OBJECTIVE: To investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states, the present study employed diffusion tensor imaging along the perivascular space (DTI-ALPS) index.
METHODS: Sample size was calculated using the pwr package in R software. This cross-sectional study enrolled 22 patients with normal glucose metabolism (NGM), 20 patients with prediabetes, and 22 patients with type 2 diabetes mellitus (T2DM). A 3.0T magnetic resonance imaging was used to evaluate the function of the glymphatic system. The mini-mental state examination (MMSE) was used to assess general cognitive function. The DTI-ALPS index of bilateral basal ganglia and the mean DTI-ALPS index was calculated. Further, the correlation between DTI-ALPS and clinical features was assessed.
RESULTS: The left-side, right-side, and mean DTI-ALPS index in the T2DM group were significantly lower than that in the NGM group. The right-side DTI-ALPS and mean DTI-ALPS index in the T2DM group were significantly lower than those in the prediabetes group. DTI-ALPS index lateralization was not observed. The MMSE score in the T2DM group was significantly lower than that in the NGM and prediabetes group. After controlling for sex, the left-side DTI-ALPS and mean DTI-ALPS index in the prediabetes group were positively correlated with 2-hour postprandial blood glucose level; the left-side DTI-ALPS index was negatively correlated with total cholesterol and low-density lipoprotein level. The right-side DTI-ALPS and mean DTI-ALPS index were negatively correlated with the glycosylated hemoglobin level and waist-to-hip ratio in the prediabetes group. The left-side, right-side, and mean DTI-ALPS index in the T2DM group were positively correlated with height. The left-side and mean DTI-ALPS index in the T2DM group were negatively correlated with high-density lipoprotein levels.
CONCLUSIONS: Cerebral glymphatic system dysfunction may mainly occur in the T2DM stage. Various clinical variables were found to affect the DTI-ALPS index in different glucose metabolism states. This study enhances our understanding of the pathophysiology of diabetic brain damage and provides some potential biological evidence for its early diagnosis.
目的:探讨不同糖代谢状态患者的淋巴系统功能及其临床相关性,本研究采用血管周围间隙弥散张量成像(DTI-ALPS)指数.
方法:使用R软件中的pwr软件包计算样品大小。这项横断面研究纳入了22例糖代谢正常(NGM)的患者,20名糖尿病前期患者,2型糖尿病(T2DM)患者22例。3.0T磁共振成像用于评估淋巴系统的功能。简易精神状态检查(MMSE)用于评估一般认知功能。计算双侧基底节DTI-ALPS指数及平均DTI-ALPS指数。Further,评估了DTI-ALPS与临床特征之间的相关性.
结果:左侧,右侧,T2DM组DTI-ALPS指数均显著低于NGM组。T2DM组右侧DTI-ALPS和平均DTI-ALPS指数明显低于糖尿病前期组。未观察到DTI-ALPS指数侧向化。T2DM组MMSE评分显著低于NGM和糖尿病前期组。在控制性行为后,糖尿病前期组左侧DTI-ALPS和平均DTI-ALPS指数与餐后2小时血糖水平呈正相关;左侧DTI-ALPS指数与总胆固醇和低密度脂蛋白水平呈负相关.糖尿病前期组右侧DTI-ALPS和平均DTI-ALPS指数与糖化血红蛋白水平和腰臀比呈负相关。左边,右侧,T2DM组平均DTI-ALPS指数与身高呈正相关。T2DM组左侧及平均DTI-ALPS指数与高密度脂蛋白水平呈负相关。
结论:脑淋巴系统功能障碍可能主要发生在T2DM阶段。发现各种临床变量在不同的葡萄糖代谢状态下影响DTI-ALPS指数。这项研究增强了我们对糖尿病脑损伤的病理生理学的理解,并为其早期诊断提供了一些潜在的生物学证据。