2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性

doi:10.3877/cma.j.issn.2095-8757.2022.01.004

中华老年病研究电子杂志 ›› 2022, Vol. 09 ›› Issue (01) : 9 -15. doi: 10.3877/cma.j.issn.2095-8757.2022.01.004

老年内分泌疾病

2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性

高阳¹, 徐志鹏², 刘彦超³, 郑杰³, 何本荣³, 江涛³, 孙飞³, 梁奕⁴, 王建枝³^,^†(

)

^1. 430030　武汉，华中科技大学同济医学院病理生理学系　神经系统重大疾病教育部重点实验室；430030　武汉脑科医院影像科
^2. 430071　武汉，武汉大学中南医院神经内科
^3. 430030　武汉，华中科技大学同济医学院病理生理学系　神经系统重大疾病教育部重点实验室
^4. 430030　武汉脑科医院影像科

收稿日期:2021-07-06 出版日期:2022-02-28
通信作者: 王建枝
基金资助:
湖北省卫健委科研项目(WJ2021M041); 武汉市卫健委科研项目(WX20Q04)

Association between white matter hyperintensity load and distribution characteristics with cognitive impairment in type 2 diabetic patients

Yang Gao¹, Zhipeng Xu², Yanchao Liu³, Jie Zheng³, Benrong He³, Tao Jiang³, Fei Sun³, Yi Liang⁴, Jianzhi Wang³^,^†()

^1. Ministry of Education Key Laboratory for Neurological Disorders, Department of Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Radiology, Wuhan Brain Hospital, Wuhan 430030, China
^2. Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
^3. Ministry of Education Key Laboratory for Neurological Disorders, Department of Pathophysiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
^4. Department of Radiology, Wuhan Brain Hospital, Wuhan 430030, China

Received:2021-07-06 Published:2022-02-28
Corresponding author: Jianzhi Wang

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引用本文：

高阳, 徐志鹏, 刘彦超, 郑杰, 何本荣, 江涛, 孙飞, 梁奕, 王建枝. 2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性[J]. 中华老年病研究电子杂志, 2022, 09(01): 9-15.

Yang Gao, Zhipeng Xu, Yanchao Liu, Jie Zheng, Benrong He, Tao Jiang, Fei Sun, Yi Liang, Jianzhi Wang. Association between white matter hyperintensity load and distribution characteristics with cognitive impairment in type 2 diabetic patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(01): 9-15.

目的

探讨2型糖尿病（T2DM）患者认知功能障碍与脑白质高信号（WMH）负荷及分布特征的关系。

方法

2013—2015年，从华中科技大学同济医学院附属同济医院招募年龄匹配的T2DM患者40例，健康对照者20例（健康对照组）。T2DM患者中有轻度认知功能障碍（MCI）者20例（T2DM伴MCI组），无MCI者20例（T2DM无MCI组）。采用Fazekas量表（FS）及改良Scheltens量表（MSS）进行磁共振WMH视觉评估，对比3组WMH负荷及分布特征差异，并采用Spearman相关性分析法分析WMH负荷与认知功能评分之间的相关性。随访5年后对比健康对照者与T2DM患者的WMH负荷、分布区域及认知功能变化情况。组间比较采用方差分析、秩和检验及χ²检验。

结果

3组研究对象FS、MSS评分的差异有统计学意义（F=8.600、9.176，P<0.01），其中T2DM患者明显高于健康对照组（P<0.05或0.01）。3组研究对象脑室周、额叶、基底节、颞叶、枕叶MSS评分的差异有统计学意义（F=12.069、6.575、8.358、4.869、6.037，P<0.01），其中T2DM患者高于健康对照组（P<0.05或0.01），且T2DM伴MCI组基底节区、颞叶、枕叶的MSS评分均明显高于T2DM无MCI组（P<0.05）。认知功能评分与WMH负荷呈负相关（P<0.05或0.01）。相对于5年前，健康对照者简易智能精神状态检查量表评分明显降低（t=3.167，P<0.01）；健康对照者及T2DM患者的蒙特利尔认知评估量表评分均明显降低（t=5.734、3.863，P<0.01），FS及MSS评分均明显增高（FS评分：t=3.811、4.564，MSS评分：t=4.839、6.010，P<0.01）。

结论

T2DM患者认知功能障碍与WMH密切相关，磁共振WMH负荷及脑区分布特征可能作为T2DM患者认知功能障碍评估潜在的影像标志物。

关键词: 2型糖尿病, 轻度认知功能障碍, 脑白质高信号, 随访

Objective

To evaluate the correlation between white matter hyperintensity (WMH) load and distribution characteristics with cognitive impairment in type 2 diabetic (T2DM) patients.

