2型糖尿病性脑梗死患者颈动脉颅外段及指动脉病变的临床研究

【作者】 王燕宏；

【导师】 魏利华； 庞晋萍；

【作者基本信息】 山西医科大学 ， 神经病学， 2005， 硕士

【摘要】 目的 探讨 2 型糖尿病性脑梗死患者颈动脉颅外段及指动脉的病变特征及其危险因素,以指导临床及时采取正确有效的干预措施,预防脑血管病的发生。 方法 利用彩色多普勒超声对 80 例 2 型糖尿病性脑梗死患者、30 例单纯糖尿病患者及 41 例性别、年龄匹配的健康对照人群的颈动脉和指动脉进行检测,并分析颈动脉内中膜厚度(IMT)与脑血管病危险因素间的关系。 结果 (1)糖尿病合并脑梗死组的 BMI、 SBP、 DBP 、LDL、TG、 CH 、ApoB、FIB 水平明显高于其他 2 组 (P<0.05),而 HDL、ApoA、ApoA/ApoB 的比值水平明显低于其他 2 组(P<0.05)。糖尿病病程、空腹血糖、GHBA1 、GHBA1c 水平在糖尿病合并脑梗死组与单纯糖尿病组间无明显差异(P>0.05)。(2)糖尿病合并脑梗死组 CCA-IMT、ICA-IMT 明显大于其它 2 组 (P<0.05); 糖尿病合并脑梗死组斑块发生率及管腔狭窄的发生率远远高于正常对照组(P<0.01),而与单纯糖尿病组相比其差异不具有统计学意义, 在糖尿病合并脑梗死组中斑块类型主要为软斑及混合斑,其所占比例达 63.2%,与其它 2 组相比其差异显著(P<0.01)。(3)多元线性逐步回归分析提示颈总动脉 IMT 增厚与 LDL、高血压病史呈正相关,与 HDL 呈负相关。而与血压水平、空腹血糖水平、TC、TG 等无明显相关性。(4)糖尿病合并脑梗死组指动脉 PI 、RI 均大于其他 2 组(P<0.05),而 EDV 低于其它 2 组,单纯糖尿病组 EDV 、RI 与对照组也有明显差异(P<0.05)。 结论 2 型糖尿病性脑梗死患者颈动脉颅外段动脉粥样硬化程度较重,指动脉血流动力学改变明显;血糖本身可能不是导致颈动脉粥样硬化的主要因素,2 型糖尿病可能通过脂质代谢紊乱和高血压而促进颈动脉 IMT 增厚和脑血管病的发生;利用超声对 2 型糖尿病患者进行颈动脉颅外段及指动脉的检测,对早期发现血管病变,预防脑血管病的发生有重要的参考价值。更多还原

【Abstract】 Objective To study the Changes of extracranial carotid arteries and proper palmar digital arteries in type 2 diabetic patients with cerebral infarction and its risk factors and to provide clinical index for the prophylaxis of ischemic cerebrovascular disease . Methods The extracranial carotid arteries and proper palmar digital arteries of 80 patients with type 2 diabetic combine cerebral infarction, 30 patients with type 2 diabetic and 41 healthy collators were detected by colour-Doppler ultrasound ,the relationships between carotid IMT and risk factors of cerebrovascular disease were evaluated . Results (1)The levels of BMI 、SBP、 DBP、 LDL、 TG、 CH、 ApoB and FIB were significantly higher in diabetic subjects with cerebral infarction than those in the other two groups (P <0.05).However ,the levels of HDL、ApoA1 and ratio of ApoA1 /ApoB were significantly lower in diabetic subjects with cerebral infarction than in the other two groups(P<0.05).(2) IMTs both in the common carotid artery(CCA) and internal carotid artery(ICA) in diabetic subjects with cerebral infarction were significantly greater than in the other two groups(P<0.05); The prevalence of plaque and lumen stenosis in diabetic subjects with cerebral infarction were significantly higher than in the control group(P<0.05); Moreover,soft-plaque and mixed-plaques could be more frequently encountered in diabetic subjects with cerebral infarction(63.2%).(3)By multiple linear stepwise regression analysis,we found increased CCA—IMT was significantly associated with LDL、hypertension and HDL.(4)The PI and RI of proper palmar digital arteries in diabetic subjects with cerebral infarction were significantly higher than in the other two groups(P<0.05). However ,the EDV were significantly lower in diabetic subjects with cerebral infarction than in the other two groups(P<0.05). Conclusion (1) The atherosclerosis degree in extracranial Carotid Arteries and the changes of blood flow of proper palmar digital arteries in type 2 diabetic patients with cerebral infarction were severe; (2)Blood glucose level may not be an important risk factor to the atherosclerosis degree in extracranial Carotid Arteries , diabetes may develop increased carotid IMT and cerebrovascular disease by dyslipidemia and abnormal hemorheology;(3)The measurement of extracranial carotid arteries and proper palmar digital arteries by colour-Doppler ultrasound should be of important clinical value for earlier diagnosing and choosing treatment methods and for the prophylaxis of cerebrovascular disease .更多还原