糖尿病脑梗塞患者大脑结构功能康复的磁共振成像研究

Diabetes mellitus (DM) plays an important role in the occurrence of the cerebral infarction (CI). Despite the lack of insufficient proof, clinical studies have demonstrated that the CI patients undergo a poor prognosis and rehabilitative neural functions in contrast with the non-DM. Previous magnetic resonance imaging (MRI) studies showed that DM patients had abnormalities in cerebral vessels, nerves and functions, with the similar findings were found in mice models. In this study, with multi-modal MRI technologies (DKI, ESWAN, PWI, OEF, fMRI, etc.), we tend to observe structural and functional changes of the barin in both DM and non-DM CI patients, assessing their neural rehabilitation via the use of clinical scales (NIHSS , an mRS, Fugl-Meyer, etc.) in the following 6 months. Above all, in this study, we expect to find out dynamic changes of brain structure and function in the CI patients with DM, to reveal the impacts and relative weights of the brain blood vessels, nerves and function remodeling on the recoveries of these patients respectively, to uncover objective imaging proofs on the worse prognosis and rehabilitation of the DM-CI, as well as the underlying mechanism.

糖尿病是脑梗塞的重要危险因素，并且临床研究显示糖尿病脑梗塞患者较非糖尿病脑梗塞患者的预后和神经功能康复都要差，但缺乏客观的证据。而先前的磁共振脑成像研究显示糖尿病会造成大脑的血管、神经和脑功能状态的异常。并且提供了脑梗塞模型鼠康复过程中大脑功能和结构（神经和血管）改变的证据。本项研究拟采用多模态磁共振成像技术（DKI、ESWAN、PWI、OEF、fMRI等）随访观察糖尿病及非糖尿病患者脑梗塞后6个月内大脑结构和功能的变化，使用临床量表（NIHSS、mRS、Fugl-Meyer等）评估神经功能康复情况。研究糖尿病脑梗塞患者临床康复过程中大脑结构和功能的动态变化特点。探讨大脑神经、血管、功能重塑等各因素对糖尿病脑梗塞患者临床康复的影响及其权重，进而寻找糖尿病脑梗塞患者的预后和神经功能康复差的客观证据，并回答可能的影响机制。

糖尿病是脑梗塞的重要危险因素，并且临床研究显示糖尿病脑梗塞患者较非糖尿病脑梗塞患者的预后和神经功能康复都要差。过去的临床前期动物研究表明糖尿病会造成大脑的血管、神经纤维和脑功能状态的异常，但缺乏人体的研究证据。本项目以大脑中动脉脑梗塞患者作为研究对象，采用多模态磁共振成像技术（包括DWI、T1/T2WI、SWI、DTI、PWI、resting-fMRI）主要分析了静脉血管、血脑屏障以及神经纤维，评价它们与糖尿病脑梗塞预后的关系，已发现了一些重要结果：（1）深部髓静脉异常与脑梗塞预后相关，但对糖尿病脑梗塞预后无影响；（2）糖尿病会加重缺血灶的血脑屏障破坏，并且血脑屏障破坏是糖尿病脑梗塞预后的独立因素；（3）糖尿病还会损伤缺血灶以往的正常白质纤维束，导致网络间功能连接下降，影响糖尿病脑梗塞的康复。本项目的这些重要发现能帮助我们进一步理解糖尿病情况下的脑梗塞康复机制，并为临床治疗糖尿病脑梗塞提供了客观的理论依据，也为后续进一步研究奠定了工作基础。