| ObjectivesTo explore the relationship between type 2 diabetes mellitus(T2DM)and cognitive function,we gave T2 DM patients cognitive tests,brain functional imaging,continuous glucose monitoring and analysised the levels of inflammatory factors such as high-mobility group box-1(HMGB1)and so on.Methods1.Select nighty diagnosed type 2 diabetic patients and 81 normal and fitness person,Recorded general information of participants such as age,height and other datas.The levels of HMGB1,interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in serum were measured by ELISA.Gave all subjects a cognitive test by using montreal cognitive assessment(MoCA).The NAA,Cho,Cr of hippocampus were determined by ~1H-MRS.All participants underwent 3.0 Tesla rs-fMRI examination,the functional connection between other brain regions and left hippocampus(seed region)was analyzed by Granger analysis.Compare the differents of MoCA score,the brain function,the levels of NAA,Cho,Cr.Analysis the relationship between MoCA score and the levels of NAA,Cho,HMGB-1,TNF-α,IL-1β,IL-6.Analyze which is the influence factor of MoCA score.2.The 90 T2 DM patients were divided by the score of MoCA in two groups,48 in T2DM-MCI group(MoCA<26)and 45 in T2DM-NCI group(26≤MoCA≤30).Record the general clinical data and conduct a head MRI in all objects.The continuous glucose monitoring system(CGMS)device was used to obtain a minimum of 72 h of glycemic data.Compare the differents of glucose variability in two groups.Analysis the relationship between glucose variability and MoCA score,the levels of NAA,Cho,HMGB-1,TNF-α,IL-1β,IL-6.Analyze whether the glucose variability is the influence factor of MoCA score.3.The 90 T2 DM patients were divided by the BMI in two groups,28 in T2DM-OB group(BMI≥28kg/m2),39 in T2DM-OW group(BMI24-27.9kg/m2)and 28 in T2DM-NW group(BMI24-27.9kg/m2).Compare the differents of MoCA scores in three groups.Analysis the relationship between BMI and MoCA score,the levels of NAA,Cho,HMGB-1,TNF-α,IL-1β,IL-6.Analyze whether BMI is the influence factor of MoCA score.Results1.Compared to the NC group,the levels of FBG,HbAlc,HMGB-1,TNF-α,IL-1β,IL-6 were increase in T2 DM group(P<0.05).Compared to the NC group,the MoCA score were decreased in T2 DM group(P<0.05).The level of executive function,memory and attention were decreased in T2 DM group.rs-fMRI: The collective of epencephalon,precuneus,parietal lobe,gyrus frontalis medius,precentral gyrus,posterior central gyrus and hippocampus are abnormal in T2 DM group.~1H-MRS: Compared to NC group,the levels of NAA/Cr in two said were decreased in T2DM(P<0.05).2.Correlation analysis showed that the levels of education history,left NAA/Cr,right NAA/Cr were positively related to MoCA socre(P< 0.05).The levels of HMGB1,IL-1β,IL-6,TNF-a,left Cho,HbAlc,age,BMI were significantly related to the MoCA socre(P<0.05).3.Compared to T2DM-NCI,FBG,HbAlc were increased and HDL-C was decreased in T2DM-MCI group(P<0.05).The MAGE,MODD were increased in T2 DM group.The levels of NAA/Cr in two sides were decreased,the level of left Cho/Cr was increased in T2 DM group.The levels of HMGB1,IL-1β,IL-6,TNF-a were increased in T2 DM group(P<0.05).Correlation analysis showed that MoCA score was negnatively related to MAGE,MODD(P<0.05).MAGE was negnatively related to NAA/Cr in two sides,and was positively related to left NAA/Cr,HMGB1,IL-1β,IL-6,TNF-a.Multivariate linear regression analysis showed MAGE,left NAA/Cr,HMGB1,IL-6 levels were risk factors of MoCA score(P<0.05).4.Compared to T2DM-NW and T2DM-OW groups,the levels of FBG,HbAlc,TG,TC were increased and HDL-C was decreased in T2DM-OB group(P<0.05).In T2 DM,MoCA score of the T2DM-OB group were lower than the T2DM-NW group(P<0.05)and the T2DM-OW group(P<0.05),and the MoCA score were no difference between the T2DM-NW group and the T2DM-OW group(P>0.05).The executive function score of the T2DM-OW group were better than the T2DM-NW group(P<0.05)and the T2DM-OB group(P<0.05),The language score of the T2DM-NW group were better than the T2DM-OB group(P<0.05),and the memory score of the T2DM-OW group were better than the T2DM-OB group(P<0.05).Compared to the T2DM-OW group and the T2DM-NW group,the level of right hippocampal NAA/Cr was lower in the T2DM-OB group(P<0.05).The levels of HMGB1,IL-1β,IL-6 and TNF-a were gradually increased by evevatory BMI.BMI was positively correlated with right NAA/Cr,negnatively related to the levels of HMGB1,IL-1β,IL-6,TNF-a(P < 0.05).Multiple stepwise regression analysis showed that BMI were the independent impact factors of MoCA score.Conclusion1.The level of executive function,memory,attention was decreased in T2 DM patients.T2 DM hippocampus metabolic substance levels change,hippocampus function connection to some brain areas abnormal were the structure foundation for cognitive function.Inflammation is involved in the mechanisms of cognitive dysfunction.2.Glucose variability is the main factors of T2 DM patients with cognitive impairment.Glucose variability may caused the abnormal of functional connection and hippocampus metabolic substance,and aggravated inflammatory reaction.3.Cognitive function in obesity T2 DM patients was lower than normal weight and overweight T2 DM patients,The level of executive function in overweight T2 DM patients was higher than normal weight T2 DM patients.4.BMI is the main factors of type 2 diabetes mellitus with cognitive impairment.Obesity may caused the abnormal of functional connection and hippocampus metabolic substance,and aggravated inflammatory reaction. |
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