2型糖尿病脑灌注及糖尿病视网膜氧张量的相关性

Correlation between Cerebral Perfusion and Retinal Oxygenation Response of Diabetic Retinopathy in Type 2 Diabetes Mellitus

目的研究不合并高血压的2型糖尿病不同分期糖尿病视网膜病变患者与正常对照组磁共振脑灌注差异性及磁共振视网膜氧张量改变,分析各组有差异的脑灌注参数与视网膜氧张量相关性。方法选取2017年6月至2019年12月云南大学附属医院内分泌科及眼科收治的2型糖尿病患者34例,其中糖尿病视网膜病变增殖期组(Proliferative stage of diabetic retinopathy,PDR)10例及无视网膜病变糖尿病组(Non diabetic retinopathy,NDR)24例,收集正常对照组(Normal control,NC)21例,所有研究对象均排除高血压。行磁共振头颅平扫、磁共振血管成像、吸氧前、后磁共振双侧眼球3D T1WI扰相梯度回波序列、脑动态磁敏感对比增强灌注成像扫描。Student t检验分析各组参数差异,运用Pearson分析各组相对脑血流量(Relative cerebral blood flow,rCBF)值与PDR组、NDR组颞侧、鼻侧、视盘区视网膜氧张量(△P0_(2))相关性。结果PDR组左侧颞下回、双侧扣带回rCBF低于NDR组及NC组,差异有统计学意义(P<0.05)。PDR组右侧颞下回、左侧枕叶、左侧扣带回相对脑血流容量(Relative cerebral blood volume,rCBV)低于NDR组及NC组(P<0.05),右侧海马旁回PDR组高于NDR组及NC组(P<0.05);PDR组左侧颞下回、左侧小脑半球、双侧额中回平均通过时间(mean transmit time,MTT)高于NDR组及NC组(P<0.05),PDR组左侧海马旁回、桥脑右侧低于NDR组及NC组(P<0.05)。左侧小脑半球、双侧额中回、左侧颞下回及右侧扣带回达峰时间(time to peak,TTP)PDR组TTP高于NDR组和NC组(P<0.05),脑桥右侧、右侧海马旁回PDR组低于NDR和NC组(P<0.05)。吸氧30minPDR组、NDR组、NC组双侧颞侧、视盘、鼻侧△P0_(2)差异有统计学意义(P<0.05)。PDR组及NDR组左侧颞下回及双侧扣带回rCBF与双侧眼球颞、鼻侧及视盘△P0_(2)有不同程度相关性(P<0.05)。结论2型糖尿病脑血流灌注与糖尿病视网膜病变的程度具有较强的关联性,MR视网膜氧张量可以做为糖尿病脑毛细血管病变的一种影像学标志物。

Objective To study MR cerebral perfusion and the retinal oxygenation response in patients with different stages of diabetic retinopathy without hypertension and normal control group,and to analyze the correlation between different cerebral perfusion parameters and retinal oxygenation response.Methods From June 2017 to December 2019,34 patients with diagnosed type 2 diabetes mellitus(T2DM)and 21 healthy controls were enrolled in the Department of Endocrinology and ophthalmology department,the Affiliated Hospital of Yunnan University.T2DM patients were divided into proliferative stage of diabetic retinopathy(PDR)group and non-diabetic retinopathy(NDR)group according to ophthalmofundoscopy.All subjects with hypertension were excluded.Plain MR,magnetic resonance angiography(MRA),dynamic susceptibility contrast-perfusion weighted imaging(DSCPWI),orbital 3 D-spoiled GRASS(3 D-SPGR)before and after oxygen uptake scans were performed.Continuous variables were analyzed by unpaired t-test.Pearson product moment correlation was performed between relative cerebral blood flow(rCBF)and variables of retinal delta PO(2)(△P0_(2))in bilateral temporal,nasal and optic disc of eyeballs of PDR and NDR group.Results rCBF of left inferior temporal gyrus and bilateral cingulate gyrus in PDR group was lower than that in NDR group and NC group(P<0.05).Relative cerebral blood volume(rCBV)of right inferior temporal gyrus,left occipital lobe and left cingulate gyrus in PDR group was lower than that in NDR group and NC group(P<0.05),and the rCBV of right parahippocampal gyrus in PDR group was higher than that in NDR group and NC group(P<0.05).The mean transit time(MTT)of left inferior temporal gyrus,left cerebellar hemisphere and bilateral middle frontal gyrus in PDR group was higher than that in NDR group and NC group(P<0.05).The mean transit time of left parahippocampal gyrus and right pons in PDR group was lower than that in NDR group and NC group(P<0.05).Time to peak(TTP)of left cerebellar hemisphere,bilateral middle frontal gyrus,left inferior temporal gyrus and right cingulate gyrus in PDR group was higher than that in NDR group and NC group(P<0.05),and TTP of right pontine and right parahippocampal gyrus in PDR group was lower than that in NDR and NC group(P<0.05).The difference of △P0_(2) in bilateral temporal,nasal and optic disc of eyeballs between PDR group,NDR group and NC group was statistically significant(P<0.05).rCBF of left inferior temporal gyrus and bilateral cingulate gyrus in PDR group and NDR group were correlated with △P0_(2) of bilateral temporal,nasal and optic disc(P<0.05).Conclusions There was significant association between cerebral blood flow perfusion and the diabetic retinopathy(DR)severity in type 2 diabetes mellitus.MRI retinal oxygenation response can be used as an imaging marker of diabetic cerebral capillary disease.