目的:2型糖尿病的特征是高血糖和胰岛素抵抗形式的代谢失调,并可能对大脑结构和脉管系统产生深远的影响。这项研究的主要目的是确定2型糖尿病和高血压对大脑健康的综合影响超过高血压单独的大脑区域。第二个目标是测试该人群的血管损伤和结构性脑测量是否与认知功能相关。
方法:我们招募了18名患有高血压的糖尿病参与者(HTN+T2DM,7女人,71.8±5.6岁)和22名仅患有高血压的参与者(HTN,12个女人,73.4±6.2年)。在连续屏气期间使用血氧水平依赖性(BOLD)MRI评估脑血管反应性(CVR)。使用从T1加权图像估计的皮质厚度(CThk)测量来评估灰质结构。还进行了认知和血液数据的分析。
结果:与HTN相比,HTN+T2DM在右枕叶空间重叠区域的CVR和CThk降低(P<0.025);CVR组差异更大,包括双侧枕顶区(P<0.025)。而CVR与认知功能指标无显著相关性(P>0.05),右舌回ROI中的CThk和通过顶点分析得到的区域(包括后扣带,precuneus,上额叶和中额叶,中颞区和下颞区(P<0.025)与执行功能相关。
结论:与年龄匹配的HTN对照组相比,T2DM和HTN患者的CVR和CThk降低。这项研究确定了受T2DM和HTN合并症综合影响的大脑区域,新的证据表明,相应的皮质变薄可能导致认知能力下降。
OBJECTIVE: Type 2 diabetes mellitus is characterized by metabolic dysregulation in the form of hyperglycemia and insulin resistance and can have a profound impact on brain structure and vasculature. The primary aim of this study was to identify brain regions where the combined effects of type 2 diabetes and hypertension on brain health exceed those of hypertension alone. A secondary objective was to test whether vascular impairment and structural brain measures in this population are associated with cognitive function.
METHODS: We enrolled 18 diabetic participants with hypertension (HTN + T2DM, 7 women, 71.8 ± 5.6 years) and 22 participants with hypertension only (HTN, 12 women, 73.4 ± 6.2 years). Cerebrovascular reactivity (CVR) was assessed using blood oxygenation level dependent (BOLD) MRI during successive breath holds. Gray matter structure was evaluated using cortical thickness (CThk) measures estimated from T1-weighted images. Analyses of cognitive and blood data were also performed.
RESULTS: Compared to HTN, HTN + T2DM had decreased CVR and CThk in a spatially overlapping region of the right occipital lobe (P < 0.025); CVR group differences were more expansive and included bilateral occipito-parietal areas (P < 0.025). Whereas CVR showed no significant associations with measures of cognitive function (P > 0.05), CThk in the right lingual gyrus ROI and regions resulting from a vertex-wise analysis (including posterior cingulate, precuneus, superior and middle frontal, and middle and inferior temporal regions (P < 0.025) were associated with executive function.
CONCLUSIONS: Individuals with T2DM and HTN showed decreased CVR and CThk compared to age-matched HTN controls. This study identifies brain regions that are impacted by the combined effects of comorbid T2DM and HTN conditions, with new evidence that the corresponding cortical thinning may contribute to cognitive decline.