Inflammation-associated declines in cerebral vasoreactivity and cognition in type 2 diabetes
Inflammation-associated declines in cerebral vasoreactivity and cognition in type 2 diabetes
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DOI：
10.1212/wnl.0000000000001820
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发表时间：
2015-08-04
期刊：
影响因子：
9.9
通讯作者：
Novak, Vera
中科院分区：
文献类型：
--
作者：
Chung, Chen-Chih;Pimentel, Daniela;Novak, Vera
目的：本前瞻性研究的目的是探讨2型糖尿病（T2DM）患者炎症、脑血管调节和认知能力下降之间的关系。方法：65名参与者（年龄66岁9.2岁，35名患有T2DM， 33名女性）参加了这项为期2年的前瞻性研究。3特斯拉MRI连续动脉自旋标记用于测量整体和局部脑灌注和血管反应性。在研究开始和结束时对神经心理学测量进行评估。使用最小二乘模型检验血清炎症标志物、区域脑血管反应性和认知功能之间的关联。结果：经过2年的随访，T2DM患者的整体和局部脑血管反应性下降，多项认知任务下降（p < 0.0001-0.012）。在T2DM组中，较低的脑血管反应性与日常生活活动评分的较大下降相关(r(adj)(2) = 0.35, p = 0.04)，较低的整体血管舒张性与执行功能的较大下降相关(r（adj)(2) = 0.6, p = 0.047）。只有T2DM组(r（adj)(2) = 0.16-0.53, p = 0.007-0.048）与基线时较高的血清可溶性细胞间和血管粘附分子、较高的皮质醇和较高的c反应蛋白水平相关(r(adj)(2) = 0.16-0.53, p = 0.007-0.048)，与糖尿病控制和24小时血压无关。较高的糖化血红蛋白A（1c）水平与T2DM组血管收缩的增加有关。结论：炎症可进一步损害脑血管调节功能，从而加速老年T2DM患者执行功能和日常活动能力的下降。
Objective:The aim of this prospective study was to investigate the relationships between inflammation, cerebral vasoregulation, and cognitive decline in type 2 diabetes mellitus (T2DM) over a 2-year span.Methods:Sixty-five participants (aged 66 9.2 years, 35 with T2DM, 33 women) were enrolled for this 2-year prospective study. Continuous arterial spin labeling at 3-tesla MRI was used to measure global and regional cerebral perfusion and vasoreactivity. Neuropsychological measures were evaluated at the beginning and completion of the study. The associations between serum inflammatory markers, regional cerebral vasoreactivity, and cognitive functions were examined using least squares models.Results:After 2 years of follow-up, participants with T2DM had diminished global and regional cerebral vasoreactivity and a decline in multiple cognitive tasks compared with baseline (p < 0.0001-0.012). In the T2DM group, lower cerebral vasoreactivity was associated with a greater decrease in daily living activities score (r(adj)(2) = 0.35, p = 0.04), and lower global vasodilation was associated with a greater decline in executive function (r(adj)(2) = 0.6, p = 0.047). Higher serum soluble intercellular and vascular adhesion molecules, higher cortisol, and higher C-reactive protein levels at baseline were associated with greater decreases in cerebral vasoreactivity and vasodilation only in the T2DM group (r(adj)(2) = 0.16-0.53, p = 0.007-0.048), independent of diabetes control and 24-hour blood pressure. Higher glycated hemoglobin A(1c) levels were associated with a greater increase in vasoconstriction in the T2DM group.Conclusions:Inflammation may further impair cerebral vasoregulation, which consequently accelerates decline in executive function and daily activities performance in older people with T2DM.