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Abstract：
BACKGROUND: Cognitive dysfunction is the main manifestation of central neuropathy. Although cognitive impairments tend to be overlooked in patients with diabetes mellitus (DM), there is a growing body of evidence linking DM to cognitive dysfunction. Hyperglycemia is closely related to neurological abnormalities, while often disregarded in clinical practice. Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM (T2DM).
OBJECTIVE: To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c (HbA1c) levels.
METHODS: A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital. The participants were divided into four groups according to their HbA1c levels using the interquartile method, namely Q1 (< 7.875%), Q2 (7.875%-9.050%), Q3 (9.050%-11.200%) and Q4 (≥ 11.200%). Clinical data were collected and measured, including age, height, weight, neck/waist/hip circumferences, blood pressure, comorbidities, duration of DM, and biochemical indicators. Meanwhile, neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.
RESULTS: The HbA1c level was significantly associated with urinary microalbumin (mALB), triglyceride, low-density lipoprotein cholesterol (LDL-C), homeostasis model assessment of insulin resistance (HOMA-IR), and beta cell function (HOMA-β), N-acetylaspartate/creatine (NAA/Cr), and NAA/choline (NAA/Cho). Spearman correlation analysis showed that mALB, LDL-C, HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c (P < 0.05), whereas HOMA-β was negatively correlated with the HbA1c level (P < 0.05). Ordered multiple logistic regression analysis showed that NAA/Cho [Odds ratio (OR): 1.608, 95% confidence interval (95%CI): 1.004-2.578, P < 0.05], LDL-C (OR: 1.627, 95%CI: 1.119-2.370, P < 0.05), and HOMA-IR (OR: 1.107, 95%CI: 1.031-1.188, P < 0.01) were independent predictors of poor glycemic control.
CONCLUSIONS: The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control, which may be the basis for the changes in cognitive function in diabetic patients.
OBJECTIVE: To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c (HbA1c) levels.
METHODS: A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital. The participants were divided into four groups according to their HbA1c levels using the interquartile method, namely Q1 (< 7.875%), Q2 (7.875%-9.050%), Q3 (9.050%-11.200%) and Q4 (≥ 11.200%). Clinical data were collected and measured, including age, height, weight, neck/waist/hip circumferences, blood pressure, comorbidities, duration of DM, and biochemical indicators. Meanwhile, neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.
RESULTS: The HbA1c level was significantly associated with urinary microalbumin (mALB), triglyceride, low-density lipoprotein cholesterol (LDL-C), homeostasis model assessment of insulin resistance (HOMA-IR), and beta cell function (HOMA-β), N-acetylaspartate/creatine (NAA/Cr), and NAA/choline (NAA/Cho). Spearman correlation analysis showed that mALB, LDL-C, HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c (P < 0.05), whereas HOMA-β was negatively correlated with the HbA1c level (P < 0.05). Ordered multiple logistic regression analysis showed that NAA/Cho [Odds ratio (OR): 1.608, 95% confidence interval (95%CI): 1.004-2.578, P < 0.05], LDL-C (OR: 1.627, 95%CI: 1.119-2.370, P < 0.05), and HOMA-IR (OR: 1.107, 95%CI: 1.031-1.188, P < 0.01) were independent predictors of poor glycemic control.
CONCLUSIONS: The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control, which may be the basis for the changes in cognitive function in diabetic patients.
摘要：
背景：认知功能障碍是中枢神经病变的主要表现。尽管糖尿病（DM）患者的认知障碍往往被忽视，越来越多的证据表明DM与认知功能障碍有关.高血糖与神经系统异常密切相关，虽然在临床实践中经常被忽视。2型糖尿病(T2DM)患者脑神经递质水平的变化与多种神经系统异常有关,可能与血糖控制密切相关。
目的：评估不同血红蛋白A1c（HbA1c）水平的T2DM患者的脑神经递质浓度。
方法：选择上海东方医院内分泌科的T2DM患者130例。参与者根据他们的HbA1c水平使用四分位法分为四组，即第一季度(<7.875%)，Q2（7.875%-9.050%），Q3（9.050%-11.200%）和Q4（≥11.200%）。收集和测量临床数据，包括年龄,高度,体重,颈部/腰部/臀部圆周,血压,合并症,DM的持续时间，和生化指标。同时,用质子磁共振波谱检测左侧海马和左侧脑干区的神经递质。
结果：HbA1c水平与尿微量白蛋白（mALB）显着相关，甘油三酯，低密度脂蛋白胆固醇（LDL-C），胰岛素抵抗的稳态模型评估（HOMA-IR），和β细胞功能（HOMA-β），N-乙酰天冬氨酸/肌酸(NAA/Cr),和NAA/胆碱（NAA/Cho）。Spearman相关分析表明,LDL-C,左脑干区HOMA-IR、NAA/Cr与HbA1c水平呈正相关(P<0.05),HOMA-β与HbA1c水平呈负相关(P<0.05)。有序多因素logistic回归分析显示,NAA/Cho[比值比(OR):1.608,95%置信区间(95CI):1.004~2.578,P<0.05],LDL-C（OR：1.627，95CI：1.119-2.370，P<0.05），HOMA-IR(OR:1.107,95CI:1.031~1.188,P<0.01)是血糖控制不良的独立预测因子。
结论：T2DM患者左脑干区域脑神经递质浓度与血糖控制密切相关。这可能是糖尿病患者认知功能变化的基础。
目的：评估不同血红蛋白A1c（HbA1c）水平的T2DM患者的脑神经递质浓度。
方法：选择上海东方医院内分泌科的T2DM患者130例。参与者根据他们的HbA1c水平使用四分位法分为四组，即第一季度(<7.875%)，Q2（7.875%-9.050%），Q3（9.050%-11.200%）和Q4（≥11.200%）。收集和测量临床数据，包括年龄,高度,体重,颈部/腰部/臀部圆周,血压,合并症,DM的持续时间，和生化指标。同时,用质子磁共振波谱检测左侧海马和左侧脑干区的神经递质。
结果：HbA1c水平与尿微量白蛋白（mALB）显着相关，甘油三酯，低密度脂蛋白胆固醇（LDL-C），胰岛素抵抗的稳态模型评估（HOMA-IR），和β细胞功能（HOMA-β），N-乙酰天冬氨酸/肌酸(NAA/Cr),和NAA/胆碱（NAA/Cho）。Spearman相关分析表明,LDL-C,左脑干区HOMA-IR、NAA/Cr与HbA1c水平呈正相关(P<0.05),HOMA-β与HbA1c水平呈负相关(P<0.05)。有序多因素logistic回归分析显示,NAA/Cho[比值比(OR):1.608,95%置信区间(95CI):1.004~2.578,P<0.05],LDL-C（OR：1.627，95CI：1.119-2.370，P<0.05），HOMA-IR(OR:1.107,95CI:1.031~1.188,P<0.01)是血糖控制不良的独立预测因子。
结论：T2DM患者左脑干区域脑神经递质浓度与血糖控制密切相关。这可能是糖尿病患者认知功能变化的基础。
