2型糖尿病小脑亚区灰质体积改变及其与胰岛素抵抗的相关性研究

Study of gray matter volume changes in cerebellar subregions of type 2 diabetes and its correlation with insulin resistance

目的采用基于体素的形态学分析方法,利用空间无偏倚幕下模板对小脑进行精细亚区分割,探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者小脑亚区灰质体积的异常模式。材料与方法前瞻性纳入T2DM患者75名,健康对照53名,收集所有受试者的头颅MRI数据、临床资料和认知心理量表。以独立样本t检验比较两组间小脑亚区灰质体积的差异,与临床数据和认知心理量表评分行Pearson或Spearman相关性分析。结果与健康对照组相比,T2DM患者蒙特利尔认知评估量表评分降低、汉密尔顿抑郁与焦虑量表评分增高(P<0.001);右侧小脑CrusⅠ、双侧小脑小叶Ⅰ-Ⅴ/Ⅰ-Ⅳ亚区灰质体积减小(体素水平P<0.001,簇大小>100);身体质量指数与右侧小叶Ⅰ-Ⅴ(r=0.265,P=0.022)、左侧小叶Ⅰ-Ⅳ(r=0.323,P=0.005)亚区灰质体积呈正相关,右侧CrusⅠ亚区灰质体积与空腹胰岛素水平(r=-0.263,P=0.023)和胰岛素抵抗稳态模型指数(r=-0.327,P=0.004)呈负相关。结论T2DM患者存在轻度认知功能减退及抑郁焦虑的风险,其右侧CrusⅠ灰质体积减小可能与胰岛素抵抗有关。

Objective:A voxel-based morphometry(VBM)was used to investigate the abnormal patterns of gray matter volume of cerebellar subregions of type 2 diabetes mellitus(T2DM)patients using spatially unbiased infratentorial template for fine subregion segmentation of the cerebellum.Materials and Methods:Seventy-five patients with T2DM and 53 healthy controls(HCs)were recruited,and collected cranial MRI image data,clinical data,and cognitive-psychological scales from all subjects.Differences in gray matter volume in cerebellar subregions between T2DM and HCs were compared by independent samples t test,and Pearson or Spearman correlation analysis was performed with clinical data and scores of cognitive-psychological scales in differential cerebellar subregions.Results:Compared with HCs,T2DM patients had lower Montreal Cognitive Assessment scores and higher 24-item Hamilton Depression Scale and Hamilton Anxiety Scale scores(P<0.001).Reduced gray matter volume in the right cerebellar CrusⅠand bilateral cerebellar lobulesⅠ-Ⅴ/Ⅰ-Ⅳsubregions(voxel level P<0.001,cluster size>100).The body mass index was positively correlated with right lobulesⅠ-Ⅴ(r=0.265,P=0.022),left lobulesⅠ-Ⅳ(r=0.323,P=0.005)subregions gray matter volume,and gray matter volume in right CrusⅠsubregion was negatively correlated with fasting insulin levels(r=-0.263,P=0.023)and updated homeostasis model assessment insulin resistance index(r=-0.327,P=0.004).Conclusions:Patients with T2DM are at risk for mild cognitive impairment and depression and anxiety,and reduced gray matter volume of right CrusⅠmay be associated with insulin resistance.