Functional magnetic resonance imaging reveals differences in brain activation in response to thermal stimuli in diabetic patients with and without diabetic peripheral neuropathy.
Functional magnetic resonance imaging reveals differences in brain activation in response to thermal stimuli in diabetic patients with and without diabetic peripheral neuropathy.
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功能磁共振成像揭示了患有和不患有糖尿病周围神经病变的糖尿病患者对热刺激的大脑激活反应的差异。
DOI：
10.1371/journal.pone.0190699
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Ma C
中科院分区：
文献类型：
--
作者：
Li J;Zhang W;Wang X;Yuan T;Liu P;Wang T;Shen L;Huang Y;Li N;You H;Xiao T;Feng F;Ma C
糖尿病影响外周和中枢神经系统。本研究的目的是探讨脑活动的变化，以响应热刺激糖尿病患者和无糖尿病周围神经病变（DPN）使用功能磁共振成像（fMRI）。共招募了36名右利手志愿者：8名2型糖尿病合并DPN患者，13名2型糖尿病无DPN患者（NDPN患者）和15名健康志愿者（HV）。进行血氧水平依赖性基线扫描，首先在没有任何刺激的情况下，然后在右下肢的外侧施加四个阶段的热刺激（0、10、34和44°C，以随机顺序）。每次热刺激之间有240秒的休息时间。每个刺激会话包括三个周期的30 s刺激，然后是30 s休息。每次刺激后，参与者在视觉模拟量表上对疼痛和瘙痒感知进行评分。使用Statistical Parameter Mapping 8和Data Processing Assistant for Resting-State fMRI对fMRI数据序列进行分析。在对温度刺激的反应中，DPN患者表现出比HV和NDPN患者更强的激活，不仅在参与躯体感觉通路的脑区（右颞叶、左尾状核、额回和扣带回），而且在认知相关的脑区（右颞叶、左海马和左梭状回）。在0°C刺激下，NDPN患者的蚓部1-3的激活大于HV。功能磁共振成像可能有助于早期发现DPN引起的中枢神经系统损害。我们的研究结果表明，与糖尿病神经病变相关的中枢神经系统损害可能不仅限于运动和感觉相关的皮层区域。认知相关的大脑区域，如海马和梭状回也受到DPN引起的功能变化的影响。这表明，功能磁共振成像可以检测到早期阶段的认知功能障碍的DPN患者的症状变得临床显着之前。
Diabetes affects both the peripheral and central nervous systems. The aim of this study was to explore the changes in brain activity in response to thermal stimuli in diabetic patients with and without diabetic peripheral neuropathy (DPN) using functional magnetic resonance imaging (fMRI). A total of 36 right-handed volunteers were enrolled: eight patients with Type-2 diabetes mellitus and DPN, 13 patients with Type-2 diabetes mellitus lacking DPN (NDPN patients), and 15 healthy volunteers (HV). Blood oxygenation level-dependent baseline scans were performed, first without any stimuli, and then with four sessions of thermal stimuli (0, 10, 34, and 44°C, in a random order) applied to the lateral side of the right lower extremity. There was a 240-s rest interval between each thermal stimulation. Each stimulation session consisted of three cycles of 30 s of stimulation followed by 30 s of rest. After each stimuli session, the participant rated pain and itch perception on a visual analog scale. The fMRI data series were analyzed by using Statistical Parametric Mapping 8 and Data Processing Assistant for Resting-State fMRI. In response to temperature stimuli, DPN patients showed stronger activation than HV and NDPN patients, not only in brain areas that participate in somatosensory pathways (right insula, left caudate nucleus, frontal gyrus, and cingulate cortex), but also in the cognition-related cerebral areas (right temporal lobe, left hippocampus, and left fusiform gyrus). Activation of vermis 1–3 was greater in NDPN patients than in HV in response to 0°C stimulation. fMRI may be useful for the early detection of central nervous system impairment caused by DPN. Our results indicate that central nervous system impairment related to diabetic neuropathy may not be limited to motion- and sensation-related cortical regions. Cognition-associated cerebral regions such as the hippocampus and fusiform gyrus are also affected by functional changes caused by DPN. This suggests that fMRI can detect the early stages of cognitive impairment in DPN patients before the symptoms become clinically significant.
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