Wessels A M, Simsek S, Remijnse P L, Veltman D J, Biessels G J, Barkhof F, Scheltens P, Snoek F J, Heine R J, Rombouts S A R B
Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Diabetologia. 2006 Oct;49(10):2474-80. doi: 10.1007/s00125-006-0283-7. Epub 2006 May 16.
AIMS/HYPOTHESIS: In addition to nephropathy, retinopathy and peripheral neuropathy, a microvascular complication of type 1 diabetes that may be tentatively referred to as 'diabetic encephalopathy' has gained increasing attention. There is growing evidence that lowered cognitive performance in patients with type 1 diabetes is related to chronic hyperglycaemia rather than recurrent episodes of severe hypoglycaemia, as previously speculated. The aim of our study was to use magnetic resonance imaging (MRI) to establish whether long-term hyperglycaemia, resulting in advanced retinopathy, contributes to structural changes in the brain (reduced grey matter).
SUBJECTS, MATERIALS AND METHODS: We applied voxel-based morphometry on magnetic resonance images to compare grey matter density (GMD) between three groups of participants. GMD is used as a marker of cortical atrophy. We compared 13 type 1 diabetic patients with a microvascular complication (i.e. proliferative retinopathy) with 18 type 1 diabetic patients who did not have retinopathy in order to assess the effects of microvascular changes on GMD. Both patient groups were compared with 21 healthy control subjects to assess the effect of diabetes in itself.
Patients with diabetic retinopathy showed reduced GMD in the right inferior frontal gyrus and right occipital lobe compared both with patients without retinopathy and with healthy controls (p<0.05).
CONCLUSIONS/INTERPRETATION: Our data show that patients with type 1 diabetes, who, as a consequence of chronic hyperglycaemia, had developed advanced retinopathy, also showed increased focal cortical atrophy on brain MRI.
目的/假设：除肾病、视网膜病变和周围神经病变外，1型糖尿病的一种微血管并发症（可暂称为“糖尿病性脑病”）已日益受到关注。越来越多的证据表明，1型糖尿病患者认知能力下降与慢性高血糖有关，而非如之前推测的那样与严重低血糖的反复发作有关。我们研究的目的是利用磁共振成像（MRI）确定导致晚期视网膜病变的长期高血糖是否会导致大脑结构改变（灰质减少）。
受试者、材料与方法：我们对磁共振图像应用基于体素的形态测量法，以比较三组参与者之间的灰质密度（GMD）。GMD用作皮质萎缩的标志物。我们将13例患有微血管并发症（即增殖性视网膜病变）的1型糖尿病患者与18例无视网膜病变的1型糖尿病患者进行比较，以评估微血管变化对GMD的影响。将这两组患者与21名健康对照者进行比较，以评估糖尿病本身的影响。
与无视网膜病变的患者及健康对照者相比，患有糖尿病视网膜病变的患者右侧额下回和右侧枕叶的GMD降低（p<0.05）。
结论/解读：我们的数据表明，因慢性高血糖而出现晚期视网膜病变的1型糖尿病患者，在脑部MRI上也显示局灶性皮质萎缩增加。
