初诊2型糖尿病患者胰岛素强化治疗前后海马区NAA/Cr、Cho/Cr的变化

目的研究初诊2型糖尿病患者胰岛素强化治疗前后海马区N-乙酰天门冬氨酸复合物( NAA)/肌酸( Cr)、胆碱复合物( Cho)/Cr的变化。方法氢质子磁共振波谱(1 H-MRS)检测30例初诊2型糖尿病患者双侧海马区NAA/Cr、Cho/Cr,同时检测空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白( HbAlc)、三酰甘油( TG)、胆固醇( CHO)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、HOMA-β细胞功能指数( HOMA-β)和HOMA-胰岛素抵抗指数( HOMA-IR)。胰岛素泵强化降糖10~14 d,血糖达标后复查上述指标予以对比。结果胰岛素强化治疗后,患者 FPG、2 hPG、TG、CHO、LDL、HOMA-IR水平降低(P<0．05,P<0．01),HOMA-β水平升高( P <0．05)；左右侧海马区 NAA/Cr 升高( P <0．05),右侧海马区 Cho/Cr 降低( P <0．05),左侧海马区
　　Cho/Cr呈下降趋势,但差异无统计学意义；NAA/Cr、Cho/Cr与血糖、HOMA-β、HOMA-IR有一定相关性。结论胰岛素强化治疗初诊2型糖尿病,可改善患者血糖、血脂,同时可升高双侧海马区NAA/Cr、降低右侧海马区Cho/Cr,其机制可能与血糖降低、胰岛素分泌增加、胰岛素抵抗改善有关。

Changes of Cho/Cr and NAA/Cr in hippocampus,before and after intensive insulin therapy in newly diagnosed type 2 diabetic patients

Objective Changes in hippocampus N-acetyl aspartic acid compound (NAA)/creatine(Cr), choline compound ( Cho)/Cr before and after treatment of intensive insulin in patients with newly diagnosed type 2 diabetes mellitus. Methods Proton magnetic resonance spectroscopy (1H-MRS) was detected in 30 cases of newly diag-nosed type 2 diabetic patients with bilateral hippocampal NAA, Cho and Cr ratio, the simultaneous detection of FPG, 2 hPG, HbAlc, TG, CHO, LDL, HDL, HOMA-β and HOMA-IR. Treated with insulin pump intensive 10~ 14 days, the blood glucose level after the review index was compared. Results After intensive insulin therapy, patients with FPG, 2 hPG, TG, CHO, LDL, HOMA-IR decreased (P<0. 05,P<0. 01), HOMA-βincreased (P<0. 05 ); the left and right hippocampus NAA/Cr increased ( P <0. 05 ) , the right hippocampus Cho/Cr de-creased (P<0. 05), left hippocampus Cho/Cr area decreased, but no statistical difference. The relationship be-tween NAA/Cr, Cho/Cr and blood glucose, HOMA-β, HOMA-IR. Conclusion Intensive insulin therapy in new-ly diagnosed type 2 diabetes can improve blood glucose, blood lipids, and elevate NAA/Cr, bilateral hippocampus decreased Cho/Cr on the right side of the hippocampus, and its mechanism may be related to decrease of blood sug-ar, increase in insulin secretion,insulin resistance improvement.