2型糖尿病脑灌注及糖尿病视网膜氧张量的相关性

熊煜欣; 汤俊; 蔺汝云; 聂嘉敏; 周敏洁; 邵举薇

doi:10.12259/j.issn.2095-610X.S20211046

2型糖尿病脑灌注及糖尿病视网膜氧张量的相关性

doi: 10.12259/j.issn.2095-610X.S20211046

1.
云南大学附属医院（云南省第二人民医院，云南省眼科医院）内分泌科，云南昆明　650021
2.
澄江市凤麓街道社区卫生服务中心，云南昆明　650000
3.
云南大学附属医院（云南省第二人民医院，云南省眼科医院）质控部，云南昆明　650021
4.
放射科，云南昆明　650021

基金项目: 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2018FE001（-267）]；中华国际医学交流基金会 2020 中华放射医学会 SKY 影像科研基金科研基金资助项目（Z-2014-07-2003-12）；云南省内分泌临床医学中心基金资助项目（ZX2019-02-02）

详细信息

作者简介:
熊煜欣（1979～），男，云南昆明人，硕士，主治医师，主要从事内分泌诊治工作。汤俊与熊煜欣对本文具有同等贡献

通讯作者:
邵举薇，E-mail： wavevivi@163.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2021-08-11
- 刊出日期: 2021-10-25

Correlation between Cerebral Perfusion and Retinal Oxygenation Response of Diabetic Retinopathy in Type 2 Diabetes Mellitus

1.
The Endocrinology Department of the Affiliated Hospital of Yunnan University （The Second People Hospital of Yunnan Province），Kunming Yunnan 650021
2.
Community Healthcare Center of Chengjiang fenglu street，Chengjiang Yunnan 653100
3.
Quality Control Department of the Affiliated Hospital of Yunnan University （The Second People Hospital of Yunnan Province），Kunming Yunnan 650021
4.
The Radiology Department of the Affiliated Hospital of Yunnan University （The Second People Hospital of Yunnan Province），Kunming Yunnan 650021，China

