2型糖尿病骨质疏松患者静息态脑功能局部一致性研究

The Regional Homogeneity of Resting⁃State Functional Magnetic Resonance Imaging in Patients with Type 2 Diabetic Osteoporosis

目的探讨2型糖尿病(T2DM)糖尿病性骨质疏松(DOP)患者静息态脑功能自发性活动改变,揭示骨质疏松对认知损害的影响机制。方法根据骨质疏松的诊断标准将29例T2DM患者分为DOP组和非DOP组(对照组)。采用认知量表评价被试者的认知状态。通过静息态功能磁共振成像(rs-fMRI)扫描,计算全脑的局部一致性(ReHo)改变差异,并与临床指标、认知评分进行皮尔逊相关分析。结果DOP组患者左颞中回、右侧枕上回、右侧顶上小叶、右侧角回及左侧楔前叶ReHo值升高。左颞中回ReHo值与平均骨密度(BMD AVG)和平均T值(T AVG)呈正相关;右侧枕上回和右侧顶上小叶的ReHo值与蒙特利尔认知评估(MoCA)评分呈负相关;右侧顶上小叶的ReHo值与骨钙素(OC)呈负相关。结论DOP组患者在静息态下存在多个脑区的异常活动,提示骨质疏松对T2DM患者的脑认知功能产生联合损伤效应。默认模式网络(DMN)是骨质疏松引起脑功能损害的主要靶网络,OC可能是导致骨质疏松患者认知功能障碍的关键因素。

Objective The present study is aimed to explore the changes of spontaneous activity of resting⁃state func⁃tional magnetic resonance imaging in type 2 diabetes mellitus(T2DM)with diabetic osteoporosis patients(DOP),and to reveal the mechanism of osteoporosis on cognitive impairment.Methods According to the diagnostic criteria of osteoporo⁃sis,twenty⁃nine T2DM patients were divided into two groups:diabetic osteoporosis group(DOP)and diabetic non⁃osteopo⁃rosis group(Control group).Montreal Cognitive Assessment(MoCA)was used to evaluate the Cognitive status of the sub⁃jects.The difference of Regional homogeneity(ReHo)was calculated by the resting⁃state functional magnetic resonance im⁃aging,and Pearson correlation analysis were performed with some clinical indicators and MoCA scores.Results Compared with Control group,we demonstrated significantly increased ReHo values in the left middle temporal gyrus(MTG),right su⁃perior occipital gyrus(SOG),right superior parietal lobule(SPL),right angular gyrus(AG)and left precuneus(PE).Addi⁃tionally,We also found a significant positive correlation between increased ReHo values in the left MTG and the average bone mineral density(BMD AVG)(r=0.601,P=0.023),average T scores(T AVG)(r=0.658,P=0.011).The ReHo values of the right SOG(r=-0.686,P=0.01)and right SPL(r=-0.734,P=0.004)showed negative correlation with MoCA scores,as well as negative correlation between increased ReHo values in the right SPL and osteocalcin(OC)level(r=-0.705,P=0.007).Conclusion Compared with Control group,DOP patients showed increased spontaneous activity in multiple brain regions,suggesting that osteoporosis has a joint effect on the cognitive function of T2DM patients.As an in⁃termediate of bone metabolism,osteocalcin may be a key factor causing cognitive impairment,namely“responsible bone me⁃tabolism marker”.