Keymeulen B, Jacobs A, de Metz K, de Sadeleer C, Bossuyt A, Somers G
Department of Internal Medicine, Vrije Universiteit Brussel, Belgium.
Nucl Med Commun. 1995 Jan;16(1):10-6. doi: 10.1097/00006231-199501000-00005.
Regional distribution of cerebral blood flow was determined semi-quantitatively with 99Tcm-HMPAO brain SPET under basal conditions in Type 1 (insulin-dependent) diabetic patients of recent onset and longer disease duration, and related to metabolic control and history of hypoglycaemic events. Long-term diabetic patients showed significantly more alterations in regional cerebral blood flow than diabetics of recent onset and healthy controls. Regional hypoperfusion, predominantly localized in the fronto-temporal cortex, was almost exclusively observed in patients with long-term diabetes. The latter finding was related to lower HbA1c levels (i.e. better metabolic control) and to the frequency of impending hypoglycaemia, but not to age of the patient, duration of diabetes or to chronic diabetes complications. The incidence of hypoperfusion was comparable in patient groups with or without a medical history of hypoglycaemic coma. However, regions of hypoperfusion were larger in the patients who had experienced hypoglycaemic coma. It is concluded that regional cerebral hypoperfusion in long-term Type 1 (insulin-dependent) diabetics, as evidenced by HMPAO-SPET can be related to the frequency and degree of hypoglycaemic events and to tight metabolic control, which is however at the expense of an increased risk of recurrent hypoglycaemia.
在基础状态下，采用99锝-六甲基丙二胺肟脑单光子发射计算机断层扫描（99Tcm-HMPAO brain SPET）对近期发病和病程较长的1型（胰岛素依赖型）糖尿病患者的脑血流区域分布进行了半定量测定，并将其与代谢控制及低血糖事件史相关联。长期糖尿病患者的脑血流区域改变明显多于近期发病的糖尿病患者和健康对照者。脑血流灌注不足主要局限于额颞叶皮质，几乎仅见于长期糖尿病患者。后一发现与较低的糖化血红蛋白（HbA1c）水平（即更好的代谢控制）以及即将发生低血糖的频率有关，但与患者年龄、糖尿病病程或慢性糖尿病并发症无关。有或无低血糖昏迷病史的患者组中，灌注不足的发生率相当。然而，经历过低血糖昏迷的患者中，灌注不足区域更大。结论是，99Tcm-HMPAO脑单光子发射计算机断层扫描所显示的长期1型（胰岛素依赖型）糖尿病患者的脑血流区域灌注不足，可能与低血糖事件的频率和程度以及严格的代谢控制有关，而严格的代谢控制是以低血糖复发风险增加为代价的。