摘要

摘要: 目的研究不合并高血压的2 型糖尿病不同分期糖尿病视网膜病变患者与正常对照组磁共振脑灌注差异性及磁共振视网膜氧张量改变，分析各组有差异的脑灌注参数与视网膜氧张量相关性。方法选取2017年6月至2019年12月云南大学附属医院内分泌科及眼科收治的2型糖尿病患者34例，其中糖尿病视网膜病变增殖期组（Proliferative stage of diabetic retinopathy，PDR）10例及无视网膜病变糖尿病组（Non diabetic retinopathy，NDR）24例，收集正常对照组（Normal control，NC）21例，所有研究对象均排除高血压。行磁共振头颅平扫、磁共振血管成像、吸氧前、后磁共振双侧眼球3D T1WI 扰相梯度回波序列、脑动态磁敏感对比增强灌注成像扫描。Student t检验分析各组参数差异，运用Pearson分析各组相对脑血流量（Relative cerebral blood flow，rCBF）值与PDR 组、NDR组颞侧、鼻侧、视盘区视网膜氧张量（△P0₂）相关性。结果 PDR组左侧颞下回、双侧扣带回rCBF低于NDR组及NC组，差异有统计学意义（P < 0.05）。PDR组右侧颞下回、左侧枕叶、左侧扣带回相对脑血流容量（Relative cerebral blood volume，rCBV）低于NDR组及NC组（ P < 0.05），右侧海马旁回PDR组高于NDR组及NC组（ P < 0.05）；PDR组左侧颞下回、左侧小脑半球、双侧额中回平均通过时间（mean transmit time，MTT）高于NDR组及NC组（ P < 0.05），PDR组左侧海马旁回、桥脑右侧低于NDR组及NC组（ P < 0.05）。左侧小脑半球、双侧额中回、左侧颞下回及右侧扣带回达峰时间（time to peak，TTP）PDR组TTP高于NDR组和NC组（ P < 0.05），脑桥右侧、右侧海马旁回PDR组低于NDR和NC组（ P < 0.05）。吸氧30minPDR组、NDR组、NC组双侧颞侧、视盘、鼻侧△P0 ₂差异有统计学意义（P < 0.05）。PDR组及NDR组左侧颞下回及双侧扣带回rCBF与双侧眼球颞、鼻侧及视盘△P0 ₂有不同程度相关性（P < 0.05）。结论 2型糖尿病脑血流灌注与糖尿病视网膜病变的程度具有较强的关联性，MR视网膜氧张量可以做为糖尿病脑毛细血管病变的一种影像学标志物。
- 2 型糖尿病 /
- 糖尿病视网膜病变 /
- 脑血流灌注 /
- 视网膜氧张量
Abstract: Objective To study MR cerebral perfusion and the retinal oxygenation response in patients with different stages of diabetic retinopathy without hypertension and normal control group, and to analyze the correlation between different cerebral perfusion parameters and retinal oxygenation response. Methods From June 2017 to December 2019, 34 patients with diagnosed type 2 diabetes mellitus （T2DM） and 21 healthy controls were enrolled in the Department of Endocrinology and ophthalmology department, the Affiliated Hospital of Yunnan University. T2DM patients were divided into proliferative stage of diabetic retinopathy （PDR） group and non-diabetic retinopathy （NDR） group according to ophthalmofundoscopy. All subjects with hypertension were excluded. Plain MR, magnetic resonance angiography （MRA）, dynamic susceptibility contrast-perfusion weighted imaging （DSC-PWI）, orbital 3D-spoiled GRASS （3D-SPGR） before and after oxygen uptake scans were performed. Continuous variables were analyzed by unpaired t-test. Pearson product moment correlation was performed between relative cerebral blood flow （rCBF） and variables of retinal delta PO_（2）（△P0₂） in bilateral temporal, nasal and optic disc of eyeballs of PDR and NDR group. Results rCBF of left inferior temporal gyrus and bilateral cingulate gyrus in PDR group was lower than that in NDR group and NC group （P < 0.05）. Relative cerebral blood volume （rCBV） of right inferior temporal gyrus, left occipital lobe and left cingulate gyrus in PDR group was lower than that in NDR group and NC group （ P < 0.05）, and the rCBV of right parahippocampal gyrus in PDR group was higher than that in NDR group and NC group （ P < 0.05）. The mean transit time （MTT） of left inferior temporal gyrus, left cerebellar hemisphere and bilateral middle frontal gyrus in PDR group was higher than that in NDR group and NC group （ P < 0.05）. The mean transit time of left parahippocampal gyrus and right pons in PDR group was lower than that in NDR group and NC group （ P < 0.05）. Time to peak （TTP） of left cerebellar hemisphere, bilateral middle frontal gyrus, left inferior temporal gyrus and right cingulate gyrus in PDR group was higher than that in NDR group and NC group （ P < 0.05）, and TTP of right pontine and right parahippocampal gyrus in PDR group was lower than that in NDR and NC group （ P < 0.05）. The difference of △ P0 ₂ in bilateral temporal, nasal and optic disc of eyeballs between PDR group, NDR group and NC group was statistically significant （P < 0.05）. rCBF of left inferior temporal gyrus and bilateral cingulate gyrus in PDR group and NDR group were correlated with △P0 ₂ of bilateral temporal, nasal and optic disc （P < 0.05）. Conclusions There was significant association between cerebral blood flow perfusion and the diabetic retinopathy （DR） severity in type 2 diabetes mellitus. MRI retinal oxygenation response can be used as an imaging marker of diabetic cerebral capillary disease.
- Type 2 Diabetes Mellitus /
- Diabetic retinopathy /
- Cerebral blood perfusion /
- Retinal oxygenation response

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图 1 眼球放置测值ROI位置

视盘（1），颞侧（2），鼻侧（3）。

Figure 1. The ROI position of the orbital

下载: 全尺寸图片幻灯片

图 2 PDR组、NDR组及NC组30min双眼鼻侧、颞侧、视盘MR △P0₂柱状图

Figure 2. The bar graph showed difference of MR △P0₂ of nasal，temporal and optic disc of both eyes in PDR group，NDR group and NC group

下载: 全尺寸图片幻灯片

表 1 3组临床资料及血糖指标比较（ $ \bar x \pm s $）

Table 1. The clinical characteristics of the control and the T2DM groups （ $ \bar x \pm s $）

项目	PDR组（n = 10）	NDR组（n = 24）	NC组（n = 21）	F/t值	P值
性别（男/女）	7/3	8/16	5/16	---	0.49
年龄（岁）	49.87 ± 9.16	59.73 ± 8.69	46.55 ± 14.40	2.31	0.12
病程（a）	15.50 ± 4.67	7.90 ± 3.58	---	0.51	0.62
FPG（mmol/L）	10.67 ± 4.02	9.03 ± 4.64	4.79 ± 0.60	1.26	0.75
HbAlc（%）	10.09 ± 2.12	7.29 ± 1.80	5.63 ± 0.34	1.45	0.49
动脉收缩压（mm/Hg）	124.44 ± 6.27	125.61 ± 4.46	122.59 ± 5.92	0.64	0.54
动脉舒张压（mm/Hg）	84.74 ± 4.99	89.42 ± 4.25	83.53 ± 5.42	0.18	0.84
FPG：空腹血糖，HbA1c：糖化血红蛋白。

