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《eBioMedicine》报道糖尿病前期患者已出现白质微结构损伤

2022-07-31 国家神经疾病临床医学研究中心 网络

对糖尿病的干预应提前至结合IFG/IGT的糖尿病前期,以预防更严重的白质微结构损伤带来的一系列神经类疾病。

近日,首都医科大学附属北京天坛医院、国家神经系统疾病临床医学研究中心与北京航空航天大学和丽水市中心医院开展合作,在《eBiomedicine》(IF: 11.205,中科院分区:医学1区)上发表了题为“Reduced White Matter Microstructural Integrity in Prediabetes and Diabetes: A Population-based Study”的论著。研究基于血管床评估与认知损伤和血管事件社区人群队列研究(PRECISE)的基线调查数据,探索糖尿病前期及糖尿病患者的大脑白质微结构损伤。第一作者:荆京、周怡君、潘岳松、蔡学礼;通讯作者:刘涛、韦铁民、王拥军。

糖尿病是威胁人类健康的主要慢性疾病之一,给人们带来了沉重的健康和经济负担,据2018年糖尿病流行病学调查统计,我国糖尿病前期和糖尿病的患病率已分别高达38.1%和12.4%。糖尿病通常会引起一系列全身性疾病,包括多种神经系统疾病,如卒中、痴呆等。已有研究表明,高血糖会对患者的大脑白质造成影响,如白质高信号增多、白质结构萎缩等,近年来还有研究通过弥散张量成像(DTI)计算发现糖尿病患者的大脑存在明显的白质微观结构损伤。然而,这些与白质微结构相关的研究均针对糖尿病,而对于糖尿病前期的研究却十分有限。

研究共纳入2218例含有完整DTI和血糖数据的受试者。根据美国糖尿病协会(American Diabetes Association, ADA)2019年的最新糖尿病诊断标准,将2218名样本划分为1205名糖尿病前期患者,504名糖尿病患者以及509名健康对照。为进一步探索糖尿病前期首先出现白质微结构损伤的可能阶段,本研究将糖尿病前期人群分为两个亚组:将同时存在空腹血糖受损(IFG)和糖耐受受损(IGT)的样本定义为“结合IFG/IGT糖尿病前期”,其余样本定义为“非结合IFG/IGT糖尿病前期”(图1)。

接下来利用DTI结合基于纤维追踪的空间统计(Tract-based Spatial Statistic, TBSS)方法,计算大脑白质的各向异性分数(Fraction Anisotropy, FA)和平均弥散指数(Mean Diffusivity, MD),评估糖尿病前期和糖尿病患者的大脑白质微结构损伤。其中FA值下降或MD值升高均代表白质微结构受损。并通过线性混合模型评估高血糖和白质微结构损伤之间的关系。

TBSS结果显示,与健康对照相比,在两个糖尿病前期亚组中,结合IFG/IGT糖尿病前期人群出现局部白质微结构损伤(图2a);而糖尿病人群出现全脑性的白质微结构损伤(图2b),受损最严重的脑区主要包括胼胝体体部、双侧丘脑后部辐射、双侧前放射冠、双侧外囊和右侧额枕下束(图2c)。这些白质微结构损伤均与高血糖有关。

图2. TBSS结果。a. 结合IFG/IGT糖尿病前期vs.健康对照,红色表示FA下降区域,蓝色表示MD上升区域;b. 糖尿病vs.健康对照,红色表示FA下降区域,蓝色表示MD上升区域;c. 糖尿病组白质微结构损伤最严重的脑区(基于John Hopkin University-ICBMDTI81白质图谱)。

综上所述,该研究表明白质微结构损伤在糖尿病前期就已经出现在局部脑区中,并且首先出现在结合IFG/IGT的糖尿病前期,说明结合IFG/IGT的糖尿病前期人群是糖尿病前期中的高危人群,提示结合IFG/IGT的糖尿病前期是大脑白质微结构损伤的重要转折点。因此,对糖尿病的干预应提前至结合IFG/IGT的糖尿病前期,以预防更严重的白质微结构损伤带来的一系列神经类疾病。

全文链接:

Jing Jing, Zhou Yijun, Pan Yuesong, Cai Xueli, Zhu Wanlin, Zhang Zhe, Li Zixiao, Liu Chang, Meng Xia, Cheng Jian, Wang Yilong, Li Hao, Wu Zhenzhou, Wang Suying, Niu Haijun, Wen Wei, Liu Tao, Wei Tiemin, Wang Yongjun, Sachdev Perminder S. (2022). Reduced white matter microstructural integrity in prediabetes and diabetes: A population-based study. eBioMedicine, 82, 104144.

https://www.sciencedirect.com/science/article/pii/S2352396422003255

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    2022-10-28 sunylz
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    2022-10-30 kalseyzl
  4. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1577914, encodeId=4ae215e7914d4, content=<a href='/topic/show?id=cda91148004' target=_blank style='color:#2F92EE;'>#Medicine#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=246, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11480, encryptionId=cda91148004, topicName=Medicine)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54cd16396700, createdName=ms1692212821629096, createdTime=Mon Jul 18 09:30:05 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611679, encodeId=4a5e16116e9bf, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, 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    2023-06-23 linagood
  5. 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    2022-12-22 jeanqiuqiu
  6. 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  7. 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