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目的探讨用MR灌注成像结合醋甲唑胺负荷试验评估糖尿病患者的脑血管储备功能(CVR)。方法对80例糖尿病患者和10例正常人在口服醋甲唑胺前后进行2次检查,选取双侧尾状核头部、豆状核、丘脑、额上回、颞上回及楔叶作为兴趣区(ROI),测量的参数包括局部脑血容量(rCBV)和平均通过时间(rMTT)。根据公式局部脑血流量(rCBF)=rCBV/rMTT和CVR(%)=(服药后rCBF-服药前rCBF)/服药前rCBF×100%,计算CVR。结果 (1)糖尿病组各ROI的rMTT、rCBV和rCBF在醋甲唑胺负荷前后无统计学意义(P>0.05);对照组各ROI的rMTT在醋甲唑胺负荷后缩短(P<0.05),rCBV和rCBF在醋甲唑胺负荷后增加(P<0.05);(2)糖尿病组的CVR较对照组的CVR明显降低(P<0.05);(3)病程>10年的糖尿病患者的CVR较病程<10年的CVR明显降低(P<0.05);(4)糖尿病组中,视网膜正常组、合并视网膜病变Ⅰ~Ⅲ期组、合并视网膜病变Ⅳ~Ⅵ期组,CVR依次降低(P<0.05);(5)糖尿病组中高血压组较血压正常组CVR降低(P<0.05)。结论糖尿病患者的CVR较同年龄组正常人下降,处于亚临床缺血的状态,病程>10年者和合并视网膜病变、高血压者,CVR下降更明显。
Objective To evaluate the cerebrovascular reserve function (CVR) in diabetic patients with MR perfusion imaging and metforzamide stress test. Methods 80 patients with diabetes and 10 normal subjects were examined twice before and after oral administration of methazolamide. The bilateral caudate nucleus, leptoid nucleus, thalamus, superior frontal gyrus, superior temporal gyrus and wedge leaf were selected as the interest Zone (ROI), measured parameters include regional cerebral blood volume (rCBV) and mean transit time (rMTT). CVR was calculated according to the formula rCBF = rCBV / rMTT and CVR (%) = (rCBF after administration rCBF - rCBF before administration) / 100 rCBF before administration. Results (1) The rMTT, rCBV and rCBF of ROI in diabetic group were not significantly different before and after acetaminophen (P> 0.05). The rMTT in each ROI of control group was shorter after acetaminophen (P <0.05) , rCBV and rCBF increased after acetaminophen (P <0.05); (2) CVR in diabetic group was significantly lower than that in control group (P <0.05); (3) CVR (4) In the diabetic group, the normal retinal group, with stage Ⅰ ~ Ⅲ retinopathy, group Ⅳ ~ Ⅵ with retinopathy, CVR decreased in turn (P < 0.05). (5) The CVR of hypertensive group was lower than that of normotensive group in diabetic group (P <0.05). Conclusions The CVR of diabetic patients is lower than that of normal subjects in the same age group, and is in the state of subclinical ischemia. The duration of CVR is more than 10 years and the patients with complicated retinopathy and hypertension have more obvious CVR.