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表 2 3组全脑各差异性脑区PWI参数比较（ $ \bar x \pm s $）

Table 2. Comparison of PWI parameters in different brain regions of the control and the T2DM groups （ $ \bar x \pm s $）

PWI参数	差异脑区	PDR组（n = 10）	NDR组（n = 24）	NC组（n = 21）	F值	P值
rCBV rCBF	左侧枕叶右侧颞下回左侧扣带回右侧海马旁回左侧颞下回	1.54 ± 1.50 1.26 ± 0.82 1.10 ± 0.65 2.92 ± 1.13 44.99 ± 9.95	2.04 ± 1.40 2.00 ± 1.99 2.02 ± 1.03 2.11 ± 1.29 58.82 ± 23.89	2.35 ± 1.26 4.16 ± 2.51 4.15 ± 1.31 1.15 ± 0.48 58.36 ± 24.00	0.71 3.82 14.31 4.62 5.40	0.048^* 0.039^* 0.000^* 0.022^* 0.013^*
MTT TTP	左侧扣带回右侧扣带回左侧小脑半球左侧颞下回左侧额中回右侧额中回左侧海马旁回桥脑右侧左侧小脑半球左侧额中回右侧额中回右侧扣带回左侧颞下回桥脑右侧右侧海马旁回	54.43 ± 8.92 67.26 ± 18.56 13.04 ± 3.98 12.93 ± 3.67 11.30 ± 3.09 10.27 ± 2.24 8.46 ± 1.84 11.74 ± 3.27 29.89 ± 7.29 28.39 ± 7.35 28.73 ± 7.34 28.14 ± 7.64 27.78 ± 8.06 18.77 ± 8.34 18.18 ± 5.28	56.64 ± 8.73 60.03 ± 10.81 11.58 ± 2.80 11.70 ± 3.58 8.47 ± 2.22 8.71 ± 2.54 10.37 ± 3.38 10.80 ± 3.12 15.55 ± 3.81 15.89 ± 4.36 25.71 ± 7.88 17.36 ± 8.59 24.18 ± 8.94 27.57 ± 7.51 27.15 ± 7.66	63.91 ± 11.13 68.94 ± 10.78 6.81 ± 1.05 8.32 ± 2.23 6.84 ± 1.68 5.91 ± 0.57 11.73 ± 4.65 9.63 ± 4.23 22.75 ± 6.19 18.40 ± 8.47 27.53 ± 6.16 25.26 ± 7.94 18.00 ± 8.87 30.69 ± 8.11 28.04 ± 6.15	3.56 0.85 5.13 5.17 5.51 3.82 7.09 4.51 9.07 8.03 3.88 4.66 4.794 3.718 4.465	0.048^* 0.443^* 0.017^* 0.011^* 0.012^* 0.038^* 0.004^* 0.023^* 0.001^* 0.003^* 0.037^* 0.021^* 0.019^* 0.041^* 0.024^*
rCBV：相对脑血流量，rCBF：相对脑血流容积，MTT：平均通过时间，TTP：达峰时间，^*P < 0.05，（单位：mL/100 g/min）。

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表 3 PDR组左侧颞下回、双侧扣带回CBF和眼各部位MR氧张量相关性分析（r，P）

Table 3. The correlation analysis between CBF value of left inferior temporal gyrus，bilateral cingulate gyrus and retinal oxygenation response in PDR group （r，P）

部位	左鼻侧	左颞侧	左视盘	右鼻侧	右颞侧	右视盘
左颞下回左扣带回右扣带回	0.724，0.002 0.701，0.004 0.748，0.001	−0.826,0.0001 −0.844,0.0001 −0.806,0.0003	0.558，0.031 0.530，0.042 0.586，0.022	0.100，0.725 0.132，0.639 0.065，0.819	−0.287，0.300 −0.255，0.359 −0.320，0.245	−0.071，0.801 −0.039，0.891 −0.106，0.707

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表 4 NDR组左侧颞下回、双侧扣带回CBF和眼各部位MR氧张量相关性分析（r，P）

Table 4. The correlation analysis between CBF value of left inferior temporal gyrus，bilateral cingulate gyrus and retinal oxygenation response in NDR group （r，P）

