Department of Human Metabolism, University of Sheffield, Sheffield, U.K.
Academic Unit of Radiology, University of Sheffield, Sheffield, U.K.
Diabetes. 2019 Apr;68(4):796-806. doi: 10.2337/db18-0509. Epub 2019 Jan 7.
Diabetic distal symmetrical peripheral polyneuropathy (DSP) results in decreased somatosensory cortical gray matter volume, indicating that the disease process may produce morphological changes in the brains of those affected. However, no study has examined whether changes in brain volume alter the functional organization of the somatosensory cortex and how this relates to the various painful DSP clinical phenotypes. In this case-controlled, multimodal brain MRI study of 44 carefully phenotyped subjects, we found significant anatomical and functional changes in the somatosensory cortex. Subjects with painful DSP insensate have the lowest somatosensory cortical thickness, with expansion of the area representing pain in the lower limb to include face and lip regions. Furthermore, there was a significant relationship between anatomical and functional changes within the somatosensory cortex and severity of the peripheral neuropathy. These data suggest a dynamic plasticity of the brain in DSP driven by the neuropathic process. It demonstrates, for the first time in our knowledge, a pathophysiological relationship between a clinically painful DSP phenotype and alterations in the somatosensory cortex.
糖尿病远端对称性周围多发性神经病（DSP）导致体感皮质灰质体积减少，表明该疾病过程可能会使受影响人群的大脑产生形态变化。然而，尚无研究检查脑容量的变化是否会改变体感皮层的功能组织，以及这与各种疼痛性 DSP 临床表型有何关系。在这项针对 44 名精心表型化受试者的病例对照、多模态脑 MRI 研究中，我们发现体感皮层存在显著的解剖和功能变化。感觉迟钝的疼痛性 DSP 患者的体感皮质最薄，下肢代表疼痛的区域扩大，包括面部和唇部区域。此外，体感皮层内的解剖和功能变化与周围神经病变的严重程度之间存在显著关系。这些数据表明，DSP 中的神经病理性过程驱动大脑具有动态的可塑性。它首次证明，在我们的认知范围内，临床上疼痛性 DSP 表型与体感皮层改变之间存在病理生理学关系。
