Microvascular perfusion abnormalities of the Thalamus in painful but not painless diabetic polyneuropathy: a clue to the pathogenesis of pain in type 1 diabetes.
Microvascular perfusion abnormalities of the Thalamus in painful but not painless diabetic polyneuropathy: a clue to the pathogenesis of pain in type 1 diabetes.
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DOI：
10.2337/dc10-1550
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发表时间：
2011-03
期刊：
影响因子：
16.2
通讯作者：
Tesfaye S
中科院分区：
文献类型：
--
作者：
Selvarajah D;Wilkinson ID;Gandhi R;Griffiths PD;Tesfaye S
痛性糖尿病神经病变(DN)的发病机制尚不清楚，涉及中枢和外周机制。本研究探讨痛性糖尿病肾病患者是否存在丘脑血流灌注异常。18例1型糖尿病患者(无糖尿病肾病6例，有痛性糖尿病肾病5例，无痛性糖尿病肾病7例)和6例健康志愿者(HV)入选。用磁共振灌注成像评价丘脑和尾状核的微血管灌注特征(相对脑血容量[rCBV]、血流量[rCBF]和通过时间[ttFM])。选择尾状核作为体内控制区。痛性糖尿病肾病患者丘脑rCBV显著增加(均值228.7[19.5]；无糖尿病肾病202.3[2 5.8]；无痛糖尿病肾病216.5[65.5]；HV，181.9[5 1.7]；P=0.0 4)；最长ttFM(S)(疼痛糖尿病肾病38.4[3.6]；无糖尿病肾病35.3[13.2]；无痛糖尿病肾病35.9[13.7]；高血压33.7[14.9]；P=0.0 7)。尾状核血流灌注指标差异无统计学意义。痛性糖尿病肾病与丘脑血管增多有关。这可能为探讨糖尿病肾病疼痛的发病机制提供重要线索。
The pathogenesis of painful diabetic neuropathy (DN) remains undetermined, with both central and peripheral mechanisms implicated. This study investigates whether thalamic perfusion abnormalities occur in painful DN. Eighteen subjects with type 1 diabetes (no DN = 6, painful DN = 5, painless DN = 7) and six healthy volunteers (HV) were recruited. Microvascular perfusion characteristics (relative cerebral blood volume [rCBV], flow [rCBF], and transit time [ttFM]) of the thalamus and caudate nucleus were assessed using magnetic resonance perfusion imaging. The caudate nucleus was chosen to serve as an in vivo control region. Subjects with painful DN had significantly greater thalamic rCBV (means [SD]; painful DN, 228.7 [19.5]; no DN, 202.3 [25.8]; painless DN, 216.5 [65.5]; HV, 181.9 [51.7]; P = 0.04) and the longest ttFM(s) (painful DN, 38.4 [3.6]; no DN, 35.3 [13.2]; painless DN, 35.9 [13.7]; HV, 33.7 [14.9]; P = 0.07). There was no significant difference in markers of caudate nucleus perfusion. Painful DN is associated with increased thalamic vascularity. This may provide an important clue to the pathogenesis of pain in DN.