基于定量MRS技术探讨海马代谢物对Ⅱ型糖尿病患者发生轻度认知障碍的预测价值

Exploring the Predictive Value of Hippocampal Metabolites for the Development of Mild Cognitive Impairment in Patients with TypeⅡDiabetes Based on Quantitative MRS Technique

目的探讨定量磁共振波谱成像(MRS)对Ⅱ型糖尿病(T2DM)患者发生轻度认知障碍(MCI)的预测价值。方法前瞻性搜集符合糖尿病诊断标准的T2DM患者124例,入组后搜集临床资料、血清学指标及进行MRS检查,随后进行为期2年的认知功能纵向随访。依据随访期间是否发生认知障碍将患者分为认知障碍组(MCI组)和认知正常组(NC组)。比较两组患者基线期临床资料、血清指标以及MRS指标,采用多因素Logistic回归分析确定T2DM患者发生MCI的独立影响因素。采用受试者工作特征曲线(ROC)分析各因素对MCI发生的预测效能,采用Pearson相关性分析蒙特利尔认知评估量表(MoCA)评分与基线时胰岛素抵抗指数(HOMA⁃IR)、N⁃乙酰天冬氨酸(NAA)之间的相关性。结果与NC组相比,MCI组患者基线高密度脂蛋白(HDL⁃C)、海马NAA水平降低,身体质量指数(BMI)、HOMA⁃IR水平升高,差异均具有统计学意义(P<0.05)。多因素Logistic回归显示HOMA⁃IR(OR=3.37,95%CI:1.64~6.96,P<0.01)和海马NAA(OR=0.38,95%CI:0.21~0.68,P<0.01)是T2DM患者发生MCI的独立影响因素。ROC曲线分析显示HOMA⁃IR、NAA水平、两者联合预测T2DM患者发生MCI的曲线下面积(AUC)分别为0.66、0.64、0.80。相关性分析显示MCI阶段MoCA评分与基线HOMA⁃IR存在负相关关系(r=-0.552,P<0.01),与NAA存在正相关关系(r=0.562,P<0.01)。结论较高的胰岛素抵抗水平和较低的海马NAA水平与T2DM患者发生MCI密切相关。

Objective To explore the predictive value of quantitative magnetic resonance spectroscopy(MRS)for mild cognitive impairment(MCI)in patients with typeⅡdiabetes mellitus(T2DM).Methods A total of 124 patients diagnosed with typeⅡdiabetes were prospectively enrolled,and clinical data,serum indicators,and MRS examinations were collected upon entry.A 2⁃year longitudinal cognitive function follow⁃up was conducted.Patients were categorized into the mild cognitive impairment group(MCI)group and the Normal Cognition(NC)group based on the occurrence of cognitive impairment during the follow⁃up.Differences in baseline clinical data,serum indicators,and MRS indices between the two groups were compared.Independent influencing factors for MCI in T2DM patients were determined using multifactorial logistic regression analysis.The predictive efficacy of each factor for the occurrence of MCI was analyzed using Receiver Operating Characteristic(ROC)curves.Results Compared to the NC group,patients in the MCI group exhibited significantly lower baseline HDL⁃c and hippocampal NAA levels,while BMI and HOMA⁃IR levels were higher;all differences were statistically significant(P<0.05).Multifactorial logistic regression revealed that HOMA⁃IR(OR=3.37,95%CI:1.64-6.96,P<0.01)and hippocampal NAA(OR=0.38,95%CI:0.21-0.68,P<0.01)were independent influencing factors for the occurrence of MCI in diabetic patients.ROC curve analysis demonstrated AUC values of 0.66 for HOMA⁃IR,0.64 for NAA levels,and 0.80 for their combined prediction of MCI in T2DM patients.Correlation analysis indicated a negative correlation between MoCA scores at the MCI stage and baseline HOMA⁃IR(r=-0.552,P<0.01)and a positive correlation with NAA(r=0.562,P<0.01).Conclusion Higher levels of insulin resistance and lower levels of hippocampal NAA are closely associated with the occurrence of MCI in patients with typeⅡdiabetes.