Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes.
Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes.
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DOI：
10.1007/s00125-007-0792-z
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发表时间：
2007-11
期刊：
影响因子：
8.2
通讯作者：
Kappelle, L. J.
中科院分区：
文献类型：
--
作者：
Manschot, S. M.;Biessels, G. J.;de Valk, H.;Algra, A.;Rutten, G. E. H. M.;van der Grond, J.;Kappelle, L. J.
关键词：
2型糖尿病脑并发症的决定因素尚不清楚。本研究旨在确定与2型糖尿病患者认知功能受损和脑MRI异常相关的代谢和血管因素。该研究包括122名患者和56名对照。神经心理学测试分数分为五个认知领域，并表示为标准化的z值。脑部MRI扫描评估白色病变（WML）、皮质和皮质下萎缩和梗死。收集有关葡萄糖代谢、血管危险因素和微血管和大血管疾病的数据。与对照组相比，2型糖尿病患者有更多的皮质（p < 0.001）和皮质下（p < 0.01）萎缩和深层WML（p = 0.02），他们的认知能力更差。在2型糖尿病组的多变量回归分析中，高血压（p < 0.05）和血管事件史（p < 0.01）与较差的认知能力相关，而使用他汀类药物与较好的认知能力相关（p < 0.05）。视网膜病变和脑梗死与更严重的皮质萎缩相关（均为p < 0.01），使用他汀类药物与较少的萎缩相关（p < 0.05）。胰岛素水平和脑梗死与更严重的WML相关，而他汀类药物使用与较轻的WML相关（所有p < 0.05）。2型糖尿病与认知的适度损害以及MRI上的萎缩和血管病变相关。这种“糖尿病脑病”是一种多因素疾病，动脉粥样硬化（大血管病变）血管疾病是一个重要的决定因素。慢性高胰岛素血症、高胰岛素血症和高血压可能发挥其他作用。本文的在线版本（doi：10.1007/s 00125 -007-0792-z）包含乌得勒支糖尿病脑病研究组的详细信息，可供授权用户使用。
The determinants of cerebral complications of type 2 diabetes are unclear. The present study aimed to identify metabolic and vascular factors that are associated with impaired cognitive performance and abnormalities on brain MRI in patients with type 2 diabetes. The study included 122 patients and 56 controls. Neuropsychological test scores were divided into five cognitive domains and expressed as standardised z values. Brain MRI scans were rated for white matter lesions (WML), cortical and subcortical atrophy, and infarcts. Data on glucose metabolism, vascular risk factors and micro- and macrovascular disease were collected. Patients with type 2 diabetes had more cortical (p < 0.001) and subcortical (p < 0.01) atrophy and deep WML (p = 0.02) than the control group and their cognitive performance was worse. In multivariate regression analyses within the type 2 diabetes group, hypertension (p < 0.05) and a history of vascular events (p < 0.01) were associated with worse cognitive performance, while statin use was associated (p < 0.05) with better performance. Retinopathy and brain infarcts on MRI were associated with more severe cortical atrophy (both p < 0.01) and statin use with less atrophy (p < 0.05). Insulin level and brain infarcts were associated with more severe WML and statin use with less severe WML (all p < 0.05). Type 2 diabetes is associated with modest impairments in cognition, as well as atrophy and vascular lesions on MRI. This ‘diabetic encephalopathy’ is a multifactorial condition, for which atherosclerotic (macroangiopathic) vascular disease is an important determinant. Chronic hyperglycaemia, hyperinsulinaemia and hypertension may play additional roles. The online version of this article (doi:10.1007/s00125-007-0792-z) contains details of the Utrecht Diabetic Encephalopathy Study Group, which are available to authorised users.
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