2型糖尿病相关执行功能网络改变特征——静息态功能磁共振研究

Executive dysfunction and altered cerebral functional network in type 2 diabetes mellitus:a study of resting-state functional MRI

目的:本研究应用神经心理学测验与静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-fMRI)分析2型糖尿病(type 2 diabetes mellitus,T2DM)患者执行功能损伤及相关脑功能网络改变。方法:对39例T2DM患者和32例健康对照完善神经心理学测验,分别应用Stroop色词试验、连线试验、语音流畅性及数字广度测试评价执行功能中抑制、定势转换、任务启动和工作记忆四个成分。应用rs-fMRI提取两组被试的默认网络、凸显网络、背侧注意网络及执行控制网络,进行统计学比较并分析静息态功能连接(resting-state functional connectivity,rs-FC)与执行功能的相关性。结果:T2DM组与对照组的总体认知功能无显著差异(MMSE:T2DM组:28.30±0.27,对照组:28.84±0.26,P=0.156;Mo CA:T2DM组:25.08±0.32,对照组:26.13±0.43,P=0.050)。T2DM患者抑制和定势转换功能较对照组显著降低(抑制:T2DM组:-45.79±3.24,对照组:-32.40±2.85,P=0.004;定势转换:T2DM组:-52.23±5.02,对照组:-30.63±4.00,P=0.002),但任务启动和工作记忆功能无显著差异(任务启动:T2DM组:6.03±0.33,对照组:6.94±0.42,P=0.089;工作记忆:T2DM组:6.10±0.34,对照组:6.5±0.43,P=0.421)。与对照组相比,T2DM组的默认网络和执行控制网络的网络内rs-FC减低,而凸显网络rs-FC增强。T2DM患者抑制功能与默认网络及执行控制网络的rs-FC呈显著正相关,定势转换功能则与默认网络的rs-FC相关。结论:本研究表明T2DM患者可以在总体认知功能正常阶段即出现执行功能损伤,并且执行功能与脑网络rs-FC改变相关。

Objective To investigate the executive dysfunction and related alteration of cerebral functional network in patients with type 2 diabetes mellitus(T2DM)with neuropsychological assessments and resting-state functional magnetic resonance imaging(rs-fMRI).Methods Thirty-nine T2DM patients and thirty-two healthy controls(HCs)were included.The Stroop word color test,Trail making test,Phonemic Fluency,and Digital span test were used to evaluate inhibition,shifting,initiation and working memory,respectively.The default mode network(DMN),salience network(SN),dorsal attention network(DAN)and executive control network(ECN),were extracted with rs-fMRI.Results There was no significant difference in the global cognition between two groups(MMSE:T2DM:28.30±0.27,HC:28.84±0.26,P=0.156;MoCA:T2DM:25.08±0.32,HC:26.13±0.43,P=0.050).The patients with T2DM showed impairment in inhibition and shifting(Inhibition:T2DM:-45.79±3.24,HC:-32.40±2.85,P=0.004;Shifting:T2DM:-52.23±5.02,HC:-30.63±4.00,P=0.002).There was no significant difference in initiation and working memory(Initiation:T2DM:6.03±0.33,HC:6.94±0.42,P=0.089;working memory:T2DM:6.10±0.34,HC:6.5±0.43,P=0.421).Compared to the NC group,the T2DM group showed decreased functional connectivity(FC)in DMN and ECN,and increased FC in SN.The performance in inhibition was positively correlated with the rs-FC in DMN and ECN,while the shifting was positively correlated with the rs-FC in DMN.Conclusion These findings suggest that the executive dysfunction could occur at the stage of normal global cognition,and correlate with alteration of rs-FC in T2DM.