Wisse Laura E M, de Bresser Jeroen, Geerlings Mirjam I, Reijmer Yael D, Portegies Marileen L P, Brundel Manon, Kappelle L Jaap, van der Graaf Yolanda, Biessels Geert Jan
UMC Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; UMC Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
UMC Utrecht, Department of Radiology, Utrecht, The Netherlands.
J Neurol Sci. 2014 Sep 15;344(1-2):32-6. doi: 10.1016/j.jns.2014.06.008. Epub 2014 Jun 14.
It has been suggested that in patients with type 2 diabetes mellitus (T2DM), brain atrophy is most pronounced in the hippocampus, but this has not been investigated systematically. The present pooled analysis of three studies examined if hippocampal atrophy is more prominent than global brain atrophy in patients with T2DM relative to controls.
Data were derived from a cohort study of patients with vascular disease (SMART-Medea (T2DM=120; no T2DM=502)), and from two case-control studies (UDES1 (T2DM=61; controls=30) and UDES2 (T2DM=54; controls=53)). In SMART-Medea and UDES1, hippocampal volume was obtained by manual tracing on 1.5 Tesla (T) MRI scans. Total brain and intracranial volume (ICV) were determined by an automated segmentation method. In UDES2, hippocampal and total brain volume were determined by FreeSurfer and ICV by manual segmentation on 3 T MRI scans.
The pooled analyses, adjusted for age and sex, showed a significant negative relation between T2DM and total brain-to-ICV ratio (standardized mean difference=-1.24%, 95% CI: -1.63; -0.86), but not between T2DM and hippocampal-to-ICV ratio (0.00%, 95% CI: -0.01; 0.00) or between T2DM and hippocampal-to-total brain volume ratio (0.01%, 95% CI: -0.01; 0.02). In patients with T2DM no associations were found between brain volume measures and HbA1c or memory.
Patients with T2DM had greater brain atrophy but not hippocampal atrophy, compared to controls. These findings do not support specific vulnerability of the hippocampus in patients with T2DM.
有人提出，2型糖尿病（T2DM）患者的脑萎缩在海马体中最为明显，但尚未对此进行系统研究。本对三项研究的汇总分析检验了T2DM患者相对于对照组，海马体萎缩是否比全脑萎缩更显著。
数据来自一项血管疾病队列研究（SMART-Medea（T2DM = 120；无T2DM = 502））以及两项病例对照研究（UDES1（T2DM = 61；对照组 = 30）和UDES2（T2DM = 54；对照组 = 53））。在SMART-Medea和UDES1中，通过在1.5特斯拉（T）MRI扫描上手动追踪获得海马体体积。全脑和颅内体积（ICV）通过自动分割方法确定。在UDES2中，通过FreeSurfer确定海马体和全脑体积，通过在3T MRI扫描上手动分割确定ICV。
在对年龄和性别进行校正后的汇总分析显示，T2DM与全脑与ICV比率之间存在显著负相关（标准化平均差 = -1.24%，95%CI：-1.63；-0.86），但T2DM与海马体与ICV比率之间（0.00%，95%CI：-0.01；0.00）或T2DM与海马体与全脑体积比率之间（0.01%，95%CI：-0.01；0.02）无相关性。在T2DM患者中，未发现脑容量测量值与糖化血红蛋白或记忆力之间存在关联。
与对照组相比，T2DM患者存在更严重的脑萎缩，但不存在海马体萎缩。这些发现不支持T2DM患者中海马体存在特定易损性。
