高频超声评价2型糖尿病患者下肢周围神经病变临床观察

目的探讨高频超声用于评价2型糖尿病合并周围神经病变患者下肢股神经和隐神经异常改变的临床价值。方法共81例2型糖尿病患者分为无周围神经病变组(40例)和合并周围神经病变组(41例),通过彩色多普勒超声观察股神经和隐神经内部回声及连续性,测量并比较神经宽径、厚径和横截面积。结果正常对照组受试者股神经和隐神经横切面扫描呈略高回声,内部呈细小筛网格状,纵切面扫描内部呈条状低回声和平行线样排列的条状略高回声;无周围神经病变组患者内部回声略减低,细小筛网格状结构模糊,纵切面条状低回声结构欠清晰;合并周围神经病变组患者内部回声明显减低,细小筛网格状结构显示不清,纵切面条状低回声结构模糊。与正常对照组相比,糖尿病组患者股神经宽径(均P=0.000)、厚径(P=0.023,0.036)和横截面积(均P=0.000)增大;隐神经宽径(P=0.010,0.014)、厚径(均P=0.001)和横截面积(P=0.002,0.004)增大;合并周围神经病变组患者股神经和隐神经厚径(P=0.048,0.012)和横截面积(P=0.031,0.034)较无周围神经病变组增大。结论高频超声可以清晰地显示2型糖尿病合并周围神经病变患者股神经和隐神经主干内部回声及各径线的异常改变,为临床诊断提供客观依据,具有重要临床意义。     

Transcranial Doppler ultrasonography: year 2000 update.

In this update, the main clinical applications of transcranial Doppler ultrasonography are reassessed. A specific format for technology assessment, personal experience, and an extensive review of the literature form the basis of the evaluation. The document is approved by the American Society of Neuroimaging and the Neurosonology Research Group of the World Federation of Neurology.     

高血压病程与高血压患者无症状性脑动脉病变的相关性研究

目的探讨高血压病患者病程与无症状性脑动脉病变的相关性 方法收集245例住院高血压病患者,排除中风或中风史、合并糖尿病或其他颅内疾病的患者。按病程分为<5年、5-10年和>10年三组,应用经颅多普勒超声(TCD)评介病人脑动脉病变,SPSS10.0统计包分析TCD结果和病程之间的相关性。结果各病程组各动脉血速间无差异。 高血压病5年内组和5-10年组之间脑动脉总异常率无差异,但高血压病程>10年后总血管异常率显著增加 除大脑前、后动脉之外,其他各主要动脉异常率和高血压病程呈现直线相关,尤以颈内动脉末端、大脑中动脉血管血速增快(狭窄)率最显著。结论病程是高血压患者无症状性脑血管病变的危险因素     

眼动脉血管反应性在2型糖尿病患者脑血管病变中的诊断价值

目的 评估眼动脉血管反应性在2型糖尿病脑血管病变中的临床诊断价值.方法 运用经颅多普勒诊断仪,对27例2型糖尿病患者和23例健康体检者行TCD检查,对比分析两组人群大脑中动脉(MCA)及眼动脉(OA)的平均血流速度(Vm)、搏动指数(PI)、屏气指数(BHI)的差异程度.结果 糖尿病组与对照组比较,OA的平均血流速度(Vm)、屏气后的平均血流速度(Vm’)、屏气指数(BHI)均降低,与对照组比较均有统计学意义;糖尿病组与对照组比较,MCA的搏动指数(PI)、屏气后的搏动指数(PI’)均增高,与对照组比较均有统计学意义.结论 糖尿病患者MCA、OA的脑血管反应性检测,能早期识别2型糖尿病大血管和微血管病变,为2型糖尿病患者早期及时提供防治依据.     

Hyperechoic middle cerebral artery: acute occlusion detected by transcranial duplex ultrasonography.

The authors describe the appearance of acute thromboembolic occlusion of the middle cerebral artery (MCA) using transcranial duplex ultrasonography. Acute occlusion of the MCA commonly leads to severe cerebral infarction. In patients with acute MCA occlusion, secondary edema and elevated intracranial pressure are major causes of increased morbidity and mortality. Thus, the prompt detection of occlusion influences early therapy, including thrombolysis and increased control of intracranial pressure. The hyperdense appearance of the acutely occluded MCA as seen using computed tomography (CT) has been extensively reported in the literature. However, its appearance using transcranial duplex ultrasonography has not been reported. The authors report four patients who had clinical features of ischemia throughout the MCA territory. All patients were studied with CT and transcranial duplex ultrasonography within 6 hours of the onset of symptoms. Head CT of all four patients showed a hyperdense MCA sign with infarction of the MCA territory. Transcranial duplex studies using either pulsed Doppler or color Doppler sonography displayed a hyperechoic MCA with no evidence of flow. Subsequent duplex ultrasonography and magnetic resonance angiography showed all four patients had ipsilateral occlusion of the internal carotid artery. Transcranial duplex ultrasonography assists in the early diagnosis of acute MCA occlusion. The affected vessel is displayed as a hyperechoic structure associated with no flow using Doppler examination.     

