目的 采用基于体素的脑形态 学 M R I测量方法分析 2型糖尿病 ( T y p e 2 diabetes,T2DM)伴认知功能障碍 (Cognitive impairment,CI)患者全脑灰 质结构的变化。方法 选择我院收治的40 例T2DM并CI(D-CI组)与45例T2DM无CI患者 (T2DM组)作为研究对象，选择同期入院体 检的30例正常健康人作为对照组，入院后 三组均完成常规MRI及三维磁化准备快速 梯度回波检查，获取全脑容积数据，并采 用VBM8工具进行数据处理，对三组脑灰 质、白质体积进行基于体素的统计学比 较，并将其与CI关系进行偏相关分析。结 果 三组脑白质总体积对比差异无统计学 意义(P>0.05)，D-CI组总灰质体积低于 T2DM组与对照组(P<0.05)，T2DM组总灰质 体积低于对照组(P<0.05)；D-CI组左右侧 海马体积均低于T2DM组与对照组，T2DM组 左右侧海马体积低于对照组(P<0.05)，其 余各分区灰质结构体积比较差异无统计学 意义(P>0.05)；T2DM左侧颞中回体积、左 侧海马体积、右侧海马体积均与患者认 知功能障碍程度呈负相关(r=-0.697、- 0.415、-0.512，P<0.05)。结论 T2DM与 T2DM伴CI患者均伴不同脑区灰质体积萎 缩，但T2DM伴CI患者脑区萎缩程度更高， 以颞中回灰质体积及海马区体积缩小更为 明显。

Objective To analyze the changes in structure of whole brain gray matter in patients with type 2 diabetes mellitus (T2DM) and cognitive impairment (CI) by voxelbased brain morphological MRI method. Methods 40 cases of patients with T2DM complicated with CI (D-CI group) and 45 patients with T2DM and without CI (T2DM group) treated in our hospital from February 2011 to January 2016 were enrolled in the study. Another 30 healthy subjects were selected as the control group at the same time. After admission, patients in the three groups were examined with conventional MRI and three-dimensional magnetization prepared rapid gradient echo to collect the whole brain volume data, and the data were processed by using VBM8 tools. The gray matter and white matter volume was statistically analyzed, and its relationship with CI was analyzed by the partial correlation analysis. Results There was no significant difference among the three groups in the total volume of cerebral white matter (P>0.05). The total gray matter volume showed D-CI group < T2DM group < the control group (P<0.05). There was no significant difference among groups in gray matter volume, white matter volume and brain volume (TIV) (P>0.05). The left and right cerebral hippocampal volume showed D-CI group < T2DM group < the control group, and the gray matter structure volume in the other zones showed no statistically significant difference (P>0.05). The left middle temporal gyrus volume, left cerebral hippocampal volume and right cerebral hippocampal volume of patients with T2DM were negatively correlated with the degree of cognitive impairment (r=-0.697, -0.415, -0.512, P<0.05). Conclusion Patients with T2DM and patients with T2DM complicated with CI have gray matter volume atrophy in different areas of the brain, and brain atrophy is more severe in patients with T2DM complicated with CI. The decrease of gray matter volume in the middle temporal gyrus and the hippocampus is more obvious.