T2DM患者比较,T2DM伴MCI患者的左侧内嗅皮质、左侧外侧眶额皮层、左侧后扣带回皮质、右侧外侧眶额皮质、右侧眶部皮质、右侧岛叶皮质体积均降低(P均<0.05);T2DM伴MCI患者的左侧内嗅皮质体积与听觉词语学习测验评分(即刻)呈正相关(r=0.452,P=0.018)。结论 T2DM伴MCI患者出现多个脑区皮质体积降低,其中左侧内嗅皮质体积可作为诊断和衡量T2DM伴MCI的潜在生物学指标。

Objective To evaluate the potential cerebral cortical volume alterations in type 2 diabetes mellitus （T2DM） patients with mild cognitive impairment （MCI） compared with T2DM patients and healthy controls, and to observe the correlations with the scores of neuropsychological scales. Methods Cortical volume based on high-resolution MR TIWI data from 30 healthy controls （HC）, 30 T2DM patients and 30 T2DM with MCI patients were evaluated with FreeSurfer software and compared with variance analysis. The correlations between cerebral cortical volume which had statistical difference and the scores of neuropsychological scales were analyzed. Results There were significant differences in auditory verbal learning test （AVLT） scores, complex figure test-delayed recall （20 rain） scores, digit symbol-coding subtest scores, MoCA scores and higher trail-making tesvA scores, as well as trail-making test-g scores between T2DM and T2DM with MCI patients （all P〈0.05）. Compared with T2DM patients, cortical volume of left entorhinal cortex, left lateral orbitofrontal gyrus, left posterior cingulate gyrus and the right lateral orbitofrontal gyrus, right pars orbitalis, right insula reduced in T2DM with MCI patients （all P〈0.05）. In T2DM with MCI patients, AVLT scores were positively correlated with volume of the left entorhinal cortex （r=0. 452, P=0. 018）. Conclusion Several cortical volume reductions are exhibited in T2DM patients with MCI. The volume of the left entorhinal cortex may be a potential biomarker to diagnose and evaluate MCI in T2DM.