2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性

Association between white matter hyperintensity load and distribution characteristics with cognitive impairment in type 2 diabetic patients

目的:探讨2型糖尿病(T2DM)患者认知功能障碍与脑白质高信号(WMH)负荷及分布特征的关系。方法:2013—2015年,从华中科技大学同济医学院附属同济医院招募年龄匹配的T2DM患者40例,健康对照者20例(健康对照组)。T2DM患者中有轻度认知功能障碍(MCI)者20例(T2DM伴MCI组),无MCI者20例(T2DM无MCI组)。采用Fazekas量表(FS)及改良Scheltens量表(MSS)进行磁共振WMH视觉评估,对比3组WMH负荷及分布特征差异,并采用Spearman相关性分析法分析WMH负荷与认知功能评分之间的相关性。随访5年后对比健康对照者与T2DM患者的WMH负荷、分布区域及认知功能变化情况。组间比较采用方差分析、秩和检验及χ^(2)检验。结果:3组研究对象FS、MSS评分的差异有统计学意义(F=8.600、9.176,P<0.01),其中T2DM患者明显高于健康对照组(P<0.05或0.01)。3组研究对象脑室周、额叶、基底节、颞叶、枕叶MSS评分的差异有统计学意义(F=12.069、6.575、8.358、4.869、6.037,P<0.01),其中T2DM患者高于健康对照组(P<0.05或0.01),且T2DM伴MCI组基底节区、颞叶、枕叶的MSS评分均明显高于T2DM无MCI组(P<0.05)。认知功能评分与WMH负荷呈负相关(P<0.05或0.01)。相对于5年前,健康对照者简易智能精神状态检查量表评分明显降低(t=3.167,P<0.01);健康对照者及T2DM患者的蒙特利尔认知评估量表评分均明显降低(t=5.734、3.863,P<0.01),FS及MSS评分均明显增高(FS评分:t=3.811、4.564,MSS评分:t=4.839、6.010,P<0.01)。结论:T2DM患者认知功能障碍与WMH密切相关,磁共振WMH负荷及脑区分布特征可能作为T2DM患者认知功能障碍评估潜在的影像标志物。

Objective To evaluate the correlation between white matter hyperintensity(WMH)load and distribution characteristics with cognitive impairment in type 2 diabetic(T2DM)patients.Methods Twenty T2DM patients with mild cognitive impairment(MCI),20 T2DM patients without MCI and 20 age-matched non-diabetic controls were recruited from Tongji Hospital during the year 2013 and 2015.WMH was evaluated based on the visual scales of Fazekas(FS)and modified Scheltens(MSS),and the correlation between WMH load and cognitive function were analyzed by Spearman correlation analysis.After 5 years of follow-up,the changes in WMH load,WMH distribution features and cognitive function were compared between the healthy controls and T2DM patients.Analysis of variance rank sum test and chi square test were used for the comparison.Results There was significant difference in FS and MSS scores among the three groups(F=8.600,9.176,P<0.01),and the scores of T2DM patients were significantly higher than those of healthy controls(P<0.05 or<0.01).The MSS scores of periventricular,frontal lobe,basal ganglia,temporal lobe and occipital lobe of the three groups were significantly different(F=12.069,6.575,8.358,4.869,6.037,P<0.01).The MSS scores of T2DM patients were higher than those of healthy controls(P<0.05 or<0.01),and the MSS scores of basal ganglia,temporal lobe and occipital lobe in T2DM with MCI group were higher than those in T2DM without MCI group(P<0.05).WMH load was negatively correlated with cognitive function(P<0.05 or<0.01).After 5 years following-up,the mini-mental state examination score decreased significantly in healthy controls(t=3.167,P<0.01),the montreal cognitive assessment score decreased significantly in both healthy controls and T2DM patients(t=5.734,3.863,P<0.01),and the FS and MSS scores increased significantly in both healthy controls and T2DM patients(FS score:t=3.811,4.564;MSS score:t=4.839,6.010;P<0.01).Conclusion Cognitive impairment in T2DM patients is related with WMH,and the load and distribution of WMH may be used as promising imaging biomarkers for the evaluation of cognitive impairment in T2DM patients.