颈动脉超声对冠状动脉粥样硬化性心脏病合并缺血性脑血管疾病患者颅内动脉狭窄性病变的预测价值

目的探讨颈动脉超声评价冠状动脉粥样硬化性心脏病(CAD)合并缺血性脑血管(ICVD)患者颅内动脉狭窄性病变的预测价值。方法对209例经血管造影证实冠状动脉狭窄(≥70%)同时合并缺血性脑血管疾病的患者采用彩色多谱勒超声(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为脑动脉狭窄组与非狭窄组,分别比较两组患者颈动脉超声检查结果中差异有统计学意义的指标。结果颈动脉球部内-中膜(IMT)增厚、不均质回声斑块、多发斑块、颈动脉狭窄与CAD患者合并颅内动脉狭窄性病变之间具有良好的相关关系,(P<0.05)。结论颈动脉内膜增厚、不均质回声斑块,多发斑块、颈动脉狭窄与CAD合并ICVD患者颅内动脉狭窄性病变之间有明显的相关性。采用CDFI对冠状动脉狭窄的患者进行颈动脉检测,在心脑血管事件高危人群中进行筛选,对临床诊断与治疗具有重要的指导意义。     

2型糖尿病合并脑梗死患者颈动脉、血脂及血浆纤维蛋白原的变化

目的 探讨2型糖球病合并脑梗死（DC1）患者颈动脉、血脂及血浆纤维蛋白原（Fg）的变化。方法 对58例DC1患者（DC1组）及36例非糖尿病不合并脑梗死患者（对照组）进行颈动脉超声检测，观察颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径；并作血糖、血脂和Fg含量测定。结果 DC1组颈动脉粥样硬化斑块的发生率（79．3％）、颈总动脉（CCA）内膜-中层厚度（1MT）和CCA内径与对照组比较差异有极显著性（均P〈0．01），斑块发生部化以CCA分叉处及颈内动脉（ICA）入口和起始处最多（86．0％）；以软斑为主（62．5％）。脑梗死部位与出现斑块的颈动脉存在同侧相关性（P〈0．01）。DC1组血糖、总胆固醇、三酰甘油及Fg较对照组显著增高（均P〈0．01）。结论 DC1患者大多有颈动脉粥样硬化及血脂、血糖、Fg水平异常，对糖尿病患者颈动脉粥样硬化斑块和血脂、血糖等异常进行早期干预，对预防脑梗死的发生有重要临床意义。     

2型糖尿病患者伴发脑梗死危险因素的研究

目的 探讨2型糖尿病伴发脑梗死的危险因素。方法 对32例2型糖尿病伴发脑梗死患者（A组）及30例单纯2型糖尿病患者（B组）分别询问生活习惯、病史，检测血脂、血糖、体质量、身高，超声检测颈总动脉内-中膜厚度（CCA—IMT）、斑块的发生率等，并进行相关性分析。结果 A、B两组间患者在年龄、吸烟史、糖尿病病程、以及高密度脂蛋病白、空腹血糖水平比较差异有显著性（均P〈0．05）；体质量指数、血总胆固醇、纤维蛋白原、糖化血红蛋水平的比较差异具有极显著性（均P〈0.01）；CCA—IMT及斑块发生率的比较差异也具有显著性（P〈0．05～0．01）；CCA—IMT与年龄、糖尿病病程、血纤维蛋白原、空腹血糖、糖化血红蛋白水平明显正相关（r分别为0．58、0.37、0．45、0.39、0．48，均P〈0．01），与血高密度脂蛋白水平呈负相关（r=-0．41，P〈0．05）。结论 观察空腹血糖、糖化血红蛋白、高密度脂蛋白、纤维蛋白原，监测CCA—IMT及斑块情况，适时干预，对2型糖尿病患者预防脑梗死并发症是有价值的。     

颈动脉超声对冠状动脉狭窄患者缺血性脑血管疾病的评价及其与传统危险因素的关系

目的探讨颈动脉超声对预测冠状动脉狭窄患者颅内动脉狭窄的价值,以及颈动脉超声相对于其它动脉粥样硬化主要危险因素预测缺血性心脑血管疾病的优越性。方法对209例经血管造影证实冠状动脉狭窄(≥70%)的患者采用彩色多谱勒血流成像(CDFI)和经颅多普勒超声(TCD)分别检查颈动脉和颅内动脉,并将患者分为颈动脉狭窄组与非狭窄组;脑动脉狭窄组与非狭窄组,分别比较狭窄组与非狭窄组之间的危险因素及生化指标,进一步对冠状动脉狭窄合并颅内动脉狭窄的主要危险因素与颈动脉超声结果中具有显著性统计学意义的指标,分析二者之间的相关性。结果颈动脉超声对缺血性心脑血管疾病的预测价值较传统的危险因素更高。结论高血压病、颈动脉球部内膜增厚、多发斑块及不均质回声斑块对冠状动脉狭窄患者颅内动脉狭窄有明显的促进作用。采用CDFI对确诊冠状动脉狭窄患者进行检测,对心脑血管事件高危人群进行筛选、评价治疗疗效和预后具有重要意义。     

