2型糖尿病和肾功能损害与脑结构改变及卒中后认知功能下降有关。
Type 2 Diabetes Mellitus and Impaired Renal Function Are Associated With Brain Alterations and Poststroke Cognitive Decline.
作者信息
Ben Assayag Einor, Eldor Roy, Korczyn Amos D, Kliper Efrat, Shenhar-Tsarfaty Shani, Tene Oren, Molad Jeremy, Shapira Itzhak, Berliner Shlomo, Volfson Viki, Shopin Ludmila, Strauss Yehuda, Hallevi Hen, Bornstein Natan M, Auriel Eitan
机构信息
From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.).
出版信息
Stroke. 2017 Sep;48(9):2368-2374. doi: 10.1161/STROKEAHA.117.017709. Epub 2017 Aug 11.
BACKGROUND AND PURPOSE
Type 2 diabetes mellitus (T2DM) is associated with diseases of the brain, kidney, and vasculature. However, the relationship between T2DM, chronic kidney disease, brain alterations, and cognitive function after stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort.
METHODS
The TABASCO (Tel Aviv brain acute stroke cohort) is a prospective cohort of stroke/transient ischemic attack survivors. The volume and white matter integrity, ischemic lesions, and brain and hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were performed on 507 patients, who were diagnosed as having mild cognitive impairment, dementia, or being cognitively intact after 24 months.
RESULTS
At baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] <60 mL/min) were associated with smaller brain and hippocampal volumes, reduced cortical thickness, and worse white matter microstructural integrity. Two years later, both T2DM and eCCl <60 mL/min were associated with poorer cognitive scores, and 19.7% of the participants developed cognitive decline (mild cognitive impairment or dementia). Multiple analysis, controlling for age, sex, education, and apolipoprotein E4, showed a significant association of both T2DM and eCCl <60 mL/min with cognitive decline. Having both conditions doubled the risk compared with patients with T2DM or eCCl <60 mL/min alone and almost quadrupled the risk compared with patients without either abnormality.
CONCLUSIONS
T2DM and impaired renal function are independently associated with abnormal brain structure, as well as poorer performance in cognitive tests, 2 years after stroke. The presence of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl have an independent and additive effect on brain atrophy and the risk of cognitive decline.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
背景与目的
2型糖尿病（T2DM）与脑、肾及血管疾病相关。然而，T2DM、慢性肾脏病、脑改变与卒中后认知功能之间的关系尚不清楚。我们旨在评估卒中后纵向队列中T2DM、肾功能受损、影像学脑病理学改变与认知衰退之间的相互关系。
方法
特拉维夫脑急性卒中队列（TABASCO）是一个卒中/短暂性脑缺血发作幸存者的前瞻性队列。在基线时使用3-T磁共振成像测量脑容量、白质完整性、缺血性病变以及脑和海马体积。对507例患者进行认知测试，这些患者在24个月后被诊断为患有轻度认知障碍、痴呆或认知功能正常。
结果
在基线时，T2DM和肾功能受损（估计肌酐清除率[eCCl]<60 mL/分钟）与较小的脑和海马体积、皮质厚度降低以及较差的白质微观结构完整性相关。两年后，T2DM和eCCl<60 mL/分钟均与较差的认知评分相关，19.7%的参与者出现认知衰退（轻度认知障碍或痴呆）。在控制年龄、性别、教育程度和载脂蛋白E4的多因素分析中，T2DM和eCCl<60 mL/分钟均与认知衰退显著相关。与单独患有T2DM或eCCl<60 mL/分钟的患者相比，同时患有这两种情况使风险增加了一倍，与无任何异常的患者相比，风险几乎增加了四倍。
结论
卒中后2年，T2DM和肾功能受损与脑结构异常以及认知测试中的较差表现独立相关。同时存在这两种情况会使认知衰退风险增加四倍。T2DM和较低的eCCl对脑萎缩和认知衰退风险具有独立且累加的影响。
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