基于近红外脑功能成像技术的糖尿病中枢神经病变研究

Exploring the diabetic central neuropathy with functional near-infrared spectroscopy

目的运用近红外脑功能成像(fNIRS)技术研究2型糖尿病(T2DM)及非糖尿病人群在语素流畅性任务(VFT)下大脑血氧反应变化的差异,探究T2DM对患者认知障碍的影响和中枢神经系统的改变。方法前瞻性纳入T2DM患者(试验组)和同期健康对照者(对照组),每组各13例。收集两组受试者的一般资料及临床资料并分组进行比较。运用fNIRS技术检测两组受试者在VFT下大脑前额叶皮层氧合血红蛋白(HbO_(2))的变化趋势,分析两组被试任务状态下大脑皮层HbO_(2)变化(ΔHbO_(2))的差异和大脑激活区域的不同。结果试验组患者空腹血糖、餐后2 h血糖、fNIRS检测时随机血糖均高于对照组,MoCA量表评分低于对照组(P<0.05)。在VFT测试期间的53个通道中,试验组患者第37通道(眶额叶)ΔHbO_(2)显著高于对照组(P=0.026)。对照组两侧大脑半球均出现激活,而试验组仅分布在左侧背外侧前额叶。两组受试者全脑功能网络连接比较差异无统计学意义(P>0.05)。结论T2DM患者相比健康人群眶额叶ΔHbO_(2)更高,存在显著的认知功能障碍;其右侧背外侧前额叶未出现激活,左侧激活范围变广可能因为大脑存在代偿反应。

Objective Functional near-infrared spectroscopy(fNIRS) was used to investigate difference of cerebral blood oxygen response in verbal fluency test(VFT) between type 2 diabetes mellitus(T2DM) and non-diabetic groups,explore the effects of T2DM on cognitive impairment and changes in the central nervous system.Methods A total of 13 T2DM patients(experimental group) and 13 healthy controls(control group) were prospectively included.General data and clinical data of two groups were collected and grouped for comparison.Trend of oxygenated hemoglobin(HbO_2) in the prefrontal cortex of two groups in verbal fluency test was recorded by fNIRS.Changes of HbO_(2) in the cerebral cortex(ΔHbO2) and differences in activated brain regions were analyzed between the two groups in the task state.Results Fasting blood glucose,2 h postprandial blood glucose,and random blood glucose during fNIRS detection in the experimental group were higher than those in the control group,and MoCA scale score was lower than that in the control group(P<0.05).Among 53 channels during VFT,the mean value of ΔHbO_(2) in channel 37(orbitofrontal lobe) in the experimental group was significantly higher than that in the control group(P=0.026).Both cerebral hemispheres were activated in control group,while the distribution of experimentel group only on the left dorsolateral prefrontal.There was no significant difference in the whole brain functional network connectivity between two groups(P>0.05).Conclusion Compared with healthy people,T2DM patients have higher changes in oxyhemoglobin in the orbitofrontal lobe and significant cognitive impairment.There is no activation in the right dorsolateral prefrontal cortex,and the activation of the left side is wider,which may be due to the compensatory response of the brain.