ADA：1型糖尿病微血管病变患者的认知衰退与局灶性脑容量降低相关

相关横截面研究表明，1型糖尿病患（T1DM）者存在认知和脑结构的改变，主要发生于那些伴有周围微血管病变的患者。目前，尚未完全弄清这些脑部变化是否会随时间推移而进展。

基于上述情况，研究人员对25例T1DM合并微血管病变患者（基线年龄：46.1±7.8岁，A1C：7.9±1.0%，男性：40%，IQ：112±12.7）和25例与之相匹配的对照参试者（基线年龄：44.3±8.5岁，A1C：5.4±0.3%，男性：52%，IQ：109.4±11.0）在基线时以及随访过程中的一般认知能力、记忆力、信息处理速度、执行能力、注意力、运动功能和精神运动速度进行了评估。并在这两个时间点分别采用3D-T1结构MRI扫描来判断其全脑容量的降低情况，采用FSL-SIENA法分析数据。利用回归分析法研究组间差异及与时间的相关性，并根据基线年龄、性别、基线认知表现和/或全脑容量校正后。

四年之后，相比对照组，实验组患者执行能力的降低更为显著（患者：δz=-0.402±0.63sd vs. 对照：δz=-0.007±0.39sd；P=0.008）。此外，实验组患者全脑容量降低的百分率比对照组更大（患者：-1.34±1.0% vs. 对照：-0.68±0.63%；P=0.015），在右侧额叶区域和中央区域尤为明显。对于所有的参试者来说，额叶和中部脑容量更大程度的降低与执行能力的加速衰退相关（β=-0.330；P=0.025）。对于患者来说，更高的基线A1C与更大程度的执行能力衰退相关（β=-0.407；P=0.043），而更高的基线收缩压则与随访过程中额叶脑容量的减少相关（β=-0.501；P=0.011）。

在4年的随访中，相比健康对照者，T1DM合并微血管病变患者执行能力的下降和脑容量的降低更为显著。更差的基线血糖控制能力以及更高的基线收缩压可用于预测患者认知能力和脑部变化随时间的改变。

Selective Cognitive Decline is Related to Focal Brain Volume Loss in Type 1 Diabetes Patients with Microangiopathy: A 4-Year Follow-Up

Cross-sectional studies showed cognitive and structural brain changes in type 1 diabetes (T1DM) patients predominantly in those with peripheral microangiopathy. Whether these brain changes progress over time is not well known.

In 25 T1DM patients with microangiopathy (baseline age: 46.1±7.8yrs and A1C: 7.9±1.0%; 40% male; IQ: 112±12.7) and 25 matched controls (baseline age: 44.3±8.5yrs and A1C: 5.4±0.3%; 52% male; IQ: 109.4±11.0) we assessed general cognitive ability memory information processing speed executive functions attention motor and psychomotor speed at baseline and follow-up. A 3D-T1 structural MRI-scan at both time points was used to determine whole-brain volume loss analyzed with FSL-SIENA. Group differences and associations over time were analyzed with regression analyses corrected for baseline age sex and either baseline cognitive performance total brain volume or both.

After 4 years patients versus controls showed significantly greater decline in executive functions (patients: δz=-0.402±0.63sd vs. controls: δz=-0.007±0.39sd; P=0.008). Furthermore patients versus controls had a larger percentual whole-brain volume loss (patients: -1.34±1.0% vs. controls: -0.68±0.63%; P=0.015) most marked in the right frontal and central areas. In all participants larger loss of frontal and central brain volume was related to accelerated executive functions decline (β=-0.330; P=0.025). In patients higher baseline A1C was associated with larger executive performance decline (β=-0.407; P=0.043) and higher baseline systolic blood pressure was correlated to frontal brain volume loss at follow-up (β=-0.501; P=0.011).

At 4-years follow-up loss of executive performance and brain volume was significantly greater in T1DM patients with microangiopathy compared to healthy controls. Poorer glycemic control and higher systolic blood pressure at baseline predicted both cognitive and brain alterations over time.

编辑： 郁婷    来源：丁香园