【作者】 陈丽；

【导师】 陆建明；

【作者基本信息】 扬州大学 ， 神经内科， 2010， 硕士

【摘要】 目的:研究年龄相对较轻糖尿病患者和非糖尿病患者蒙特利尔认知评估(Montreal cognitive assessment,MoCA)评分是否相同,并进一步分析糖尿病患者及非糖尿病患者大脑海马波谱磁共振(Magnetic Resonance Spectroscopy,MRS),来观察糖尿病患者和非糖尿病患者分子水平对认知功能的影响,并进一步研究胰岛素分泌、药物治疗对认知功能的影响。方法:选择本院39例糖尿病患者作为病例组,39例非糖尿病患者作为对照组,进行性别、年龄、教育水平等配对,对照组进行简易精神状态检查法(mini mental state examination,MMSE)、HAD、MoCA评分并进行头颅磁共振海马部位MRS分析,病例组除进行MMSE、HAD、MoCA评分、头颅海马部位MRS分析外,还记录其胰岛素分泌状态即C-肽空腹状态下分泌量、治疗情况等。对评定和记录的结果进行记录整理,剔除不符合要求者或中途退出检查者。对病例组和对照组分别进行可比性分析、MMSE、HAD评分比较分析、MoCA评分总分及各项评分比较分析,对病例组和对照组进行头颅MRS所测代谢物质进行数据处理,对海马组织代谢物质进行比较分析。对病例组按照治疗情况和胰岛素分泌功能进行再次分组,并再次进行MoCA评分分析和MRS分析,以评估分析药物治疗和胰岛素功能对认知评分和海马代谢物质的影响。结果:(1)病例组和对照组性别、年龄、教育水平、HAD无明显差异,MMSE评分出现封顶效应。病例组视空间、命名、计算、抽象、注意、语言、延迟回忆、定向和总分低于对照组。其中视空间、注意、计算、语言、抽象、延迟回忆及总分明显低于正常对照组(p<0.01),而病例组和对照组海马MRS统计分析显示:左侧Cho(Choline,Cho)( p=.012<0.05)、左侧NAA(N-acetylaspartate,NAA) (p=.008<0.01)、右侧Cho (p= .033<0.05)右侧NAA (p=.034<0.05)有差异,其中左侧NAA在病例组和对照组中有显著差异。(2)按照胰岛素分泌功能取值C-肽为0.3为临界点分病例组为胰岛素分泌正常组和胰岛素分泌功能减退组,对这两组病人进行MOCA和MRS进行比较发现,两者在性别、年龄和教育水平上没有明显差异,MoCA评分中定向力有差异(p=.012<0.05),MRS评分未见有差异性。(3)对病例组按照治疗情况(未进行任何治疗的初发组、药物治疗组、胰岛素治疗组)进行分组发现各组之间认知功能评分无明显差异。这可能和病例选择、病例人数、选择偏移等有关。结论:糖尿病患者有较早期的认知功能受损,这种认知功能受损和糖尿病患者血糖代谢和胰岛素分泌有关,并在海马MRS上有早期的代谢物质异常表现。更多还原

【Abstract】 Objective :To investigatethe cognitive between diabetes and non diabetes with Montreal cognitive assessment, and then analyze those two groups of people with Magnetic Resonance Spectroscopy on brain hippocampus. So we can overview the effection between diabetes and non-diabetes on molecular level,furthe more to study how insulin secretion、drug treat effect cognition.Methods: chose 39 diabetes and 39 normal people as research object with the mach of sex,ges,ducation levels and so on. Then do MMSE ( mini mental state examination),AD,oCA test,rain hippocampus MRS.And also the diabetes will do C- peptide text,rug therapeutics conditions and so on.With all those evaluations and records,we do some sorting,rejecting the mismatch or exiter halfway.Make comparability analyses with the two group,MSE and HAD comparison analyses,oCA total score and each item comparison analyses. Do some data processing at brain hippocampus MRS,make some metabolins comparison analyses.Do the diabetes further grouping according to drug treatment condition and insulin secretion,and carry out MoCA and brain hippocampus MRS analyze,to evaluate cognition effected by drug treatment and insulin secretion function.Results:(1)There is no significant different in sex,ge,ducational level,AD between the cases and the control group,but MMSE score appearants polarization. The cases are lower than the control group in Vis-vacuity,enomination,alculation,bstract,ttention,anguage,elay reminiscence,direction location and total score. Among the total, there are significant lower than the control group such as Vis-vacuity,enomination,alculation,bstract,elay reminiscence and total score(p<0.01). there are some diversity between the cases and the control group at the hippocampus MRS in left Cho( p=.012<0.05),AA(p=.008<0.01),right Cho (p= .033<0.05),AA (p=.034<0.05),of all the above contents, left NAA apparent significantly different between the cases and the control group. (2)According to insulin secretion function take C-peptide 0.3 as breakthrough,and then to divide the diabetes insulin secretion normal group and insulin secretion abnormal group, then make comparison with MOCA and MRS those two group, we found that there is no different in sex,age,education level about those two group,but they are diversity in orientation force with MoCA, there is also no different in MRS. (3)According to drug treatment condition(non treatment,drug treatment,insulin treatment) we found that there is no significant difference.Maybe this outcome have something with the cases selection,quantity,selection offset and so on.Conclusion:there is a pristine cognition damage comparatively, and the cognition damage have something to do with blood glycometabolism and insulin secretion in diabetes, also it can reflected with implement MRS,we can found that there is abnormal metabolin in brain.更多还原