BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking ...BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.展开更多
目的探讨氢质子磁共振波谱分析(1H-MRS)在碘异常引起脑损伤病变中的应用价值。方法收集临床诊断碘异常引起脑损伤的病例28例,其中低碘组16例,高碘组12例。使用西门子1.5 T MRI,多体素相位矩阵扫描。检测低碘组和高碘组病人海马区与正常...目的探讨氢质子磁共振波谱分析(1H-MRS)在碘异常引起脑损伤病变中的应用价值。方法收集临床诊断碘异常引起脑损伤的病例28例,其中低碘组16例,高碘组12例。使用西门子1.5 T MRI,多体素相位矩阵扫描。检测低碘组和高碘组病人海马区与正常参照区域的代谢物浓度,利用SPSS12.0分析各种代谢物的变化。结果1H-MRS示低碘组胆碱降低、γ-氨基丁酸、N-乙酰天门冬氨酸减少;高碘组胆碱增加、谷氨酸升高,γ-氨基丁酸、N-乙酰天门冬氨酸减少。结论1H-MRS在碘异常引起脑损伤病变定性诊断中有重要的临床价值。展开更多
目的探讨持续饮酒的酒精使用障碍(alcohol use disorder,AUD)患者左侧前额叶白质谷氨酸代谢产物水平和认知功能的关系。方法入组14例男性AUD患者及13名男性健康受试者。应用氢质子磁共振波谱技术(proton magnetic resonance spectroscop...目的探讨持续饮酒的酒精使用障碍(alcohol use disorder,AUD)患者左侧前额叶白质谷氨酸代谢产物水平和认知功能的关系。方法入组14例男性AUD患者及13名男性健康受试者。应用氢质子磁共振波谱技术(proton magnetic resonance spectroscopy,1H-MRS)测定左侧前额叶白质谷氨酸复合代谢物的相对浓度(glutamate and glutamine/creatine,Glx/Cr),采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)及简易智力状态检查量表(mini-mental state examination,MMSE)对认知功能进行评价。结果AUD组与对照组相比,左侧前额叶白质的Glx相对浓度升高(0.84±0.09 vs.0.63±0.06,P<0.001),且MoCA评分(24.64±3.00 vs.27.23±1.83,P=0.012)、MMSE评分(26.57±2.17 vs.28.85±1.21,P=0.003)下降。AUD组左侧前额叶白质的Glx相对浓度与平均每月饮酒天数呈正相关(r=0.567,P=0.035),MoCA评分(r=-0.663,P=0.010)、MMSE评分(r=-0.687,P=0.007)与平均每月饮酒天数呈负相关。AUD患者左侧前额叶白质的Glx相对浓度与认知功能量表评分的相关关系无统计学意义(P>0.05)。结论持续饮酒的AUD患者左侧前额叶白质谷氨酸代谢产物水平升高,认知功能下降,提示长期持续饮酒可以导致患者脑部谷氨酸代谢水平改变和认知功能损害。展开更多
基金Supported by the Academic Leaders Training Program of Pudong Health Bureau of Shanghai,No.PWRd2023-03Clinical Research Fund of Shanghai Municipal Commission of Health,No.202040136+1 种基金National Natural Science Foundation of China,No.82070842Jiangxi Health Commission Science and Technology Plan Project,No.202212838 and No.202212852.
文摘BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.
文摘目的探讨氢质子磁共振波谱分析(1H-MRS)在碘异常引起脑损伤病变中的应用价值。方法收集临床诊断碘异常引起脑损伤的病例28例,其中低碘组16例,高碘组12例。使用西门子1.5 T MRI,多体素相位矩阵扫描。检测低碘组和高碘组病人海马区与正常参照区域的代谢物浓度,利用SPSS12.0分析各种代谢物的变化。结果1H-MRS示低碘组胆碱降低、γ-氨基丁酸、N-乙酰天门冬氨酸减少;高碘组胆碱增加、谷氨酸升高,γ-氨基丁酸、N-乙酰天门冬氨酸减少。结论1H-MRS在碘异常引起脑损伤病变定性诊断中有重要的临床价值。
文摘目的探讨持续饮酒的酒精使用障碍(alcohol use disorder,AUD)患者左侧前额叶白质谷氨酸代谢产物水平和认知功能的关系。方法入组14例男性AUD患者及13名男性健康受试者。应用氢质子磁共振波谱技术(proton magnetic resonance spectroscopy,1H-MRS)测定左侧前额叶白质谷氨酸复合代谢物的相对浓度(glutamate and glutamine/creatine,Glx/Cr),采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)及简易智力状态检查量表(mini-mental state examination,MMSE)对认知功能进行评价。结果AUD组与对照组相比,左侧前额叶白质的Glx相对浓度升高(0.84±0.09 vs.0.63±0.06,P<0.001),且MoCA评分(24.64±3.00 vs.27.23±1.83,P=0.012)、MMSE评分(26.57±2.17 vs.28.85±1.21,P=0.003)下降。AUD组左侧前额叶白质的Glx相对浓度与平均每月饮酒天数呈正相关(r=0.567,P=0.035),MoCA评分(r=-0.663,P=0.010)、MMSE评分(r=-0.687,P=0.007)与平均每月饮酒天数呈负相关。AUD患者左侧前额叶白质的Glx相对浓度与认知功能量表评分的相关关系无统计学意义(P>0.05)。结论持续饮酒的AUD患者左侧前额叶白质谷氨酸代谢产物水平升高,认知功能下降,提示长期持续饮酒可以导致患者脑部谷氨酸代谢水平改变和认知功能损害。