Methods

Twenty T2DM patients with mild cognitive impairment (MCI), 20 T2DM patients without MCI and 20 age-matched non-diabetic controls were recruited from Tongji Hospital during the year 2013 and 2015. WMH was evaluated based on the visual scales of Fazekas (FS) and modified Scheltens (MSS), and the correlation between WMH load and cognitive function were analyzed by Spearman correlation analysis. After 5 years of follow-up, the changes in WMH load, WMH distribution features and cognitive function were compared between the healthy controls and T2DM patients. Analysis of variance rank sum test and chi square test were used for the comparison.

Results

There was significant difference in FS and MSS scores among the three groups (F=8.600, 9.176, P < 0.01), and the scores of T2DM patients were significantly higher than those of healthy controls (P < 0.05 or < 0.01). The MSS scores of periventricular, frontal lobe, basal ganglia, temporal lobe and occipital lobe of the three groups were significantly different (F=12.069, 6.575, 8.358, 4.869, 6.037, P < 0.01). The MSS scores of T2DM patients were higher than those of healthy controls (P < 0.05 or < 0.01), and the MSS scores of basal ganglia, temporal lobe and occipital lobe in T2DM with MCI group were higher than those in T2DM without MCI group (P < 0.05). WMH load was negatively correlated with cognitive function (P < 0.05 or < 0.01). After 5 years following-up, the mini-mental state examination score decreased significantly in healthy controls (t=3.167, P < 0.01), the montreal cognitive assessment score decreased significantly in both healthy controls and T2DM patients (t=5.734, 3.863, P < 0.01), and the FS and MSS scores increased significantly in both healthy controls and T2DM patients (FS score: t=3.811, 4.564; MSS score: t = 4.839, 6.010; P < 0.01).

Conclusion

Cognitive impairment in T2DM patients is related with WMH, and the load and distribution of WMH may be used as promising imaging biomarkers for the evaluation of cognitive impairment in T2DM patients.

Key words: Type 2 diabetes mellitus, Mild cognitive impairment, White matter hyperintensity, Follow-up

表1 3组研究对象基线资料的比较[例（%）或±s]

组别	例数	性别（男/女）	年龄（岁）	合并高血压	合并高血脂	合并冠心病	吸烟
健康对照组	20	6/14	61.8±4.6	5（25.0）	4（20.0）	1（5.0）	5（25.0）
T2DM无MCI组	20	7/13	62.8±6.2	6（30.0）	4（20.0）	3（15.0）	5（25.0）
T2DM伴MCI组	20	10/10	62.0±7.2	7（35.0）	5（25.0）	3（15.0）	6（30.0）
检验值		χ²=1.833	F=0.150	χ²=0.467	χ²=0.196	χ²=1.186	χ²=0.171
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	喝酒	HbAlc（%）	受教育年限（年）	T2DM病程（年）	MMSE	MoCA
健康对照组	20	5（25.0）	5.2±0.4	10.0±3.1	0	28.7±1.1	27.2±1.1
T2DM无MCI组	20	6（30.0）	7.7±1.2	11.6±3.9	7.5（11.3）	28.2±1.3	26.6±1.7
T2DM伴MCI组	20	6（30.0）	8.1±1.8	11.2±3.1	2.8（8.7）	27.5±1.7	25.6±2.6
检验值		χ²=0.164	F=28.980	F=1.257	Z=126.5	F=3.452	F=2.300
P值		>0.05	<0.01	>0.05	<0.05	<0.05	<0.05

