Quantitative Study Of Nerve Function Damage In Type 2 Diabetes Mellitus Complicated With Cerebral Infarction By Magnetic Resonance Spectroscopy And Diffusion Tensor Technique

Objective: Application of magnetic resonance spectroscopy and Diffusion Tensor Imaging quantitative study in diabetic patients with cerebral apoplexy brain white matter metabolism,nerve fiber bundle stereo shape and the relationship between blood glucose level and the neurological function and injury condition.To analyze the biochemical,clinical and imaging features of diabetic cerebral apoplexy patients,provide valuable imaging data for the clinical treatment and the prognosis evaluation of cerebral infarction.Part 1Quantitative Study of Nerve Function Damage in Type 2 Diabetes Mellitus Complicated with Cerebral Infarction by Dffusion Tensor TechniqueObjective: The application of magnetic resonance Diffusion Tensor Imaging quantitative study of diabetes mellitus complicated with cerebral apoplexy nerve fiber bundle stereo shape and anisotropic characteristics,and the relationship between blood glucose level and the neurological function and injury condition.Methods: 1.82 patients with stroke admitted to neurology department were scanned with magnetic resonance diffusion tensor imaging within 3d.2.Used the National Institutes of Health Stroke Scale(NIHSS)to score neurological impairment.3.Collecte venous blood in 24 h,and glycosylated hemoglobin(Hb A1c)was detected by high pressure liquid chromatography.According to the glycosylated hemoglobin level,the patients were divided into good control group(group A): Hb Alc < 6.5%;blood glucose control group(group B): Hb Alc:6.5% ~ 7.5%;blood glucose control group(group C): Hb Alc > 7.5%.4.the data were analyzed by statistical software SPSS22.0.The parameters of three groups of patients with general information,NIHSS score and DTI were compared by chi square test,analysis of variance;three groups of patients with NIHSS score and Hb A1 c correlation,correlation between NIHSS score and DTI parameters using Pearson correlation analysis.Results: 1.The NIHSS scores of the three groups :Group A 4.02±4.19,Group B 4.60±2.46,Group C 6.65±2.87,the comparison of NIHSS scores in three groups was statistically significant(P < 0.05).A,B,C three groups of blood Hb A1 c compared with NIHSS,Pearson correlation analysis showed that patients with acute ischemic stroke blood Hb A1 c level was positively correlated with NIHSS(r=0.22,P < 0.05).2.The FA value of infarcts side and mirror site: the infarcts side 0.32±0.12,the mirror site 0.42±0.13,the comparison was statistically significant difference(t = 5.2,P < 0.01);The FA value of infarcts side of group A,group B,and group C : Group A 0.38±0.09,Group B 0.26±0.07,Group C 0.20±0.05,the comparison were statistically significant(P < 0.01).The blood Hb A1 C level and the NIHSS score were negatively correlated with the FA values in the three groups(r =-0.63,r =-.67,P < 0.01).Conclusion: DTI can directly show the brain white matter nerve fibers,FA values can quantitatively describe the damage of nerve fibers,this method provides a direct imaging for the disease degree and prognosis of cerebral apoplexy patients.Part2The study of stroke with 2 diabetic patients by using proton magnetic resonance spectroscopy Methods: 1.A scanning technique of hydrogen proton magnetic resonance spectroscopy was performed in the patients with cerebral apoplexy in 53 cases of neurology.2.Neurophysicians used the national institutes of health stroke scale(NIHSS score)to score neurological defects in patients.3.Collecte venous blood in 24 h,and glycosylated hemoglobin(Hb A1c)was detected by high pressure liquid chromatography.According to the glycosylated hemoglobin level,the patients were divided into good control group(group A): Hb Alc < 6.5%;blood glucose control group(group B): Hb Alc:6.5% ~ 7.5%;blood glucose control group(group C): Hb Alc > 7.5%.4.Statistical software SPSS22.0 was used to analyze the data.The general data,NIHSS scores and MRS parameters of the three groups were compared with t-test and variance analysis.The correlation between NIHSS score and Hb Alc,NIHSS score and MRS parameter correlation were analyzed by Pearson,P < 0.05 was considered to be statistically significant.Results: 1.The comparison of NIHSS scores in three groups was statistically significant(P < 0.05).A,B,C three groups of blood Hb A1 c compared with NIHSS,Pearson correlation analysis showed that patients with acute ischemic stroke blood Hb A1 c level was positively correlated with NIHSS(r = 0.23,P < 0.05)2.The three groups of patients with infarcts and its metabolites of side mirror parts were compared respectively: NAA/Cr comparative difference was statistically significant,Cho/Cr comparison difference is not obvious;Metabolic product comparison between three groups of patients with infarcts: NAA/Cr comparative difference was statistically significant(P < 0.01),Cho/Cr there was no statistically significant difference comparing(P>0.5),Lac/Cr comparative difference was statistically significant(P < 0.05);Three groups of patients' blood Hb A1 C,NIHSS score with NAA/Cr,Lac/Cr value comparison,Pearson correlation analysis showed that patients with acute ischemic stroke blood Hb A1 C level and negatively correlated with NAA/Cr(r = 0.5,P = < 0.05),with Lac/Cr no obvious correlation(r = 0.25,P = 0.252),NIHSS score and negatively correlated with NAA/Cr(r = 0.3,P = < 0.05),with Lac/Cr no obvious correlation(r = 0.29,P = 0.287).Conclusion: NAA/Cr,Cho/Cr and Lac/Cr as detection index quantitative shows the onset afterbrain chemical substance metabolism in patients with cerebral apoplexy,the changes of magnetic resonance spectroscopy for the disease severity and prognosis of cerebral apoplexy patients provides direct imaging.Using MRS imaging method,the adverse effects of high glucose hemoglobin on brain parenchyma were explained from the perspective of imaging,and the technique was consistent with the clinical NIHSS score in the evaluation of stroke diseases.