Department of Radiology, University Hospital, LMU Munich, Munich, Germany
Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
BMJ Open Diabetes Res Care. 2021 Jun;9(1). doi: 10.1136/bmjdrc-2020-002050.
As white matter hyperintensities (WMHs) of the brain are associated with an increased risk of stroke, cognitive decline, and depression, elucidating the associated risk factors is important. In addition to age and hypertension, pre-diabetes and diabetes may play important roles in the development of WMHs. Previous studies have, however, shown conflicting results. We aimed to investigate the effect of diabetes status and quantitative markers of glucose metabolism on WMH volume in a population-based cohort without prior cardiovascular disease.
400 participants underwent 3 T MRI. WMHs were manually segmented on 3D fluid-attenuated inversion recovery images. An oral glucose tolerance test (OGTT) was administered to all participants not previously diagnosed with diabetes to assess 2-hour serum glucose concentrations. Fasting glucose concentrations and glycated hemoglobin (HbA1c) levels were measured. Zero-inflated negative binomial regression analyses of WMH volume and measures of glycemic status were performed while controlling for cardiovascular risk factors and multiple testing.
The final study population comprised 388 participants (57% male; age 56.3±9.2 years; n=98 with pre-diabetes, n=51 with diabetes). Higher WMH volume was associated with pre-diabetes (p=0.001) and diabetes (p=0.026) compared with normoglycemic control participants after adjustment for cardiovascular risk factors. 2-hour serum glucose (p<0.001), but not fasting glucose (p=0.389) or HbA1c (p=0.050), showed a significant positive association with WMH volume after adjustment for cardiovascular risk factors.
Our results indicate that high 2-hour serum glucose concentration in OGTT, but not fasting glucose levels, may be an independent risk factor for the development of WMHs, with the potential to inform intensified prevention strategies in individuals at risk of WMH-associated morbidity.
脑白质高信号（WMHs）与中风、认知能力下降和抑郁的风险增加有关，因此阐明其相关的危险因素非常重要。除了年龄和高血压外，糖尿病前期和糖尿病可能在 WMH 的发展中起重要作用。然而，先前的研究结果存在矛盾。我们旨在调查在无心血管疾病病史的人群中，糖尿病状态和葡萄糖代谢的定量标志物对 WMH 体积的影响。
400 名参与者接受了 3T MRI 检查。WMHs 在 3D 液体衰减反转恢复图像上进行手动分割。所有未被诊断为糖尿病的参与者均进行口服葡萄糖耐量试验（OGTT），以评估 2 小时血清葡萄糖浓度。测量空腹血糖浓度和糖化血红蛋白（HbA1c）水平。在控制心血管危险因素和多次检验的情况下，对 WMH 体积和血糖状态测量指标进行零膨胀负二项回归分析。
最终研究人群包括 388 名参与者（57%为男性；年龄 56.3±9.2 岁；98 名参与者为糖尿病前期，51 名参与者为糖尿病）。与血糖正常的对照组相比，调整心血管危险因素后，糖尿病前期（p=0.001）和糖尿病（p=0.026）患者的 WMH 体积更高。调整心血管危险因素后，2 小时血清葡萄糖（p<0.001），而空腹血糖（p=0.389）或 HbA1c（p=0.050）与 WMH 体积呈显著正相关。
我们的研究结果表明，OGTT 中高 2 小时血清葡萄糖浓度，而不是空腹血糖水平，可能是 WMH 发生的独立危险因素，这可能为高危人群的 WMH 相关发病提供强化预防策略。
