【作者】 王元春；

【导师】 陈大伟；

【作者基本信息】 吉林大学 ， 公共卫生， 2011， 硕士

【摘要】 本文综述部分主要阐述了2型糖尿病患者海马与认知功能障碍的影像学研究进展。介绍了2型糖尿病患者认知功能和海马损害的特点。并分别介绍了MRI不同序列在2型糖尿病患者海马损伤诊断和评估方面的优势、进展和不足,展望了MRI在研究糖尿病患者海马损害和认知变化方面的发展和研究方向。本文研究部分立足于糖尿病患者海马体积、神经代谢物与认知功能的相关性研究,通过2型糖尿病患者海马神经代谢物和海马体积的测量分析海马神经代谢物及体积的变化,同时检测每名患者认知评分观察认知的改变,最终通过统计学分析建立2型糖尿病患者海马神经代谢物和体积与认知评分之间变化的线性关系。最后得出结论MRI是一种活体无创性的识别及评估糖尿病认知功能损害的可视化、定量方法,对其认知功能的损害可做出早期的预警和治疗评估有所帮助。更多还原

【Abstract】 Nowadays, ,diabetes and its complication are one of the main reasons leading to paralysis and death with the development of living. Central nervous system damage and complications of diabetes have become the focus of clinical practice. Central nervous system impairment, especially cognitive impairment, is the most serious and ultimate consequences of central nervous system damage of diabetes. With the development of MRI and the imaging of central nervous system , MRI has developed to Clinical diagnostic methods from morphology studying to Morphology, physiology and function combined. So it is possible to establish a method of non-invasive in vivo to diagnosis cognitive impairment in patients with diabetes.Objective::Hippocampal volume in patients with diabetes and to explore neural metabolite changes associated with cognitive function, to find a response to the pathological basis of cognitive impairment and early diagnosis of diabetes and evaluation of cognitive impairment in patients with the disease, an important auxiliary tool to monitor efficacy.Method:According to selection criteria, select diabetic and normal control group 63 samples who comes to China-Japan union hospital for treatment, they were detected by proton magnetic resonance spectroscopy(1H-MRS) .All samples are measured three Metabolites of hippocampal neurons including Choline, N-acetyl aspartic, inositol and creatine ratio, Hippocampal volume and Montreal cognitive and mini-mental scale score .Inputs data in Excel, and analysis statistic by software SPSS 17.0. the measured data which meets normally distributed expressed with x±s, and the measured data which meets non- normally distributed expressed with median(M(QL,QU )).The balancing test of two groups of age, years of education using t-test, data were compared between the two groups meet t normally distributed , homogeneity of variance using independent samples t-test , data of two groups meet normally distributed, Variance arrhythmia using t ’-test; Two groups of data do not meet the normal distribution using rank sum test; linear correlation analysis between the data uses dual variable correlation analysis (Bivariate), Calculate the Spearman Correlation coefficient.Result:1. The 32 samples of diabetes patient and 31 of healthy, the average age of the control group is 58.54±7.03, the average age of the diabetes is 60.01+6.99. There is no significant difference between the two groups.The time of educational control group is 11.30+2.54 and diabetes group is 11.75+2.44. There is also no significant difference between the two groups. Systolic and diastolic blood pressure showed no significant difference between the two groups.2. The three metabolites ratio of diabetic group is Cho/Cr=1.41(1.22,1.56,),NAA/Cr=0.86(0.59,1.32,),MI/Cr =0.31 (0.17,0.43,),control group is Cho/Cr=1.20(1.06,1.48),NAA/Cr=1.24(1.06,1.48), MI/Cr=0.24(0.17,0.41).Non-normal data using rank sum test to compare differences between groups, PCho/Cr=0.0284, P NAA/Cr= 0.0011,P<0.05, with a statistically significant difference. P MI/Cr=0.5587,P>0.05, has not a statistically significant difference.3. Hippocampal volume of diabetic group is 3.27 (3,4), normal control group 3.48(3.01,3.91).There is a significant difference between the two groups by Rank sum test (P =0.023, P<0.05).4. Montreal Cognitive of diabetic groups is 22.52+3.97, normal control is 25.15+2.84.The two groups data is analysed by t-test,and P = 0.0347,p<0.05.There is a statistically difference. Mini-mental scale score of diabetic group is 24(23,25) and normal control group is 27(28,29), Rank sum test to compare results : P=0.0021, p<0.05, with a statistically significant difference.5. Linear correlation analysis between the data of diabetic group uses dual variable correlation analysis (Bivariate), and Calculate the Spearman Correlation coefficient.The Results is Cho / Cr with the MMSE( r= -0.46,p=0.013), MoCA(r= -0.54,p=0.003) there exists negative correlation; NAA / Cr with the MMSE(r=0.36,p=0.023), MoCA (r=0.67,p=0.011)there exists positive correlation; Volum positive correlation with the MoCA(r=0.78,p=0.002).Conclusion:1.Changes in cognitive function in patients with diabetes showed a decline in NAA and Cho elevated and volume contraction.2.Diabetes NAA / Cr NAA / Cr with the MMSE, MoCA has a linear positive correlation; Cho / Cr with the MMSE, MoCA has a linear negative correlation; hippocampal volume positive linear correlation with the MoCA.更多还原