脑白质高信号在2型糖尿病患者脑灌注与认知功能中的中介作用OA
Mediating effect of white matter hyperintensity in cerebral perfusion and cognitive function of patients with type 2 diabetes mellitus
目的 探讨2型糖尿病(T2DM)患者脑白质高信号(WMH)负荷、脑血流灌注(CBF)与认知功能的关系,并评估WMH在CBF与认知功能损害之间的中介作用.方法 选取行常规MRI及动脉自旋标记成像的36例T2DM患者和29例健康对照者,收集临床资料并评估其认知功能.比较两组间WMH体积、CBF值及认知功能差异,使用相关性分析及多元线性回归分析CBF、WMH与认知功能的关系,并进一步采用中介分析探索WMH在CBF与认知功能中的中介作用.结果 与对照组相比,T2DM组蒙特利尔认知评估量表(MoCA)评分显著降低,数字连线测验A/B(CTT-A、CTT-B)完成时间显著延长(P<0.05).与对照组相比,T2DM组大脑中动脉(MCA)供血脑区内双侧岛叶、右侧额下回、右侧顶下小叶CBF值减低(P<0.05),总WMH体积、大脑前动脉及MCA供血区的WMH体积均显著增大(P<0.05).相关性分析结果示,CTT-A与MCA-WMH体积呈正相关(r=0.418,P=0.011),与MCA-CBF呈负相关(r=-0.348,P=0.037);MCA-CBF与MCA-WMH呈负相关(r=-0.351,P=0.036).多元线性回归分析显示,MCA-WMH体积是CTT-A完成时间的独立影响因素(β=0.72,P<0.001).中介分析结果显示,MCA-WMH体积在MCA-CBF与CTT-A之间存在完全中介作用,间接效应95%CI为(-0.56,-0.05).结论 T2DM患者WMH负荷与执行功能独立相关,脑低灌注可能通过促进脑白质损伤影响认知功能.
Objective To explore the relationships between white matter hyperintensities(WMH),cerebral blood flow(CBF),and cognitive function in patients with type 2 diabetes mellitus(T2DM),and evaluate the mediating effect of WMH in the association between CBF and cognitive impairment.Methods Thirty-six T2DM patients and twenty-nine healthy controls undergoing conventional MRI and arterial spin labeling imaging were enrolled in this study.Clinical data and cognitive performance were collected.WMH volume,CBF and cognitive function were compared between T2DM group and control group.Correlation and multiple linear regression analyses were performed to explore the associations among CBF,WMH,and cognitive function.Furthermore,mediation analysis was conducted to explore the mediating role of WMH in the relationship between CBF and cognitive function.Results Compared with controls,T2DM patients had significantly lower MoCA scores and longer completion times on CTT-A and CTT-B(P<0.05).Compared with control group,CBF values in the bilateral insulae,right inferior frontal gyrus,and right inferior parietal lobule in the middle cerebral artery(MCA)territory significantly decreased in T2DM group(P<0.05),while total WMH volume,and WMH volume within anterior cerebral artery and MCA territories significantly increased(P<0.05).CTT-A completion time was positively correlated with MCA-WMH volume(r=0.418,P=0.011),and negatively correlated with MCA-CBF(r=-0.348,P=0.037).MCA-CBF was negatively correlated with MCA-WMH(r=-0.351,P=0.036).Multiple linear regression identified MCA-WMH as an independent predictor of CTT-A completion time(β=0.72,P<0.001).Mediation analysis results demonstrated that MCA-WMH fully mediated the relationship between MCA-CBF and CTT-A,with a 95%confidence interval for the indirect effect ranging from-0.56 to-0.05.Conclusion In T2DM patients,WMH burden is independently associated with executive dysfunction,and cerebral hypoperfusion may contribute to cognitive impairment by promoting white matter damage.
李菁;潘佩纯;高冰倩;张小玲;高洁
陕西省人民医院磁共振室,西安 710068陕西省人民医院磁共振室,西安 710068陕西省人民医院磁共振室,西安 710068陕西省人民医院磁共振室,西安 710068陕西省人民医院磁共振室,西安 710068
医药卫生
2型糖尿病脑血流灌注脑白质高信号认知功能磁共振成像
type 2 diabetes mellituscerebral blood perfusionwhite matter hyperintensitycognitive functionmagnetic resonance imaging
《山西医科大学学报》 2026 (7)
814-823,10
国家自然科学基金面上项目(82170820)
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