| Objective:The research on the application of proton magnetic resonance spectroscopy(~1H-MRS)and diffusion tensor imaging(DTI)technique for the detection of brain metabolites of type 2 diabetes mellitus and cerebral white matter microstructural damage,and to explore the correlation between the level of glycosylated hemoglobin(HbA1c)and ~1H-MRS in patients with type2 diabetic metabolic changes of brain tissue and brain white matter fiber fractional anisotropy changes.Methods:We collected 65 cases of T2DM at the second hospital of Hebei Medical University from June 2017 to December 2017.T2DM patients were divided into three groups according to the level of Hb A1c:group A,HbA1c<7%,21cases;group B,7%<HbA1c<9%,22 cases;group C,Hb A1c≥9%,20 cases.At the same time,20 healthy volunteers were recruited in the physical examination center to match the experimental group with sex,age and years of education.All the volunteers were scanned by 3.0T MRI routine sequence;multi-voxel ~1H-MRS scanning,scanning the area of interest including bilateral center of semi oval circle,bilateral frontal lobe and bilateral basal ganglia,the machine automatically calculate the NAA/Cr,Cho/Cr,Mi/Cr,Glx/Cr and Lac/Cr concentration ratio;DTI scan,and then after processing the work software to process the FA diagram,using the method of manual placement of ROI,ROI size was(20±2)mm~2,a region of interest placed parts including bilateral center of semi oval,anterior limb and the posterior limb of the internal capsule.The statistical analysis was carried out by SPSS22.0software,and the difference between P<0.05 was statistically significant.Results:1.There was a statistically significant difference in the HbA1c level and FPG level between the three groups of T2DM,group A,group B and group C.There was no significant difference in the sex ratio,age,blood fat and blood pressure between the three groups of A,B,C and the control group of the D.2.There was no significant difference between T2DM of the group A,B,C and the control group D in the brain white matter lesion score.3.The ratio of NAA/Cr in the bilateral semi oval center,bilateral lobar white matter and bilateral basal ganglia in the three groups of T2DM patients A,B and C decreased compared with that of the control group D,The ratio of the concentration of Cho/Cr and Mi/Cr in bilateral semi oval center,bilateral lobar white matter and bilateral basal ganglia region in the three groups of T2DM patients A,B and C was higher than that in the control group D group.There was no significant difference in the ratio of Glx/Cr,Lac/Cr between the three groups of T2DM,A,B and C in the bilateral half oval center,bilateral frontal lobe white matter and bilateral basal ganglia.Multiple comparisons show that:Bilateral center of semi oval circle:There were significant differences in the ratio of NAA/Cr,Cho/Cr and Mi/Cr concentrations between group A and group B,group A and C,B group and C group,and the difference was statistically significant.Bilateral frontal lobed white matter:T2DM patients of group A and group C in NAA/Cr,Cho/Cr and Mi/Cr concentration ratio comparison,the difference was statistically significant;T2DM patients of group B and group C in Cho/Cr concentration ratio difference was statistically significant,the group B and group C had no significant difference in the concentration ratio.There was no significant difference in the ratio of NAA/Cr,Cho/Cr and Mi/Cr in group A and group B in T2DM patients.Bilateral basal ganglia:T2DM patients of group A and group C were compared in NAA/Cr,Cho/Cr and Mi/Cr concentration ratio,the difference was statistically significant;T2DM patients of group A and group B have statistical significant difference in the ratio of the concentration of Cho/Cr,T2DM patients of group A and group B in NAA/Cr and Mi/Cr concentration ratio had no significant difference;group B and group C have statistical significance in the difference of the ratio of the concentration of Mi/Cr,group B and group C in NAA/Cr and Cho/Cr concentration ratio difference was not statistically significant.4.In group A,group B and group C,the value of FA in bilateral semi oval center,inner capsule forelimb and hind limb were lower than that of control group D.Multiple comparison showed that there was significant difference between group A of T2DM and group C,group B and group C in bilateral center of semi oval circle,inner capsule forelimb and posterior limb of internal capsule.The difference between the A group and the B group in the T2DM group and the B group was statistically significant only in the bilateral internal capsule forelimb FA value.There was no statistical difference between the bilateral and the posterior limbs of the inner capsule and the posterior limb of the internal capsule.5.The ratio of NAA/Cr concentration in bilateral semi oval center,right bilateral frontal lobar white matter and bilateral basal ganglia region was negatively correlated with HbA1c level in T2DM patients.The concentration ratio of Cho/Cr and Mi/Cr in bilateral semi oval center,bilateral frontal lobar white matter and basal ganglia region was positively correlated with the level of HbA1c in T2DM patients.The FA value of bilateral semi oval center,inner capsule forelimb and posterior limb of internal capsule was negatively correlated with Hb A1c level in T2DM patients.Conclusions:1.Abnormal changes in brain metabolism and brain micro-structure have occurred in T2DM patients with no obvious abnormal MR in the brain.2.~1H-MRS can analyze abnormal metabolic changes of brain tissue in T2DM patients from the metabolic point of view,and NAA/Cr concentration ratio is negatively correlated with HbA1c level,and Cho/Cr and Mi/Cr concentration ratio is positively correlated with HbA1c level.3.DTI can reflect the damage of white matter fiber bundle in T2DM patients from abnormal structure of white matter,and the FA value of T2DM patients is lower than that of normal control group.The change of FA value is negatively correlated with HbA1c level. |
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