利拉鲁肽治疗急性脑梗死合并2型糖尿病患者脑白质纤维束改变的临床研究

Clinical study of liraglutide in the treatment of acute cerebral infarction complicated with type 2 diabetes

目的探讨利拉鲁肽治疗急性脑梗死(acute cerebral infarction,ACI)合并2型糖尿病(T2DM)患者前后脑白质神经纤维束的变化,并评价其治疗效果。方法选择2020年6月~2021年6月在锦州医科大学附属第一医院神经内科就诊的首次发作ACI且合并T2DM患者100例,随机分为利拉鲁肽组50例和对照组50例。检测治疗前后血糖水平,用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损情况,用弥散张量成像(DTI)联合弥散张量纤维束成像(DTT)技术测量患者脑白质神经纤维束的各向异性分数(FA)及神经纤维束数量,比较2组治疗前后血糖、NIHSS评分和FA及神经纤维束数量差异。结果2组治疗后血糖水平和NIHSS评分均较治疗前降低,利拉鲁肽组低于对照组(P<0.05);2组治疗后病灶侧胼胝体侧束、下额枕束FA及神经纤维束数量均较治疗前升高,利拉鲁肽组高于对照组,差异有统计学意义(P<0.05)。利拉鲁肽组治疗前后胼胝体侧束和下额枕束FA与NIHSS评分呈显著负相关(r=-0.582,P=0.002;r=-0.500,P=0.001)。结论通过DTI联合DTT技术,客观地证明利拉鲁肽对脑梗死灶区脑白质神经纤维束结构有明显的改善作用,达到治疗T2DM同时能明显改善患者神经功能缺损症状。

Objective To investigate the changes in white matter nerve fiber tracts after liraglutide treatment in type 2 diabetes mellitus(T2 DM)patients complicated with acute cerebral infarction(ACI),and to evaluate the therapeutic efficacy of the drug.Methods A total of 100 T2 DM patients with first onset ACI who were treated in the Department of Neurology of the First Affiliated Hospital of Jinzhou Medical University from June 2020 to June 2021 were selected and randomly divided into liraglutide group(n=50)and control group(n=50).Their blood glucose level was detected before and after treatment.National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological deficit,and diffusion tensor imaging(DTI)combined with diffusion tensor tractography(DTT)was adopted to measure the fractional anisotropy(FA)of white matter nerve fibers and number of the nerve fiber tracts.The blood glucose level,NIHSS score,FA and number of nerve fiber tracts were compared before and after treatment and between the two groups.Results The blood glucose level and NIHSS score were significantly decreased in both groups after treatment,and the blood glucose level and the NIHSS score were obviously lower in the liraglutide group than the control group(P<0.05).After treatment,the FA values and the numbers of nerve fiber bundles in the lateral bundle of corpus callosum and inferior fronto-occipital tract on the lesion side were higher than those before treatment,and those of the liraglutide group was statistically higher than those of the control group(P<0.05).The FA values of lateral corpus callosum and inferior fronto-occipital tract were significantly negatively correlated with NIHSS score in the liraglutide group(r=-0.582,P=0.002;r=-0.500,P=0.001).Conclusion Through DTI combined with DTT technology,it is objectively proved that liraglutide can significantly improve the structure of white matter nerve fiber bundles in the infarcted area.