目的：通过测量阿尔茨海默病（Alzheimer’s disease，AD）合并及不合并二型糖尿病（Type 2 diabetes mellitus，T2DM）大脑皮质及灰质核团的弥散峰度成像（Diffusion kurtosis imaging，DKI）参数，初步探讨T2DM对AD脑灰质微结构的影响。方法：本研究纳入35例经神经内科确诊的AD患者，根据是否合并T2DM分为AD+T2DM组（13例，男6例，女7例，平均年龄（74.46±8.26）岁）及AD-T2DM组（22例，男9例，女13例，平均年龄（70.82±8.72）岁）。每例受试者由神经内科医生对其进行MMSE及MoCA评分。所有被试者均行常规MRI序列和DKI检查。经过ADW 4.6工作站处理获得DKI各参数（MK值、Ka值、Kr值、MD值、Da值、Dr值和FA值）图。由两名有经验的放射科医生在所有受试者双侧额上回及颞中回灰质、尾状核头、壳核、苍白球、丘脑、海马部位分别测量两次DKI参数值。采用两独立样本t检验比较两组间各部位的DKI参数值以及临床指标；应用Spearman相关分析评估DKI参数值与临床MMSE以及MoCA评分之间的相关性。结果：与AD-T2DM组相比，除了壳核，AD+T2DM组中所有部位的FA值均升高，但是仅在颞中回灰质存在显著差异（P＜0.05）；除了苍白球的MD值、颞中回灰质和苍白球的Da值，其余所有部位MD值及Da值均降低，然而仅在尾状核头及丘脑中存在显著差异（P＜0.05）。MK值和Ka值仅在丘脑显著降低（P＜0.05）。相关性分析显示，AD+T2DM组海马部位的弥散率值（MD值、Da值、Dr值）及颞中回灰质FA值与临床MMSE评分存在负相关；而海马部位的弥散率值、额上回灰质、颞中回灰质、背侧丘脑FA值与临床MoCA评分存在负相关（P＜0.05）。结论：AD患者合并糖尿病会加重额颞叶皮质、基底节及丘脑微观结构的改变，而利用DKI可以检测这些变化并反映患者的临床行为状态。
Abstract
Objective: To investigate the microstructure of cortex and gray nucleus in Alzheimer’s disease(AD) with and without type 2 diabetes mellitus(AD+T2DM, AD-T2DM) by measuring and comparing the diffusion kurtosis imaging(DKI) data. Methods: Thirty-five patients who were diagnosed AD by neurology department were included in the study and were divided into AD+T2DM group(13 cases, 6 males, 7 females, average age (74.46±8.26) years) and AD-T2DM group(22 cases, 9 males, 13 females, average age (70.82±8.72) years). The mental status was assessed by MMSE and MoCA scores by two neurologists. MR protocols included conventional MRI and DKI. The raw DKI data were processed using Functool 2 software in ADW 4.6 workstation. Bilateral MK, Ka, Kr, MD, Da, Dr and FA values in the superior frontal gyrus(SFG) and middle temporal gyrus(MTG), hippocampus(HIP), head of caudate nucleus(HCN), putamen(PUT), globus pallidus(GP) and thalamus(THA) were manually measured twice by two radiologists. Two independent sample t-test was used to compare the diffusion parameters in all regions and clinical indexes between the two groups. Spearman correlation analysis was used to analyze the relations between DKI parameters and MMSE or MoCA score. Result: Compared with those in AD-T2DM group, FA value significantly increased only in MTG(P<0.05), and then MD and Da value also increased in HCN and THA(P<0.05) in AD+T2DM group. Only in THA the MK and Ka value significantly decrease(P<0.05) in AD+T2DM compared to AD-T2DM group. In the correlation analysis, there were negative correlations between the diffusion rate of HIP, FA value of MTG and the clinical MMSE score in AD+T2DM group. However, there were negative correlations between the diffusing rate of HIP, FA value in SFG, MTG, THA and clinical MoCA score(P＜0.05). Conclusion: For AD patients, hyperglycemia may aggravate the microstructure damage in gray matter and nucleus, and HCN and THA are probably the parts that most easily affected. DKI parameters also reflect cognitive status to some extent.
关键词
糖尿病 /
2型 /
阿尔茨海默病 /
磁共振成像
Key words
Diabetes mellitus, type 2 /
Alzheimer disease /
Magnetic resonance imaging
中图分类号：
Ｒ587.1
Ｒ749.16
Ｒ445.2
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基金
本文受国家自然基金（编号81671646）项目资助。
