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【Diabetes Care】肥胖青少年2型糖尿病脑并发症的初
adolescents with type 2 diabetes mellitus
肥胖青少年2型糖尿病脑并发症的初步证据
P. L. Yau & D. C. Javier & C. M. Ryan & W. H. Tsui &
B. A. Ardekani & S. Ten & A. Convit
Abstract
Aims/hypothesis Central nervous system abnormalities,
including cognitive and brain impairments, have been
documented in adults with type 2 diabetes who also have
multiple co-morbid disorders that could contribute to these
observations. Assessing adolescents with type 2 diabetes
will allow the evaluation of whether diabetes per se may
adversely affect brain function and structure years before
clinically significant vascular disease develops.
摘要
目的/假说 中枢神经系统异常，包括认知功能异常和脑损伤，在同时具有可致这些异常的多种伴发病的成人2型糖尿病已有报道。评价青少年2型糖尿病的有助于评估糖尿病本身是否在临床血管疾病出现前几年即可影响大脑功能和结构。
Methods Eighteen obese adolescents with type 2 diabetes
and 18 obese controls without evidence of marked insulin
resistance, matched on age, sex, school grade, ethnicity,
socioeconomic status, body mass index and waist circum-
ference,completedMRIandneuropsychologicalevaluations.
方法 18例肥胖青少年2型糖尿病患者，18例无明显胰岛素抵抗证据，年龄、性别、年级、种族、社会经济状态、体重指数和药物匹配的肥胖对照纳入本研究，对受试者完善了MRI和神经心理评估。
Results Adolescents with type 2 diabetes performed con-
sistently worse in all cognitive domains assessed, with the
difference reaching statistical significance for estimated intellectual functioning, verbal memory and psychomotor
efficiency. There were statistical trends for executive function, reading and spelling. MRI-based automated brain structural analyses revealed both reduced white matter
volume and enlarged cerebrospinal fluid space in the whole
brain and the frontal lobe in particular, but there was no
obvious grey matter volume reduction. In addition, assess-
ments using diffusion tensor imaging revealed reduced
white and grey matter microstructural integrity.
结果 青少年2型糖尿病患者在所有认知域评价中均表现较差，在评估的智力功能、语言记忆和心理运动功效方面差异达到统计显著性。在执行功能、阅读和拼写方面有统计学趋势。以磁共振为基础的自动脑结构分析显示白质体积减少，整个大脑尤其是额叶脑脊液量增大，但灰质数量没有明显减少。此外，用弥散张量成像评估显示白色和灰质微观结构的完整性减少。
Conclusions/interpretation This is the first report docu-
menting possible brain abnormalities among obese adoles-
cents with type 2 diabetes relative to obese adolescent
controls. These abnormalities are not likely to result from
education or socioeconomic bias and may result from a
combination of subtle vascular changes, glucose and lipid
metabolism abnormalities and subtle differences in adiposity
in the absence of clinically significant vascular disease.
Future efforts are needed to elucidate the underlying
pathophysiological mechanisms.
结论/解释 这是第一次关于肥胖青少年2型糖尿病与肥胖青少年对照比较的脑异常报告。这些异常并不是教育或社会经济偏倚的结果，或许是在没有临床显著的血管疾病时血管变化、葡萄糖和脂代谢异常和肥胖度的差别所致。需要进行进一步研究以阐明潜在的病理生理学机制。
Keywords Adolescence.Apparent diffusion coefficient.
Brain complications.Cognitive performance.
Diffusion tensor imaging.Fractional anisotropy.
Obesity.Type 2 diabetes
关键词 青少年 ? 显著弥散系数 ? 脑并发症 ? 认知表现 ? 弥散张量成像 ? 部分各向异性指数 ? 肥胖 ? 2型糖尿病
Abbreviations
ADC Apparent diffusion coefficient
COWAT Controlled Oral Word Association Test
CRP C-reactive protein
CSF Cerebrospinal fluid
DSST Digit Symbol Substitution Test
DTI Diffusion tensor imaging
FA Fractional anisotropy
FDR False discovery rate
FLAIR Fast fluid-attenuated inversion recovery
FOV Field of view
GM Grey matter
HOMA-IR HOMA-insulin resistance
MPRAGE Magnetisation-prepared rapid acquisition
缩略词
ADC 显著弥散系数
COWAT 控制口头语联合测试
CRP C -反应蛋白
CSF 脑脊液
DSST 数字符号替换测试
DTI 弥散张量成像
FA 部分各向异性指数
FDR 错误发现率
FLAIR 液体衰减反转恢复序列
FOV 视场
GM 脑灰质
HOMA-IR HOMA胰岛素抵抗
MPRAGE磁化准备快速梯度回波成像
MRI Magnetic resonance imaging
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作者:admin@医学,生命科学 2011-02-13 00:05
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