血清胃促生长素水平与2型糖尿病患者认知功能、海马体积及氢质子磁共振波谱变化之间的相关性研究

Association of serum ghrelin level with cognition, hippocampal volume, and proton magnetic resonance spectrum in patients with type 2 diabetes mellitus

目的探讨血清胃促生长素（ghrelin）水平与2型糖尿病（T2DM）患者认知功能、海马体积及氢质子磁共振波谱（[1H]-MRS）变化之间的相关性。方法选取于武汉市第四医院内分泌科就诊的T2DM患者作为研究对象，收集以上所有患者的人口学资料及临床检验指标；采用酶联免疫吸附法（ELISA）检测血清胃促生长素水平；使用蒙特利尔认知评估量表（MoCA）和重复性成套神经心理状态测验量表（RBANS）对所有患者的认知功能进行评定；采用MRI检测海马体积；[^1H]-MRS检测海马代谢产物变化，包括N-乙酰天门冬氨酸（NAA）、胆碱复合物（Cho）、肌醇（MI）、肌酸（Cr）；依据MoCA评分结果将患者分为认知功能障碍组（CI组）和非认知功能障碍组（NCI组），比较以上两组的一般资料、胃促生长素及RBANS量表认知功能评分、海马体积及代谢产物有无差异。结果（1）在T2DM患者中，与NCI组患者相比，CI组患者血清胃促生长素水平下降，双侧海马体积缩小，[^1H]-MRS代谢产物NAA/Cr比值降低，MI/Cr、Cho/Cr比值升高（均P〈0.05）；（2）血清胃促生长素与T2DM患者RBANS量表即时记忆、注意力、延迟记忆、总分以及双侧海马体积、NAA/Cr比值呈正相关，与MI/Cr、Cho/Cr比值呈负相关（均P〈0.05）；（3）经logistic回归分析发现，血清胃促生长素为T2DM认知功能障碍的保护因素（P〈0.05）。结论T2DM伴认知功能障碍患者血清胃促生长素水平降低，并且与认知功能评分、海马体积以及[^1H]-MRS代谢产物之间存在一定的相关性，提示胃促生长素可能参与了T2DM患者认知功能障碍的发生及发展过程。

ObjectiveTo investigate the association of serum ghrelin level with cognition, hippocampal volume, and proton magnetic resonance spectrum （[^1H]-MRS） in patients with type 2 diabetes mellitus（T2DM）.MethodsThe T2DM patients cared at the Wuhan Fourth Hospital were recruited. Data on demographic characteristics and clinical parameters were collected. Ghrelin was measured by ELISA assay. Cognitive performance was assessed by the Montreal Cognitive Assessment （MoCA） and Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）. The changes of metabolites in hippocampus were detected by [^1H]-MRS, including N-acetyl asparate （NAA）, choline （Cho）, myo-inositol （MI）, creatine （Cr）. All patients were divided into 2 groups[cognitive impairment （CI） and non-cognitive impairment （NCI） groups] by MoCA.Results（1） Compared with patients in NCI group, the serum ghrelin level, bilateral hippocampal volume, and NAA/Cr ratio of [^1H]-MRS metabolites in CI group were decreased, but MI/Cr and Cho/Cr ratios were increased（all P〈0.05）. （2） Serum ghrelin was positively correlated with a variety of RBANS scores （including immediate memory, attention, delayed memory, and total scores）, bilateral hippocampal volume, and NAA/Cr ratio of [^1H]-MRS metabolites in T2DM patients, but it was negatively correlated with MI/Cr ratio and Cho/Cr ratio （all P〈0.05）. （3） Logistic regression analysis showed that ghrelin was a protective factor of cognition in T2DM patients.ConclusionsT2DM patients with cognitive impairment had lower levels of ghrelin, and serum ghrelin was postively correlated with their cognitive performance, hippocampal volume, and [^1H]-MRS metabolites, suggesting that serum ghrelin may be involved in the occurrence and development of cognitive dysfunction in patients with T2DM.