MacLeod K M, Hepburn D A, Deary I J, Goodwin G M, Dougall N, Ebmeier K P, Frier B M
Department of Diabetes, Royal Infirmary, Edinburgh, Scotland.
Diabetologia. 1994 Mar;37(3):257-63. doi: 10.1007/BF00398052.
Chronic hyperglycaemia and recurrent severe hypoglycaemia have both been implicated as causing cerebral damage in patients with diabetes. Although cognitive dysfunction and intellectual impairment have been demonstrated in patients with recurrent severe hypoglycaemia, structural correlates have not been described, and it is not known whether specific functional changes occur in the brains of affected patients. Regional cerebral blood flow was estimated by SPECT with 99mTechnetium Exametazime in 20 patients with IDDM. Ten patients had never experienced severe hypoglycaemia and 10 had a history of recurrent severe hypoglycaemia. Patient results were compared with 20 age- and sex-matched healthy volunteers. We observed differences between the two patient groups and the control group. Tracer uptake was greater in diabetic patients in the superior pre-frontal cortex. This effect was particularly pronounced in the group who had a history of previous severe hypoglycaemia. Patients with a history of recurrent hypoglycaemia also had a relative reduction in tracer uptake to the calcarine cortex. This suggests an alteration in the pattern of baseline regional cerebral blood flow in diabetic patients with frontal excess and relative posterior reduction in cerebral blood flow.
慢性高血糖症和反复出现的严重低血糖症都被认为会导致糖尿病患者的脑损伤。尽管已证实在反复出现严重低血糖症的患者中存在认知功能障碍和智力损害，但尚未描述其结构相关性，并且也不清楚受影响患者的大脑是否会发生特定的功能变化。通过使用99m锝依沙美肟单光子发射计算机断层扫描（SPECT）对20例胰岛素依赖型糖尿病（IDDM）患者的局部脑血流量进行了评估。其中10例患者从未经历过严重低血糖症，10例有反复严重低血糖症病史。将患者的结果与20名年龄和性别匹配的健康志愿者进行了比较。我们观察到两组患者与对照组之间存在差异。糖尿病患者在前额上皮质的示踪剂摄取量更高。这种效应在有既往严重低血糖症病史的患者组中尤为明显。有反复低血糖症病史的患者在距状皮质的示踪剂摄取量也相对减少。这表明在额叶血流量过多而相对后脑血流量减少的糖尿病患者中，基线局部脑血流模式发生了改变。
