Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 Changle Road, Xi'an, 710032, Shaanxi, China.
Nutr Diabetes. 2022 Aug 15;12(1):39. doi: 10.1038/s41387-022-00214-2.
AIMS/HYPOTHESIS: Brain structure abnormality in patients with type 2 diabetes mellitus (T2DM)-related cognitive dysfunction (T2DM-CD) has been reported for decades in magnetic resonance imaging (MRI) studies. However, the reliable results were still unclear. This study aimed to make a systemic review and meta-analysis to find the significant and consistent gray matter (GM) and white matter (WM) alterations in patients with T2DM-CD by comparing with the healthy controls (HCs).
Published studies were systemically searched from PubMed, MEDLINE, Cochrane Library and Web of Science databases updated to November 14, 2021. Studies reporting abnormal GM or WM between patients with T2DM-CD and HCs were selected, and their significant peak coordinates (x, y, z) and effect sizes (z-score or t-value) were extracted to perform a voxel-based meta-analysis by anisotropic effect size-signed differential mapping (AES-SDM) 5.15 software.
Total 15 studies and 16 datasets (1550 participants) from 7531 results were involved in this study. Compared to HCs, patients with T2DM-CD showed significant and consistent decreased GM in right superior frontal gyrus, medial orbital (PFCventmed. R, BA 11), left superior temporal gyrus (STG. L, BA 48), and right calcarine fissure / surrounding cortex (CAL. R, BA 17), as well as decreased fractional anisotropy (FA) in right inferior network, inferior fronto-occipital fasciculus (IFOF. R), right inferior network, longitudinal fasciculus (ILF. R), and undefined area (32, -60, -42) of cerebellum. Meta-regression showed the positive relationship between decreased GM in PFCventmed.R and MoCA score, the positive relationship between decreased GM in STG.L and BMI, as well as the positive relationship between the decreased FA in IFOF.R and age or BMI.
CONCLUSIONS/INTERPRETATION: T2DM impairs the cognitive function by affecting the specific brain structures. GM atrophy in PFCventmed. R (BA 11), STG. L (BA 48), and CAL. R (BA 17), as well as WM injury in IFOF. R, ILF. R, and undefined area (32, -60, -42) of cerebellum. And those brain regions may be valuable targets for future researches. Age, BMI, and MoCA score have a potential influence on the altered GM or WM in T2DM-CD.
目的/假设：几十年来，磁共振成像（MRI）研究报告称，2 型糖尿病（T2DM）相关认知功能障碍（T2DM-CD）患者存在大脑结构异常。然而，可靠的结果仍不清楚。本研究旨在通过与健康对照组（HCs）进行比较，对 T2DM-CD 患者的灰质（GM）和白质（WM）异常进行系统综述和荟萃分析。
系统检索了 PubMed、MEDLINE、Cochrane 图书馆和 Web of Science 数据库，检索时间截至 2021 年 11 月 14 日。选择报告 T2DM-CD 患者与 HCs 之间 GM 或 WM 异常的研究，并提取其显著峰值坐标（x、y、z）和效应量（z 分数或 t 值），通过各向异性效应量-符号差异映射（AES-SDM）5.15 软件进行体素荟萃分析。
本研究共纳入 7531 项研究中的 15 项研究和 16 个数据集（1550 名参与者）。与 HCs 相比，T2DM-CD 患者右侧额上回、内侧眶额回（PFCventmed. R，BA11）、左侧颞上回（STG. L，BA48）和右侧距状裂/周围皮质（CAL. R，BA17）的 GM 明显减少，以及右侧下网络、下额枕束（IFOF. R）、右侧下网络、纵束（ILF. R）和小脑未定义区域（32，-60，-42）的 FA 明显减少。Meta 回归显示，PFCventmed.R 中 GM 减少与 MoCA 评分呈正相关，STG.L 中 GM 减少与 BMI 呈正相关，IFOF.R 中 FA 减少与年龄或 BMI 呈正相关。
结论/解释：T2DM 通过影响特定的大脑结构来损害认知功能。PFCventmed. R（BA11）、STG. L（BA48）和 CAL. R（BA17）的 GM 萎缩，以及 IFOF. R、ILF. R 和小脑未定义区域（32，-60，-42）的 WM 损伤。这些脑区可能是未来研究的有价值的靶点。年龄、BMI 和 MoCA 评分可能对 T2DM-CD 中 GM 或 WM 的改变有潜在影响。
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