2型糖尿病合并认知功能障碍患者的脑白质结构变化的影像学特征分析

Structural Change Pattern of White Matter Microstructural Integrity in T2DM Cognitive Impairment Patients

目的探讨2型糖尿病(T2DM)合并认知功能障碍(T2DM-CI)患者的脑白质结构变化特征。方法纳入33例T2DM-CI患者(T2DM-CI组)、35例T2DM无合并认知功能障碍患者(T2DM-nonCI组)及43例无DM和认知功能障碍者为对照组。应用MR DTI序列检查,利用图集分割的方法计算脑白质20条纤维束弥散参数,比较组间差异,并与认知功能进行相关性分析。结果3组受试者脑白质纤维束FA值呈下降趋势,MD值呈上升趋势。T2DM-CI组与T2DMnonCI组比较,双侧皮质脊髓束、右侧扣带束海马、脐月氐体体部、腓胱体压部、右侧下额枕束、右侧下纵束的FA值差异有显著性(均P<0.05/20条纤维束)。其中,脐月氐体压部、右侧下纵束与语言功能显著相关;双侧皮质脊髓束,脐月氐体压部与处理速度差异有显著性(均P<0.05)。双侧皮质脊髓束、脐月氐体压部、双侧下额枕束,双侧上纵束的MD值差异有显著性(均P<0.05/20条纤维束)。其中,右侧下额枕束、右侧上纵束与语言功能差异有显著性(均P<0.05)。结论T2DM-CI患者脑白质结构完整性受到破坏,其中脐月氐体压部、下纵束、下额枕束、上纵束损伤可能与T2DM-CI患者语言功能受损相关,皮质脊髓束、脐月氐体压部损伤可能与处理速度受损相关。

Aim To investigate the structural change pattern of white matter microstructural integrity in type 2 diabetes mellitus with cognitive impairment.Methods 33 patients with type 2 diabetes mellitus and cognitive impairment(T2DM-CI),35 patients with T2DM and without cognitive impairment(T2DMnonCI)were enrolled.The atlas-based segmentation was used to obtain the diffusion parameters on 20 fiber tracts and their differences between the groups were compared,and the further correlation analysis was made.Results The fractional anisotropy(FA)value of white matter fiber tracts in 3 groups showed a declining trend,while the MD(mean diffusivity)value showed an escalating trend.The comparison between T2DM-nonCI group and T2DM-CI group showed that there was significant difference of FA value in bilateral corticospinal tract,right cingulum of hippocampus,forceps major,forceps minor,right inferior fronto-occipital fasciculus and right inferior longitudinal fasciculus(all P<0.05/20).Forceps minor and right inferior longitudinal fasciculus were significantly correlated with language function.Bilateral corticospinal tract and forceps minor were significantly correlated with processing speed(all P<0.05).There was significant difference of MD value in bilateral corticospinal tract,forceps minor,bilateral inferior fronto-occipital fasciculus and bilateral.Superior longitudinal fasciculus(all P<0.05/20).Right inferior frontoccipital fasciculus and right superior longitudinal fasciculus were significantly correlated with language function(all P<0.05).Conclusion Microstructural integrity of white matter was damaged in patients with cognitive impairment,and language function was significantly correlated with microstructural integrity of white matter in T2DM-CI.Forceps minor,inferior longitudinal fasciculus,inferior frontooccipital fasciculus and superior longitudinal might caused the language function impaired,and corticospinal tract,forceps minor might correlated with processing speed impaired.