基于ROI的体积测量和基于顶点的形态学分析对2型糖尿病患者皮层下灰质核团形态改变及其与认知障碍的相关性研究

Subcortical gray matter alterations and their associations with cognitive impairment in patients with type 2 diabetes mellitus by ROI-based volumetric measurements and Vertex-based morphological analysis

目的:探索2型糖尿病(Type 2 diabetes mellitus,T2DM)患者皮层下灰质核团的形态改变特征及其与T2DM患者认知功能减退的关系。方法:招募T2DM患者121例及正常对照56例,进行三维T1加权成像(3D T1WI)扫描,采用基于感兴趣区(Region of interest,ROI)的体积测量法和基于顶点的形态学分析法比较两组灰质核团即伏隔核、尾状核、壳核、杏仁核、苍白球、丘脑和海马的形状及体积差异,并与蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)等认知评估量表得分及糖化血红蛋白(HbA1C)等生化指标做偏相关分析。用受试者工作特征(Receiver operating characteristic,ROC)曲线评价这两种方法对于T2DM患者灰质核团形态改变的诊断价值。结果:基于ROI的体积测量发现T2DM组的左侧尾状核和右侧海马体积较对照组显著减小;基于顶点的形态学分析显示,T2DM组较对照组在双侧尾状核、双侧苍白球、右侧海马及右侧丘脑均出现显著萎缩样形态改变。偏相关分析显示左侧苍白球、右侧丘脑及右侧海马的结构改变与认知量表表现存在相关性。ROC曲线显示,基于顶点的形态学分析法评估T2DM患者灰质核团形态改变的曲线下面积(Area under the curve,AUC)为0.749,显著优于体积测量的0.619(P=0.02)。结论:T2DM患者的灰质核团改变与认知功能衰退相关。基于顶点的形态分析相比基于ROI的体积测量对检测T2DM患者灰质核团的结构改变更敏感,有助于早期发现T2DM患者的认知损伤,从而实现针对性干预和治疗,延缓认知衰退进展。

Objective:To explore the shape change of subcortical gray matter nuclei in patients with type 2 diabetes mellitus(T2DM)and its relationship with cognitive impairment in T2DM patients.Methods:121 patients with T2DM from the endocrine department of our hospital and 56 normal controls were recruited.The shape and volume of gray matter nuclei i.e.accumbens,caudate,putamen,amygdala,pallidus,thalamus and hippocampus between the two groups were compared by region of interest(ROI)-based volumetric measurement and Vertex-based morphological analysis and the results were partially correlated with scores on cognitive assessment scales,such as the Montreal cognitive assessment(MoCA)and biochemical indicators such as glycated hemoglobin(HbA1C).The diagnostic value of these two methods for the changes of gray matter nuclei in patients with T2DM was evaluated using the receiver operating characteristic(ROC)curve.Results:The ROI-based volumetric measurements showed that the left caudate and the right hippocampus were significantly smaller in the T2DM group compared with the control group;Compared with the normal control group,T2DM group showed significant atrophy in the bilateral caudate nucleus,bilateral pallidum,right hippocampus and right thalamus in Vertex-based analysis.Bias correlation analysis showed that structural changes of left pallidum,right thalamus and right hippocampus were significantly correlated with cognitive performance.The ROC curve showed that the area under the curve(AUC)for the Vertex-based morphological analysis method to assess morphological changes in gray matter nuclei in T2DM patients was 0.749,which was significantly better than the 0.619 from volumetric measurements(P=0.02).Conclusion:Gray matter nuclei alterations in T2DM patients were associated with cognitive decline.Vertex-based morphometric analysis is more sensitive than ROI-based volumetric measurements for detecting structural changes in gray matter nuclei in T2DM patients,which helps to detect cognitive impairment in T2DM patients at an early stage,thus enabling targeted interventions and treatments to slow down the progression of cognitive decline.