CAJ | 학술논문

目的：探讨2型糖尿病脑白质病变患者脑血管功能及认知功能变化情况。方法选取82例2型糖尿病患者，根据脑MRI结果分为脑白质病变组45例和无脑白质病变组37例，另选取年龄、性别、受教育程度匹配的健康体检者30例作为对照组。分别进行经颅多普勒（TCD）及事件相关电位（P300）检测，同时使用北京版蒙特利尔认知评估量表（MoCA）进行认知功能评分。结果脑白质病变组和无脑白质病变组大脑中动脉（ MCA ）、基底动脉（BA）的搏动指数（PI）均明显高于对照组（P均＜0．05），且脑白质病变组明显高于无脑白质病变组（P＜0．05），而MCA、BA的平均血流速度各组间比较差异均无统计学意义（P均＞0．05）。脑白质病变组P300潜伏期明显长于无脑白质病变组及对照组（ P均＜0．05），无脑白质病变组明显长于对照组（P＜0．05）；脑白质病变组P300波幅明显低于无脑白质病变组及对照组（P均＜0．05），无脑白质病变组与对照组比较差异无统计学意义（P＜0．05）。脑白质病变组MoCA评分明显低于无脑白质病变组及对照组（P＞0．05）。结论通过TCD进行PI测定可发现糖尿病患者脑微小血管病变，结合P300和MoCA测定，有助于早期发现2型糖尿病合并脑白质病变后的认知功能障碍。
목적：탐토2형당뇨병뇌백질병변환자뇌혈관공능급인지공능변화정황。방법선취82례2형당뇨병환자，근거뇌MRI결과분위뇌백질병변조45례화무뇌백질병변조37례，령선취년령、성별、수교육정도필배적건강체검자30례작위대조조。분별진행경로다보륵（TCD）급사건상관전위（P300）검측，동시사용북경판몽특리이인지평고량표（MoCA）진행인지공능평분。결과뇌백질병변조화무뇌백질병변조대뇌중동맥（ MCA ）、기저동맥（BA）적박동지수（PI）균명현고우대조조（P균＜0．05），차뇌백질병변조명현고우무뇌백질병변조（P＜0．05），이MCA、BA적평균혈류속도각조간비교차이균무통계학의의（P균＞0．05）。뇌백질병변조P300잠복기명현장우무뇌백질병변조급대조조（ P균＜0．05），무뇌백질병변조명현장우대조조（P＜0．05）；뇌백질병변조P300파폭명현저우무뇌백질병변조급대조조（P균＜0．05），무뇌백질병변조여대조조비교차이무통계학의의（P＜0．05）。뇌백질병변조MoCA평분명현저우무뇌백질병변조급대조조（P＞0．05）。결론통과TCD진행PI측정가발현당뇨병환자뇌미소혈관병변，결합P300화MoCA측정，유조우조기발현2형당뇨병합병뇌백질병변후적인지공능장애。
Objective It is to study the changes of cerebrovascular and cognitive function in type 2 diabetes mellitus ( DM) patients complicated with cerebral white matter lesions .Methods According to brain MRI examination , eighty-two DM patients were allocated to cerebral white matter lesions group (n=45) and non cerebral white matter lesions group (n=37), 30 healthy persons whose age , gender , education degree were similar to the patients were selected as control group .All the subjects in each group were measured with Transcranial Doppler ultrasonography ( TCD ) , P300 and their cognitive function scores were evaluated by Montreal Cognitive Assessment (MoCA).Results The pulsatility index (PI) of middle cerebral ar-teries ( MCA) and basilar arteries ( BA) were higher in the DM complicated with cerebral white matter lesions and without cer -ebral white matter lesions groups than that in the control group (P<0.05), and the index in cerebral white matter lesions group was higher than that in non cerebral white matter lesions group (P<0.05).There was no significant difference in the mean flow velocity (Vm) of MCA and BA among the three groups (P>0.05).The latencies of P300 and their amplitudes de-creased in the DM complicated with cerebral white matter lesions group , and there were significant difference between two DM groups (P<0.05), but there was no significant difference in the amplitudes between non cerebral white matter lesions group and control group .The scores of MoCA were significantly lower in the DM complicated with cerebral white matter lesions group than than in the non cerebral white matter lesions group and control group (P<0.05).Conclusion The PI measurement by TCD may reflect cerebral microvascular disease , P300 and MoCA are useful to early detect cognitive function impairment in the type 2 diabetes mellitus patients complicated with cerebral white matter lesions .