CAJ | 학술논문

目的探索2型糖尿病患者皮层及皮层下奖赏环路体积变化，以及胰岛素治疗对奖赏环路的影响。方法对16名2型糖尿病患者及16名健康志愿者进行脑形态学分析，其中11名2型糖尿病患者进行基线（胰岛素治疗前）及随访水平（胰岛素治疗1年）的体积测量。统计学方法采用协方差分析及配对t检验。结果2型糖尿病患者左侧岛叶及伏隔核区、右侧海马、壳核及杏仁核体积显著小于对照组。接受胰岛素治疗1年后双侧皮层奖赏系统体积（左侧：33.65±3.66 ml；右侧：33.35±4.25 ml）显著高于基线水平（左侧：31.45±2.90 ml；右侧：31.12±2.97 ml）；双侧基底节食物奖赏系统结构体积无显著差异；双侧腹侧间脑体积随访水平（左侧：3.26±0.68 ml；右侧：3.20±0.78 ml）较基线水平（左侧：2.96±0.76 ml；右侧：2.82±0.90 ml）显著增加（P<0.05）。结论2型糖尿病患者皮层及皮层下奖赏系统结构体积减小，胰岛素治疗可以改善皮层及皮层下奖赏系统结构的损害。
목적탐색2형당뇨병환자피층급피층하장상배로체적변화，이급이도소치료대장상배로적영향。방법대16명2형당뇨병환자급16명건강지원자진행뇌형태학분석，기중11명2형당뇨병환자진행기선（이도소치료전）급수방수평（이도소치료1년）적체적측량。통계학방법채용협방차분석급배대t검험。결과2형당뇨병환자좌측도협급복격핵구、우측해마、각핵급행인핵체적현저소우대조조。접수이도소치료1년후쌍측피층장상계통체적（좌측：33.65±3.66 ml；우측：33.35±4.25 ml）현저고우기선수평（좌측：31.45±2.90 ml；우측：31.12±2.97 ml）；쌍측기저절식물장상계통결구체적무현저차이；쌍측복측간뇌체적수방수평（좌측：3.26±0.68 ml；우측：3.20±0.78 ml）교기선수평（좌측：2.96±0.76 ml；우측：2.82±0.90 ml）현저증가（P<0.05）。결론2형당뇨병환자피층급피층하장상계통결구체적감소，이도소치료가이개선피층급피층하장상계통결구적손해。
Objective To elucidate the volume changes of cortical and subcortical reward circuitry in patients with type 2 diabetes mellitus. Methods High-resolution three-dimensional T1-weighted fast spoiled gradient recalled echo MRI images were obtained from 16 patients with type 2 diabetes mellitus and 16 normal controls, and 11 type 2 diabetic patients also received the same MRI scans after insulin therapy for 1 year. Volumetric analysis was performed and analysis of covariance and paired t test were applied. Results A decreased volume was found in the left insular lobe, left nucleus accumbens area, right hippocampus, putamen and amygdala in type 2 diabetic patients compared with normal controls (P<0.05). After insulin therapy for 1 year, an increased volume of bilateral cortical reward structures was observed (left, 33.65 ± 3.66 ml;right, 33.35 ± 4.25 ml) compared the baseline level (left, 31.45 ± 2.90 ml; right, 31.12 ± 2.97 ml) in diabetic patients (P<0.05). No significant volume change in the bilateral basal ganglia structures was found after insulin therapy for 1 year (P>0.05), and bilateral ventral diencephalon area showed an increased volume after the treatment (left, 3.26±0.68 ml;right, 3.20±0.78 ml) compared with the baseline (left, 2.96 ± 0.76 ml;right, 2.82 ± 0.90 ml) (P<0.05). Conclusion Type 2 diabetic patients have a decreased volume of the cortical and subcortical reward circuitry, and insulin therapy can reverse such changes and improve the damage of reward circuitry.