部位	左鼻侧	左颞侧	左视盘	右鼻侧	右颞侧	右视盘
左颞下回左扣带回右扣带回	0.661，0.0001 0.774，0.0001 0.840，0.0001	0.215，0.0001 0.564，0.002 0.311，0.107	0.762，0.0001 0.561，0.002 0.736，0.0001	0.855，0.0001 0.950，0.0001 0.959，0.0001	0.263，0.176 0.455，0.015 0.295，0.128	0.626，0.0004 0.581，0.001 0.463，0.013

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2型糖尿病脑灌注及糖尿病视网膜氧张量的相关性

doi: 10.12259/j.issn.2095-610X.S20211046

作者简介:
熊煜欣（1979～），男，云南昆明人，硕士，主治医师，主要从事内分泌诊治工作。汤俊与熊煜欣对本文具有同等贡献

通讯作者:
邵举薇，E-mail： wavevivi@163.com

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Correlation between Cerebral Perfusion and Retinal Oxygenation Response of Diabetic Retinopathy in Type 2 Diabetes Mellitus

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目录

[1]	吴斯琪, 陈刚, 肖亦爽. 急进型早产儿视网膜病变的治疗效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220513
[2]	王金瑞, 杨莹. 2型糖尿病视网膜病变相关因素研究进展, 昆明医科大学学报.
[3]	沈志祥, 朱立勋, 徐伟红. 有氧运动对2型糖尿病大鼠AGE-RAGE轴及NF-κB通路的影响, 昆明医科大学学报.
[4]	雷霍. 云南省糖尿病眼病的防治研究现状, 昆明医科大学学报.
[5]	边海霞. 糖尿病视网膜病变脂肪因子与血管病变相关因子关系的研究, 昆明医科大学学报.
[6]	秦敏丽. RBP4与炎性因子水平对2型糖尿病下肢动脉病变的诊断价值, 昆明医科大学学报.
[7]	杜娟. 大鼠2型糖尿病模型制备方法探讨, 昆明医科大学学报.
[8]	朱钊. 2型糖尿病家系人群中糖尿病视网膜病变相关因素的分析, 昆明医科大学学报.
[9]	张海静. 腹腔镜胃肠旁路治疗2型糖尿病的手术配合, 昆明医科大学学报.
[10]	刘淑清. 2型糖尿病胰岛素抵抗与认知功能障碍关系研究, 昆明医科大学学报.
[11]	唐丽丽. GLP-1与2型糖尿病及糖尿病肾病的相关性研究, 昆明医科大学学报.
[12]	茶雪平. 云南2型糖尿病家系人群中糖尿病视网膜病变的患病情况分析, 昆明医科大学学报.
[13]	. α-硫辛酸对2型糖尿病早期肾病保护作用的探讨, 昆明医科大学学报.
[14]	. 2型糖尿病合并抑郁危险因素的临床研究, 昆明医科大学学报.
[15]	. 复方地龙胶囊治疗2型糖尿病肾病的临床观察, 昆明医科大学学报.
[16]	陈关芬. 复方地龙胶囊治疗2 型糖尿病肾病的临床观察, 昆明医科大学学报.
[17]	. 运动训练对四氧嘧啶致2型糖尿病大鼠糖耐量的影响, 昆明医科大学学报.
[18]	. 糖化血红蛋白与糖尿病视网膜病变的关系研究, 昆明医科大学学报.
[19]	徐玉善. 2型糖尿病周围神经病变与颈动脉内膜中层厚度的关系探讨, 昆明医科大学学报.
[20]	李国栋. 七叶皂甙钠抗大鼠视网膜缺血-再灌注后视网膜细胞凋亡的保护作用, 昆明医科大学学报.

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2型糖尿病脑灌注及糖尿病视网膜氧张量的相关性

doi: 10.12259/j.issn.2095-610X.S20211046

作者简介: 熊煜欣（1979～），男，云南昆明人，硕士，主治医师，主要从事内分泌诊治工作。汤俊与熊煜欣对本文具有同等贡献

通讯作者: 邵举薇，E-mail： wavevivi@163.com

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Correlation between Cerebral Perfusion and Retinal Oxygenation Response of Diabetic Retinopathy in Type 2 Diabetes Mellitus

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作者简介:
熊煜欣（1979～），男，云南昆明人，硕士，主治医师，主要从事内分泌诊治工作。汤俊与熊煜欣对本文具有同等贡献

通讯作者:
邵举薇，E-mail： wavevivi@163.com