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目的探讨2型糖尿病合并高血压脑损害代谢物改变情况。方法选取2013年4月—2014年11月汕头大学医学院第二附属医院门诊或住院的2型糖尿病合并高血压患者33例为病例组,及同期与病例组性别、年龄、受教育年限相匹配的健康志愿者30例为对照组。采用美国GE signa HDX-Speed 1.5T超导型磁共振成像仪。二维磁共振频谱(2D-1HMRS)扫描:体素置于半卵圆中心层面,感兴趣区体积为7 cm×10 cm×2 cm,TR 1 500 ms,TE 35 ms。使用SAGE软件分别测定双侧额叶灰质和顶叶白质代谢物比值,包括N-乙酰天冬氨酸(NAA)/肌酸(Cr)、胆碱(Cho)/Cr。统计学分析采用SPSS 17.0统计软件。结果两组左额叶NAA/Cr、Cho/Cr和右额叶NAA/Cr、Cho/Cr及左顶叶NAA/Cr间差异有统计学意义(P<0.05),而左顶叶Cho/Cr和右顶叶NAA/Cr、Cho/Cr间差异无统计学意义(P>0.05)。其中对照组左额叶与左顶叶(t=0.77,P=0.45)、右额叶与右顶叶(t=-0.81,P=0.43)、左额叶与右额叶(t=-0.66,P=0.51)、左顶叶与右顶叶(t=-0.45,P=0.65)NAA/Cr间差异均无统计学意义;左额叶与左顶叶(t=0.49,P=0.63)、右额叶与右顶叶(t=0.53,P=0.59)、左额叶与右额叶(t=-0.96,P=0.35)、左顶叶与右顶叶(t=-0.79,P=0.93)Cho/Cr间差异亦均无统计学意义。病例组左额叶与左顶叶(t=5.40,P<0.01)、右额叶与右顶叶(t=-5.86,P<0.01)、左额叶与右额叶(t=3.14,P=0.01)、左顶叶与右顶叶(t=2.74,P=0.01)NAA/Cr间差异均有统计学意义;左额叶与左顶叶(t=-0.78,P=0.94)、左额叶与右额叶(t=-0.46,P=0.65)、左顶叶与右顶叶Cho/Cr(t=-0.90,P=0.38)Cho/Cr间差异无统计学意义,而右额叶与右顶叶(t=-2.93,P=0.04)Cho/Cr间差异有统计学意义。结论 2型糖尿病合并高血压导致的脑损害呈进展性,双侧额叶灰质及左侧顶叶白质均发生代谢功能紊乱,代谢物改变以NAA/Cr降低、Cho/Cr升高为主,额叶灰质较顶叶白质明显,左侧较右侧明显。
Objective To investigate the changes of metabolites in type 2 diabetic patients with hypertensive brain damage. Methods From April 2013 to November 2014, 33 cases of type 2 diabetes mellitus complicated with hypertension in outpatient department or hospitalized in the Second Affiliated Hospital of Shantou University Medical College were selected as the case group, matched with the gender, age and education year of the case group 30 healthy volunteers as control group. US GE signa HDX-Speed 1.5T superconducting magnetic resonance imaging. Two-dimensional magnetic resonance spectroscopy (2D-1H MRS) scan: The voxel was placed on the center of the semi-oval, with a volume of interest of 7 cm × 10 cm × 2 cm, TR 1 500 ms, and TE 35 ms. SAGE software was used to determine the ratios of bilateral frontal lobe and parietal white matter metabolites, including NAA / Cr and Cho / Cr, respectively. Statistical analysis using SPSS 17.0 statistical software. Results The NAA / Cr, Cho / Cr and NAA / Cr, Cho / Cr and NAA / Cr in the left frontal lobe were significantly different between the two groups (P <0.05) And NAA / Cr and Cho / Cr in the right parietal lobe. There was no significant difference between them (P> 0.05). The left frontal lobe and left parietal lobe (t = 0.77, P = 0.45), the right frontal lobe and the right parietal lobe (t = -0.81, P = 0.43) , P = 0.51), NAA / Cr between the left parietal lobe and the right parietal lobe (t = -0.45, P = 0.65). There was no significant difference between the left frontal lobe and the left parietal lobe (t = 0.49, , Right frontal lobe and right parietal lobe (t = 0.53, P = 0.59), left frontal lobe and right frontal lobe (t = -0.96, P = 0.35) = 0.93) Cho / Cr differences were also not statistically significant. The left frontal lobe and left parietal lobe (t = 5.40, P <0.01), right frontal lobe and right parietal lobe (t = -5.86, P <0.01) 0.01). There was significant difference in NAA / Cr between the left parietal lobe and the right parietal lobe (t = 2.74, P = 0.01) There was no significant difference in Cho / Cr between the frontal lobe and right frontal lobe (t = -0.46, P = 0.65), Cho / Cr (t = -0.90, P = 0.38) There was significant difference in Cho / Cr between leaf and right parietal lobe (t = -2.93, P = 0.04). Conclusions The brain damage induced by hypertension in type 2 diabetes mellitus is progressive. Metabolic dysfunction occurs in bilateral frontal lobe and left parietal white matter. The changes of metabolites are mainly NAA / Cr and Cho / Cr increase Leaf gray matter than the top of the white matter significantly, left more obvious than the right.