Investigation Of TCM Syndromes And MR-DKI Of 76 Patients With Type 2 Diabetes With Mild Cognitive Impairment

[Purpose]The aim of this study was to explore the characteristics of Traditional Chinese Medicine(TCM)syndromes in patients of type 2 diabetes mellitus with mild cognitive impairment.Providing reference basis for syndrome differentiation and treatment of traditional Chinese medicine.The brain parenchyma of patients with mild cognitive impairment and normal cognitive function of type 2 diabetes mellitus were quantitatively measured by Magnetic Resonance-Diffusion Kurtosis Imaging(MR-DKI).Compared with the difference of DKI parameters between the two groups.To analyze the correlation between DKI parameters and cognitive function scores,and meanwhile TCM syndromes.Finally,to explore the value of DKI in evaluating mild cognitive impairment in type 2 diabetes mellitus.[Method]In this study,152 patients with type 2 diabetes mellitus were collected and divided into mild cognitive impairment group(MCI group)76 cases and normal cognitive function group(N group)76 cases,according to the inclusion and exclusion criteria assessing by Montreal Cognitive Assessment Scale(MoCA)and Simple Mental State Scale(MMSE).Collecting patients' general information,laboratory examination and four diagnostic information of traditional Chinese medicine,determining their TCM syndromes and filling the case investigation form.At the same time,10 patients in each group with being matched with levels of age,gender,education,blood pressure and other factors were performed conventional head MRI and DKI scanning.Functool software was used for image processing on workstations.The parameters of FA,MK,MD,AK,RK,RD and AD in frontal,parietal,occipital,temporal lobe,caudate nucleus head,anterior limb of internal capsule and posterior limb of internal capsule were measured.Each part was measured twice and its average value was taken.Finally,the collected information and data were input into Excel 2007 to establish a database,and SPSS21.0 software was used for statistical analysis.[Results]1.General information:There were no significant differences in gender,age,BMI,blood pressure,course of diabetes,common complications of diabetes,complications of hypertension,coronary heart disease and hyperlipidemia,smoking and drinking history between the two groups.MCI group was significantly lower than N group in the number of cases with fatty liver disease and level of education.2.Laboratory examination,cognitive function and influencing factors:There were no significant differences in blood sugar,glycosylated hemoglobin and other laboratory tests between the two groups.There were significant differences in visual space and executive function,naming,attention,language,abstraction,delayed recall and orientation scores between the two groups.Educational level and TC level were negative factors for mild cognitive impairment in type 2 diabetes mellitus,while LDL-C and fasting insulin level were positive factors for mild cognitive impairment in type 2 diabetes mellitus.3.TCM syndromes:In MCI group,liver and kidney were the common organ diseases,meanwhile heart and spleen were involved in Chinese Medicine.There were many patients with both deficiency and excess.The main syndromes of MCI group were Qi deficiency,Yin deficiency,blood stasis,phlegm and dampness,liver and blood deficiency,heart and blood deficiency.In group N,liver and spleen were common organ diseases,meanwhile kidney and heart were involved in Chinese Medicine.There were also many patients with both deficiency and excess.The main syndromes of group N were Yin deficiency,Qi deficiency,dryness and heat,phlegm and dampness,liver and blood deficiency,spleen Qi Deficiency.In MCI group,there was no significant correlation between deficiency and excess of TCM,common syndromes and cognitive function score.4.DKI parameter measurements:The two groups were matched in gender,age and educational level.Compared with the normal cognitive function group of type 2 diabetes mellitus(N-D group),the parameters in the type 2 diabetes mellitus mild cognitive impairment group(MCI-D group)were as follows:(1)FA value:There was no significant difference in FA values between the two groups.(2)MD value:In the MCI-D group,the occipital lobe MD value was significantly increased.(3)MK value:MK values of occipital lobe,caudate nucleus head and corpus callosum knee in MCI-D group decreased significantly.(4)AD value:AD value in parietal lobe of MCI-D group decreased obviously.(5)RD value:In the MCI-D group,the RD value of the frontal lobe decreased significantly,and the RD value of the compression part of the corpus callosum increased significantly.(6)AK value:In the MCI-D group,the AK value of intracapsular forelimbs decreased significantly.(7)RK value:In the MCI-D group,RK values in the parietal lobe,occipital lobe and corpus callosum were significantly decreased.To analyze the correlation between DKI parameters and cognitive function score in MCI-D group,it was found that FA,MK,AK and RK values were positively correlated with MoCA scores.Among them,FA values of anterior limb,posterior limb of internal capsule and AK values of anterior limb of internal capsule were the most correlated.The MD,AD and RD values were negatively correlated.Among them,the MD values of anterior limb of internal capsule were the most correlated.The common syndromes in MCI-D group were not significantly correlated with DKI parameters.[Conclusion]1.Liver and kidney are common visceral diseases in type 2 diabetic patients with MCI,meanwhile heart and spleen were involved.The main TCM syndromes of MCI group were deficiency of both Qi and Yin,phlegm and blood stasis,blood deficiency of heart and liver,and were characterized by heart-blood deficiency and blood stasis.2.The values of MK(occipital lobe,caudate nucleus head and genu of corpus callosum)and RK(parietal lobe,occipital lobe and corpus callosum)of magnetic resonance DKI parameters were more sensitive to microstructural changes than other parameters.The parameters FA(anterior and posterior limbs of internal capsule),AK(anterior limb of internal capsule)and MD(anterior limb of internal capsule)had the most significant correlation with cognitive function scores,which may be an important parameter for patients' cognitive function evaluation.