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目的应用氢质子磁共振波谱(1H-MRS)技术检测2型糖尿病合并急性脑梗死梗塞侧及对应健侧代谢特点。方法应用1.5T MRI扫描仪对2型糖尿病合并急性脑梗死患者24例(DMCI组)、单纯急性脑梗死患者23例(CI组)与健康志愿者26例(HC组)均进行1H-MRS检测,测量大脑白质梗死侧及对应健侧的N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱化合物(Cho)/肌酸(Cr)、乳酸(Lac)/肌酸(Cr)比值。结果 DMCI组和CI组梗死灶的NAA/Cr比值较HC组降低,DMCI组梗死侧NAA/Cr比值较CI组降低,DMCI组梗死侧的NAA/Cr比值较对应健侧降低,并且该组健侧与HC组相比,NAA/Cr比值降低。NAA/Cr水平与空腹血糖(FBG)和糖化血红蛋白(HbA1c)水平呈负相关。Cho/Cr比值在3组之间无明显差异,DMCI组和CI组梗死区域可检测到Lac峰,且DMCI组Lac/Cr比值较CI组升高。结论 2型糖尿病的存在可加重急性脑梗死患者神经元的损伤。2型糖尿病患者脑组织在未出现梗塞灶之前可能已存在神经元受损。
Objective To detect the metabolic characteristics of infarction side and corresponding contralateral side of type 2 diabetes mellitus complicated with acute cerebral infarction by 1H-MRS. Methods Twenty-six patients with type 2 diabetes mellitus (DMCI group), 23 patients with acute cerebral infarction (CI group) and 26 healthy volunteers (HC group) were examined by 1H-MRS with 1.5T MRI scanner. (NAA) / creatine (Cr), choline compound (Cho) / creatine (Cr), lactate / creatine )ratio. Results The ratio of NAA / Cr in infarction in DMCI group and CI group was lower than that in HC group. The ratio of NAA / Cr in infarction side of DMCI group was lower than that in CI group, while NAA / Cr ratio in infarction side of DMCI group was lower than that of HC group. Compared with HC group, NAA / Cr ratio decreased. NAA / Cr levels were negatively correlated with fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) levels. There was no significant difference in Cho / Cr ratio among the three groups. The peak of Lac was detected in the infarct area of DMCI group and CI group, and the Lac / Cr ratio of DMCI group was higher than that of CI group. Conclusion The presence of type 2 diabetes can aggravate neuronal damage in patients with acute cerebral infarction. Brain tissue in patients with type 2 diabetes may have had neuronal damage before infarction develops.