Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
College of Electrics and Information Engineering, South-Central University for Nationalities, Wuhan, China.
Front Endocrinol (Lausanne). 2021 Oct 25;12:722861. doi: 10.3389/fendo.2021.722861. eCollection 2021.
We aimed to investigate the alterations of brain functional connectivity (FC) in type 2 diabetes mellitus (T2DM) patients without clinical evidence of cognitive impairment and microvascular complications (woCIMC-T2DM) using resting-state functional MRI (rs-fMRI) and to determine whether its value was correlated with clinical indicators.
A total of 27 T2DM and 26 healthy controls (HCs) were prospectively examined. Cognitive impairment was excluded using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scales, and microvascular complications were excluded by fundus photography, microalbuminuria, and other indicators. The correlation maps, derived from rs-fMRI with posterior cingulate cortex (PCC) as the seed, were compared between T2DM patients and HCs. Pearson's correlation analysis was performed to determine the relationship between the FC of PCC and the clinical indicators.
Compared with HC, woCIMC-T2DM patients showed significantly decreased FCs with PCC (PCC-FCs) in the anterior cingulate cortex (ACC), right superior frontal gyrus, right medial frontal gyrus, and right angular gyrus. Meanwhile, increased PCC-FCs was observed in the right superior temporal gyrus and calcarine fissure (CAL). The FC of PCC-ACC was negatively correlated with glycosylated hemoglobin (HbA1c) and diabetes duration, and the FC of PCC-CAL was significantly positively correlated with HbA1c and diabetes duration.
The FC, especially of the PCC with cognitive and visual brain regions, was altered before clinically measurable cognitive impairment and microvascular complications occurred in T2DM patients. In addition, the FC of the PCC with cognitive and visual brain regions was correlated with HbA1c and diabetes duration. This indicates that clinicians should pay attention not only to blood glucose control but also to brain function changes before the occurrence of adverse complications, which is of great significance for the prevention of cognitive dysfunction and visual impairment.
本研究旨在通过静息态功能磁共振成像(rs-fMRI)观察无认知功能障碍和微血管并发症的 2 型糖尿病患者（woCIMC-T2DM）脑功能连接（FC）的变化，并探讨其与临床指标的相关性。
前瞻性纳入 27 例 T2DM 患者和 26 例健康对照者（HC）。采用简易精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）排除认知障碍，通过眼底照相、微量白蛋白尿等指标排除微血管并发症。以后扣带回为种子点，比较 T2DM 患者与 HC 间的相关图。采用 Pearson 相关分析探讨后扣带回 FC 与临床指标的相关性。
与 HC 比较，woCIMC-T2DM 患者后扣带回与前扣带回皮质（ACC）、右侧额上回、右侧额中回和右侧角回的 FC（PCC-FCs）降低，右侧颞上回和距状裂（CAL）的 PCC-FCs 升高。PCC-ACC 的 FC 与糖化血红蛋白（HbA1c）、糖尿病病程呈负相关，PCC-CAL 的 FC 与 HbA1c、糖尿病病程呈正相关。
在 T2DM 患者出现临床可测量的认知和微血管并发症之前，其 PCC 与认知和视觉脑区的 FC 已发生改变。此外，PCC 与认知和视觉脑区的 FC 与 HbA1c 和糖尿病病程相关。这提示临床医生不仅要关注血糖控制，还要关注不良并发症发生前的脑功能变化，对预防认知功能障碍和视力损害具有重要意义。
