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糖尿病常伴随肾脏、视网膜及周围血管等并发症的现象已为学界熟知,对其诊断和治疗的研究较多[1-3]。糖尿病对中枢神经系统的影响近年来也引起了人们的广泛重视,“糖尿病脑病”由Reske-Nielsen等[4]提出,长期的高血糖会导致脑能量代谢障碍,从而引起认知障碍和大脑的神经生理及结构改变。笔者回顾性分析了96例2型糖尿病(type 2 diabetes,T2DM)患者的脑部PET/CT资料,探讨静息状态下T2DM患者脑葡萄糖代谢改变特点及其临床意义。
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T2DM患者组与对照组的年龄分布(t=1.834,P=0.147)、性别构成(χ2=0.008,P=0.847)差异均无统计学意义。与对照组比较,T2DM患者组18F-FDG PET/CT显示为区域性脑葡萄糖代谢减低,且这种改变基本呈双侧对称分布,涉及的脑区包括左侧额中下回、右侧额中下回、左侧颞上横回、右侧颞上横回、左侧枕上中舌回、右侧枕上中舌回、左侧楔前叶、右侧楔前叶、左侧顶下缘角回、右侧顶下缘角回、距状裂及周围皮层,全脑未见代谢增高脑区。详细分布见表 1和图 1。
脑区 MNI坐标 体素 t值 P值 X Y Z 左侧额中下回 -26 10 -66 0 633 5.73 < 0.001 右侧额中下回 -46 -60 -62 0 588 6.11 < 0.001 左侧颞上横回 -65 -30 -12 00 55 5.92 < 0.001 右侧颞上横回 -72 -36 -18 00 64 5.51 < 0.001 左侧枕上中舌回 -40 -70 -35 0 483 5.99 < 0.001 右侧枕上中舌回 -22 -75 -6 0 515 5.84 < 0.001 距状裂及周围皮层 -2 -90 -4 1677 6.05 < 0.001 左侧顶下缘角回 -37 -70 -58 0 335 5.58 < 0.001 右侧顶下缘角回 -18 -82 -56 0 144 6.42 < 0.001 左侧楔前叶 -12 -88 -67 00 72 5.82 < 0.001 右侧楔前叶 -27 -95 -72 00 56 6.33 < 0.001 注:表中,T2DM:2型糖尿病;MNI:蒙特利尔神经病学研究所。 表 1 T2DM患者组比正常对照组脑内代谢减低的区域分布
Table 1. Positions of the reduced glucose metabolism cere
2型糖尿病患者大脑静息葡萄糖代谢改变研究
Changes in resting-state brain glucose metabolism in patients with type 2 diabetes
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摘要:
目的探讨静息状态下2型糖尿病(T2DM)患者大脑葡萄糖代谢改变特点。 方法回顾性分析96例已被临床确诊的T2DM患者的头部18F-FDG PET/CT显像资料。选取96名健康体检者作为对照组。采用统计参数地形图 8软件分析T2DM患者组与对照组PET脑代谢的改变。T2DM患者组与对照组图像采用体素对体素的两独立样本t检验。 结果与对照组比较,T2DM患者18F-FDG PET/CT表现为多个脑区的葡萄糖代谢减低(t=5.51~6.42,均P < 0.001),主要包括双侧额中下回、双侧颞上横回、双侧枕上中舌回、双侧楔前叶、双侧顶下缘角回、距状裂及周围皮层;未见明显代谢增高脑区。 结论T2DM患者大脑静息葡萄糖代谢改变以区域性葡萄糖代谢减低为主,且基本呈双侧对称分布,主要涉及的脑区包括情感、认知功能区和视觉皮层区等。 -
关键词:
- 糖尿病, 2型 /
- 脑葡萄糖代谢 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 统计参数地形图
Abstract:ObjectiveTo invetigate the metabolic changes in the resting brain glucose of patients with type 2 diabetes but without brain metastasis. MethodsA total of 96 patients with type 2 diabetes were confirmed by 18F-FDG PET/CT examination. The whole-body 18F-FDG PET/CT images of the patients were retrospectively analyzed. Ninety-six healthy subjects were included as controls for comparison. The metabolic changes in resting brain glucose of the 96 patients with type 2 diabetes were analyzed using a statistical parametric mapping software. Data were processed with two independent sample t test of voxel to voxel in the images. ResultsCompared with the control group, the hypometabolic brain areas in patients with type 2 diabetes were in the bilateral middle-inferior frontal, bilateral superior-heschl gyrus, bilateral superior-middle-lingual gyrus, calcarine cortex, bilateral inferior parietal gyrus, and bilateral wedge anterior lobe(t=5.51-6.42, all P < 0.001). Hypermetabolic areas were not observed in patients. ConclusionsThe reduced metabolic cerebral regions in the patients with type 2 diabetes involved a number of functional regions related to visual cortex and mood disorders. -
表 1 T2DM患者组比正常对照组脑内代谢减低的区域分布
Table 1. Positions of the reduced glucose metabolism cere
脑区 MNI坐标 体素 t值 P值 X Y Z 左侧额中下回 -26 10 -66 0 633 5.73 < 0.001 右侧额中下回 -46 -60 -62 0 588 6.11 < 0.001 左侧颞上横回 -65 -30 -12 00 55 5.92 < 0.001 右侧颞上横回 -72 -36 -18 00 64 5.51 < 0.001 左侧枕上中舌回 -40 -70 -35 0 483 5.99 < 0.001 右侧枕上中舌回 -22 -75 -6 0 515 5.84 < 0.001 距状裂及周围皮层 -2 -90 -4 1677 6.05 < 0.001 左侧顶下缘角回 -37 -70 -58 0 335 5.58 < 0.001 右侧顶下缘角回 -18 -82 -56 0 144 6.42 < 0.001 左侧楔前叶 -12 -88 -67 00 72 5.82 < 0.001 右侧楔前叶 -27 -95 -72 00 56 6.33 < 0.001 注:表中,T2DM:2型糖尿病;MNI:蒙特利尔神经病学研究所。 -
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