Manschot S M, Biessels G J, de Valk H, Algra A, Rutten G E H M, van der Grond J, Kappelle L J
Rudolf Magnus Institute of Neuroscience, Department of Neurology, G03.228, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Diabetologia. 2007 Nov;50(11):2388-97. doi: 10.1007/s00125-007-0792-z. Epub 2007 Sep 2.
AIMS/HYPOTHESIS: The determinants of cerebral complications of type 2 diabetes are unclear. The present study aimed to identify metabolic and vascular factors that are associated with impaired cognitive performance and abnormalities on brain MRI in patients with type 2 diabetes.
The study included 122 patients and 56 controls. Neuropsychological test scores were divided into five cognitive domains and expressed as standardised z values. Brain MRI scans were rated for white matter lesions (WML), cortical and subcortical atrophy, and infarcts. Data on glucose metabolism, vascular risk factors and micro- and macrovascular disease were collected.
Patients with type 2 diabetes had more cortical (p < 0.001) and subcortical (p < 0.01) atrophy and deep WML (p = 0.02) than the control group and their cognitive performance was worse. In multivariate regression analyses within the type 2 diabetes group, hypertension (p < 0.05) and a history of vascular events (p < 0.01) were associated with worse cognitive performance, while statin use was associated (p < 0.05) with better performance. Retinopathy and brain infarcts on MRI were associated with more severe cortical atrophy (both p < 0.01) and statin use with less atrophy (p < 0.05). Insulin level and brain infarcts were associated with more severe WML and statin use with less severe WML (all p < 0.05).
CONCLUSIONS/INTERPRETATION: Type 2 diabetes is associated with modest impairments in cognition, as well as atrophy and vascular lesions on MRI. This 'diabetic encephalopathy' is a multifactorial condition, for which atherosclerotic (macroangiopathic) vascular disease is an important determinant. Chronic hyperglycaemia, hyperinsulinaemia and hypertension may play additional roles.
目的/假设：2型糖尿病脑部并发症的决定因素尚不清楚。本研究旨在确定与2型糖尿病患者认知功能受损及脑部磁共振成像（MRI）异常相关的代谢和血管因素。
本研究纳入122例患者和56例对照。神经心理学测试分数被分为五个认知领域，并表示为标准化z值。对脑部MRI扫描评估白质病变（WML）、皮质和皮质下萎缩以及梗死情况。收集有关葡萄糖代谢、血管危险因素以及微血管和大血管疾病的数据。
与对照组相比，2型糖尿病患者有更多的皮质萎缩（p<0.001）和皮质下萎缩（p<0.01）以及深部WML（p = 0.02），且其认知功能更差。在2型糖尿病组的多变量回归分析中，高血压（p<0.05）和血管事件史（p<0.01）与较差的认知功能相关，而使用他汀类药物与较好的认知功能相关（p<0.05）。视网膜病变和MRI上的脑梗死与更严重的皮质萎缩相关（均p<0.01），使用他汀类药物与较轻的萎缩相关（p<0.05）。胰岛素水平和脑梗死与更严重的WML相关，使用他汀类药物与较轻的WML相关（均p<0.05）。
结论/解读：2型糖尿病与认知功能的轻度损害以及MRI上的萎缩和血管病变相关。这种“糖尿病性脑病”是一种多因素疾病，动脉粥样硬化（大血管病变）性血管疾病是其重要决定因素。慢性高血糖、高胰岛素血症和高血压可能起额外作用。
