Abstract:

Objective　To establish a map of cerebral cortex thickness in patients with type 2 diabetes mellitus (T2DM) without consciousness disorder by brain magnetic resonance imaging and image analysis software, to analyze its distribution rule, and to explore the correlation between cerebral cortex thickness and glycated hemoglobin (HbA1c) in patients with T2DM. Methods　It was a retrospective study. From December 2020 to June 2021, 29 patients with T2DM without consciousness disorder who were diagnosed in Shouguang People's Hospital were included, including 18 males and 11 females, aged (60.43±1.47) years. High resolution three-dimensional T1 images were obtained from the 29 T2DM patients. Freesurfer software with automatic recognition and extraction system was used to calculate the thickness of each gyrus cortex based on the region of interest (ROI) of the gyrus. The obtained cortical thickness data were statistically analyzed, and the average cortical thickness of the brain region was mapped to the brain template to form a brain atlas. Pearson correlation analysis was conducted between the cortical structure data obtained and HbA1c by statistical analysis software. Paired t test was used to analyze the laterality of left and right hemispherical cortical thickness. Results　The brain regions with thicker cortex were temporal pole, entorhinal cortex, head of anterior cingulate gyrus, insula, frontal pole, middle temporal gyrus, and inferior temporal gyrus. The brain regions with thinner cortex were paracalcaneal gyrus, cuneiform lobe, lingual gyrus, posterior central gyrus, transverse temporal gyrus, lateral occipital gyrus, and superior parietal gyrus. The cortical thickness of the left and right cerebral hemispheres in T2DM patients was laterally distributed in the straight gyrus [(2.371±0.352) mm vs. (2.432±0.393) mm], lateral occipital gyrus [(2.141±0.185) mm vs. (2.201±0.221) mm], middle temporal gyrus [(2.662±0.364) mm vs. (2.724±0.353) mm], head of anterior cingulate gyrus [(2.665±0.453) mm vs. (2.791±0.506) mm], and frontal pole [(2.749±0.398) mm vs. (2.616±0.422) mm] (t=-2.613, -3.161, -3.106, -2.317, and 2.771; P=0.014, 0.004, 0.004, 0.028, and 0.010). Laterality: except the thickness of frontal polar cortex to the left, the rest of brain regions were to the right. The cortical thicknesses of left cuneiform lobe, left paracentral gyrus, left anterior central gyrus, left superior parietal gyrus, left superior marginal gyrus, left frontal pole, left transverse temporal gyrus, right cuneiform lobe, right anterior central gyrus, right anterior cuneiform lobe, right superior parietal gyrus, and right transverse temporal gyrus were significantly negatively correlated with HbA1c (r=-0.608, -0.563, -0.546, -0.535, -0.488, -0.524, -0.487, -0.554, -0.552, -0.479, -0.522, and -0.475; all P<0.01). Conclusions　In this study, we found the distribution rule and laterality of cerebral cortex thickness in patients with T2DM without consciousness disorder, which provided the image structure basis for later brain science research. There was a correlation between cerebral cortex thickness and HbA1c in patients with T2DM.

Key words:

Type 2 diabetes mellitus, MRI, Cortical thickness, Laterality, Glycosylated hemoglobin

摘要：

目的　采用脑磁共振图像及图像分析软件，建立不伴有意识障碍的2型糖尿病（T2DM）患者大脑皮质厚度图谱，分析其分布规律，探究T2DM患者大脑皮质厚度与糖化血红蛋白（HbA1c）的相关性。方法　回顾性研究，纳入2020年12月至2021年6月寿光市人民医院确诊不伴有意识障碍的T2DM患者29例，其中男18例、女11例，年龄（60.43±1.47）岁。从29例T2DM患者获得高分辨率三维T1图像，利用带有自动识别提取系统Freesurfer软件，以脑回的感兴趣区域（ROI）为基础计算每个脑回皮质厚度。对获取的皮质厚度数据进行统计分析，将脑区皮质平均厚度映射到脑模板上，形成脑图谱。利用统计分析软件对获取的皮质结构数据与HbA1c进行Pearson相关性分析。采用配对t检验分析左右半球皮质厚度的偏侧性。结果　皮质厚度较厚的脑区为颞极、内嗅皮层、前扣带回头部、岛叶、额极、颞中回、颞下回；皮质厚度较薄的脑区为距状旁回、楔叶、舌回、中央后回、颞横回、枕外侧回、顶上回。T2DM患者左右大脑半球皮质厚度存在偏侧性的脑区为直回［（2.371±0.352）mm比（2.432±0.393）mm］、枕外侧回［（2.141±0.185）mm比（2.201±0.221）mm］、颞中回［（2.662±0.364）mm比（2.724±0.353）mm］、前扣带回头部［（2.665±0.453）mm比（2.791±0.506）mm］、额极［（2.749±0.398）mm比（2.616±0.422）mm］（t=-2.613、-3.161、-3.106、-2.317、2.771，P=0.014、0.004、0.004、0.028、0.010）；偏侧性除额极皮质厚度向左偏外，其余脑区均向右偏。左侧楔叶、左侧中央旁回、左侧中央前回、左侧顶上回、左侧缘上回、左侧额极、左侧颞横回、右侧楔叶、右侧中央前回、右侧楔前叶、右侧顶上回、右侧颞横回皮质厚度与HbA1c均呈显著负相关（r=-0.608、-0.563、-0.546、-0.535、-0.488、-0.524、-0.487、-0.554、-0.552、-0.479、-0.522、-0.475，均P<0.01）。结论　本研究从不伴有意识障碍的T2DM患者大脑皮层厚度脑图谱中发现其分布规律及偏侧性，为之后脑科学的研究提供影像结构基础；T2DM患者大脑皮质厚度与HbA1c具有相关性。

关键词:

2型糖尿病, MRI, 皮质厚度, 偏侧性, 糖化血红蛋白