新确诊的2型糖尿病、糖耐量减低患者认知功能和脑白质微结构的变化及相关性

摘要

目的 探讨新确诊的2型糖尿病(T2DM)和糖耐量减低(IGT)患者是否存在认知功能障碍和脑白质微结构改变及二者是否有关.方法 新确诊的T2DM患者20例(T2DM组)、新确诊的IGT患者18例(IGT组)、正常人17例(正常组),接受蒙特利尔量表(MoCA)评分及脑白质磁共振弥散张量成像(DTI)检查[得到各向异性(FA)值],分析MoCA评分与FA值的相关性.结果 T2DM组、IGT组、正常组的MoCA评分分别为(24.78±2.42)、(26.12±1.47)、(27.16±2.21)分;组间相比,P<0.01;T2DM组与IGT组、正常组相比,P均<0.05;IGT组与正常组相比,P>0.05.T2DM组、IGT组、正常组的左侧脑白质FA值(FAl)分别为0.4578±0.0201、0.4723±0.0182、0.4876±0.0200;组间相比,P<0.01;T2DM组与IGT组、正常组相比,P均<0.05;IGT组与正常组相比,P>0.05.T2DM组、IGT组、正常组的右侧脑白质FA值(FAr)分别为0.4698±0.0193、0.4817±0.0368、0.4927±0.0224;组间相比,P<0.05;T2DM组与IGT组、正常组相比,P均<0.05;IGT组与正常组相比,P>0.05.T2DM组MoCA评分与FAl呈正相关(r=0.432,P<0.05),与FAr无相关关系(r=0.605,P>0.05).结论 新确诊的T2DM患者可能已经存轻度认知功能障碍及脑白质微结构改变,而新确诊的IGT患者的认知功能和脑白质微结构可能尚未出现改变;新确诊的T2DM患者左侧脑白质微结构的改变可能对认知功能下降有一定影响.%Objective To investigate whether there are cognitive dysfunction and white matter microstructure changes in patients with newly diagnosed type 2 diabetes mellitus (T2DM)and impaired glucose tolerance (IGT)and whether the two are related. Methods Twenty patients with newly diagnosed T2DM (T2DM group),18 newly diagnosed IGT patients (IGT group),and 17 normal subjects (normal group)received the Montreal Scale (MoCA)score and white matter mag-netic resonance diffusion tensor imaging (DTI)check [anisotropy (FA value)]. Then we analyzed the correlation between MoCA score and FA value. Results The MoCA scores of the T2DM group,IGT group,and normal group were 24. 78 ± 2. 42,26. 12 ± 1. 47,and 27. 16 ± 2. 21,respectively;the FA values of left white matter (FAl)in the T2DM group,IGT group,and normal group were 0. 4578 ± 0. 0201,0. 4723 ± 0. 0182,and 0. 4876 ± 0. 0200,respectively;the FA val-ues of right white matter (FAr)in the T2DM group,IGT group,and normal group were 0. 4698 ± 0. 0193,0. 4817 ± 0. 0368,and 0. 4927 ± 0. 0224,respectively;significant difference was found between every two groups (P < 0. 01),no significant difference was found between the IGT group and normal group (P > 0. 05),and significant difference was found between the T2DM group and IGT group,and between the T2DM group and the normal group (all P < 0. 05). There was a positive correlation between MoCA score and FAl in the T2DM group (r = 0. 432,P < 0. 05),but there was no correlation between MoCA score and FAr (r = 0. 605,P > 0. 05). Conclusion Newly diagnosed T2DM patients may have mild cog-nitive dysfunction and white matter microstructure changes,and the cognitive function and white matter microstructure in newly diagnosed IGT patients have not changed;newly diagnosed T2DM patients with left white matter changes in micro-structure may have a certain impact on cognitive decline.