表1 3组研究对象基线资料的比较[例（%）或±s]

组别	例数	性别（男/女）	年龄（岁）	合并高血压	合并高血脂	合并冠心病	吸烟
健康对照组	20	6/14	61.8±4.6	5（25.0）	4（20.0）	1（5.0）	5（25.0）
T2DM无MCI组	20	7/13	62.8±6.2	6（30.0）	4（20.0）	3（15.0）	5（25.0）
T2DM伴MCI组	20	10/10	62.0±7.2	7（35.0）	5（25.0）	3（15.0）	6（30.0）
检验值		χ²=1.833	F=0.150	χ²=0.467	χ²=0.196	χ²=1.186	χ²=0.171
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	喝酒	HbAlc（%）	受教育年限（年）	T2DM病程（年）	MMSE	MoCA
健康对照组	20	5（25.0）	5.2±0.4	10.0±3.1	0	28.7±1.1	27.2±1.1
T2DM无MCI组	20	6（30.0）	7.7±1.2	11.6±3.9	7.5（11.3）	28.2±1.3	26.6±1.7
T2DM伴MCI组	20	6（30.0）	8.1±1.8	11.2±3.1	2.8（8.7）	27.5±1.7	25.6±2.6
检验值		χ²=0.164	F=28.980	F=1.257	Z=126.5	F=3.452	F=2.300
P值		>0.05	<0.01	>0.05	<0.05	<0.05	<0.05

图1 快速反转恢复序列图像脑白质高信号分布代表图。1A：健康老年人，女性，65岁，改良Scheltens量表总分0分，脑内无点状高信号；1B：2型糖尿病无轻度认知功能障碍患者，男性，67岁，额叶见多发点状高信号，总分4分；1C：2型糖尿病伴轻度认知功能障碍患者，女性，66岁，双侧脑室额角、枕角见帽状高信号，额叶、枕叶及右侧基底节见多发点状高信号，总分8分

图2 3组人群Faekas评分及改良Scheltens评分的比较。2A、2B：2型糖尿病（T2DM）患者脑白质高信号负荷较健康对照组均明显升高，且伴轻度认知功能障碍者脑白质高信号负荷增加更明显；2C：T2DM伴轻度认知功能障碍（MCI）患者在基底节、颞叶、枕叶的改良Scheltens评分高于T2DM无MCI患者

图3 健康对照者与2型糖尿病患者随访期间脑白质高信号变化的脑区差异

表2 随访人群认知功能及脑白质高信号评分的比较（±s）

组别	例数	MMSE评分		MoCA评分		FS评分		MSS评分
组别	例数	基线	随访	基线	随访	基线	随访	基线	随访
健康对照者	13	29.1±1.0	27.6±1.9	27.5±1.5	24.5±2.5	1.1±0.8	1.9±1.2	2.9±2.8	5.9±3.9
T2DM患者	21	28.4±1.2	27.9±1.6	26.9±1.7	24.3±3.2	1.5±0.8	2.2±1.1	4.4±3.4	7.3±4.0
检验值		t=1.757	t=0.495	t=1.044	t=0.192	t=1.417	t=0.747	t=1.333	t=1.001
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 随访人群认知功能及脑白质高信号评分的比较（±s）

组别	例数	MMSE评分		MoCA评分		FS评分		MSS评分
组别	例数	基线	随访	基线	随访	基线	随访	基线	随访
健康对照者	13	29.1±1.0	27.6±1.9	27.5±1.5	24.5±2.5	1.1±0.8	1.9±1.2	2.9±2.8	5.9±3.9
T2DM患者	21	28.4±1.2	27.9±1.6	26.9±1.7	24.3±3.2	1.5±0.8	2.2±1.1	4.4±3.4	7.3±4.0
检验值		t=1.757	t=0.495	t=1.044	t=0.192	t=1.417	t=0.747	t=1.333	t=1.001
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

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Association between white matter hyperintensity load and distribution characteristics with cognitive impairment in type 2 diabetic patients

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Association between white matter hyperintensity load and distribution characteristics with cognitive impairment in type 2 diabetic patients