Starr J M, Wardlaw J, Ferguson K, MacLullich A, Deary I J, Marshall I
SHEFC Centre for the Study of the Ageing Brain, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, UK.
J Neurol Neurosurg Psychiatry. 2003 Jan;74(1):70-6. doi: 10.1136/jnnp.74.1.70.
Patients with type II diabetes are at increased risk of cognitive impairment. The retinal and renal complications of diabetes follow microvascular damage permitting small arterioles to leak, hence the cerebral damage might also follow loss of blood-brain barrier (BBB) integrity. Magnetic resonance (MR) brain imaging with intravenous gadolinium (Gd) diethylenetriamine pentaacetic acid (Gd-DTPA) was used to identify increased BBB permeability.
Ten well controlled type II diabetic patients aged 65-70 years and 10 controls underwent MR brain imaging with fluid attenuated inversion recovery (FLAIR); T1 weighted (T1W) volumetric imaging before; and T1W volumetric imaging at 5, 15, 30, 45, 60, and 90 minutes after intravenous Gd-DTPA. The T1W image before Gd-DTPA was subtracted from the images at each time point after Gd-DTPA. Net signal intensity was plotted against time for different brain regions. White matter hyperintensities were scored from the FLAIR image.
The signal intensity/time curves showed that brain signal intensity increased more in the diabetic group than controls during the first 15 minutes after Gd-DTPA, particularly in the basal ganglia (p=0.018). Signal intensity in controls peaked at five minutes and diabetics at 15 minutes. Subjects with more white matter hyperintensities had greater signal increase after Gd-DTPA, whether diabetic or not (p=0.001).
Increased BBB permeability with MR imaging was detected in patients with type II diabetes or white matter hyperintensities. Increased permeability of the BBB might account for some of the cerebral effects of type II diabetes, and so possibly also for the effect of other conditions that affect the microvasculature (like hypertension), on the brain.
II型糖尿病患者发生认知障碍的风险增加。糖尿病的视网膜和肾脏并发症是微血管损伤导致小动脉渗漏的结果，因此脑损伤可能也与血脑屏障（BBB）完整性丧失有关。静脉注射钆（Gd）二乙三胺五乙酸（Gd-DTPA）的磁共振（MR）脑成像用于识别BBB通透性增加。
10名年龄在65 - 70岁、病情控制良好的II型糖尿病患者和10名对照者接受了液体衰减反转恢复（FLAIR）序列的MR脑成像；静脉注射Gd-DTPA前进行T1加权（T1W）容积成像；静脉注射Gd-DTPA后5、15、30、45、60和90分钟进行T1W容积成像。从Gd-DTPA注射后每个时间点的图像中减去注射前的T1W图像。绘制不同脑区净信号强度随时间的变化曲线。从FLAIR图像上对白质高信号进行评分。
信号强度/时间曲线显示，在Gd-DTPA注射后的前15分钟内，糖尿病组脑信号强度的增加比对照组更多，尤其是在基底节区（p = 0.018）。对照组信号强度在5分钟时达到峰值，糖尿病组在15分钟时达到峰值。无论是否为糖尿病患者，白质高信号较多的受试者在Gd-DTPA注射后信号增加更大（p = 0.001）。
在II型糖尿病患者或白质高信号患者中检测到MR成像显示的BBB通透性增加。BBB通透性增加可能是II型糖尿病某些脑效应产生的原因，也可能是影响微血管系统的其他疾病（如高血压）对脑产生影响的原因。