星状神经节阻滞治疗2型糖尿病周围性面神经麻痹的观察

目的观察星状神经节阻滞疗法治疗2型糖尿病合并周围性面神经麻痹的效果。方法采用患侧星状神经节阻滞疗法治疗周围性面神经麻痹患者17例,观察其疗效并与20例常规治疗者比较。结果星状神经节阻滞组痊愈率高于对照组(P<0.05)。结论星状神经节阻滞可有效治疗2型糖尿病合并周围性面神经麻痹。     

Vasomotor reactivity as a predictor for syncope in patients with orthostatism

Gur AY, Auriel E, Korczyn AD, Gadoth A, Shopin L, Giladi N, Bornstein NM, Gurevich T. Vasomotor reactivity as a predictor for syncope in patients with orthostatism.
Acta Neurol Scand: 2012: 126: 32–36.
© 2011 John Wiley & Sons A/S. Objectives – Syncope in patients with orthostatic hypotension (OH) may be the result of impaired cerebral autoregulation. Cerebral autoregulation status can be determined by assessing cerebral vasomotor reactivity (VMR). We assessed and compared VMR in patients with OH with and without syncope. Material and methods – Twenty‐nine patients with OH underwent transcranial Doppler (TCD) and the Diamox test (1 g acetazolamide IV) for assessing VMR during elaboration of their OH syndrome. The percent difference between cerebral blood flow velocities (BFV) in the middle cerebral (MCA) and vertebral (VA) arteries before and after acetazolamide was defined as VMR%. We considered increases of BFV of ≥40% as being indicative of good VMR and classified our study patients as having good or impaired VMRs accordingly. Results – Mean VMR% values of the MCA and VA in patients with OH with syncope (n = 12) were significantly lower as compared with patients with OH without syncope (n = 17): 25.2 ± 20.5% and 42.5 ± 18.6%; 20.9 ± 15.5% and 40.8 ± 28.5%, respectively (P < 0.05). Conclusions – Among patients with OH, we found an association between the presence of syncope and impaired VMR. Assessment of VMR among patients with OH may predict those who are at higher risk to faint and fall and to support more aggressive intervention.     

Cerebral vasoreactivity in hypocapnia and hypercapnia in patients with diabetes mellitus type 2 with or without arterial hypertension

Background and purposeDiabetes mellitus (DM) is an independent risk factor for cardiovascular diseases. The origin of diabetic microangiopathy is multifactorial; it affects all layers of the artery wall, causing endothelial and vasoreactivity impairment. The incidence of cerebral vasoreactivity failure in diabetic patients without stroke history is not precisely determined yet. The aim of the study was to assess the cerebrovascular reactivity in hypocapnia and hypercapnia in patients with type 2 DM with or without arterial hypertension without artery stenosis and stroke history, with the use of transcranial Doppler examination.Material and methodsThe mean blood flow velocity, pulsatility index and parameters of cerebrovascular reactivity were measured in 53 patients with type 2 DM (aged 42–72 years, mean 59.5 ± 7.9) and in 27 healthy volunteers (aged 36–74 years, mean 57.0 ± 10.4). Diabetics were further divided into two subgroups according to the presence or absence of arterial hypertension.ResultsThe index of cerebrovascular reactivity in hypocapnia and hypercapnia was significantly worse and time needed to normalization of blood flow velocity was significantly longer in patients with DM in comparison with healthy volunteers.ConclusionsMost DM type 2 patients without stroke history had decreased values of cerebral vasoreactivity parameters, which suggests the presence of microangiopathy.     

Long‐term follow‐up of patients with asymptomatic occlusion of the internal carotid artery with good and impaired cerebral vasomotor reactivity

Background: Cerebral hemodynamic status might be prognostic for either the symptomatic or asymptomatic course of carotid occlusive disease. It is determined by evaluating cerebral vasomotor reactivity (VMR). We assessed VMR in asymptomatic patients with total occlusion of the internal carotid artery (ICA) and followed them to evaluate the role of impaired VMR in predicting ischaemic stroke (IS). Methods: Thirty‐five patients (21 men, mean age ± SD 68 ± 7.5 years) with unilateral asymptomatic ICA occlusion were studied by transcranial Doppler and the Diamox test (intravenous 1.0 g acetazolamide) and followed for 48 months or until reaching the end‐points of IS, transient ischaemic attack, or vascular death. VMR% was evaluated by recording the percent differences in peak systolic blood flow velocities in each middle cerebral artery at baseline and after Diamox administration. Results: Based on VMR% calculations, 14 (40%) patients had good VMRs and 21 (60%) had impaired VMRs. The global annual risk of ipsilateral ischaemic events was 5.7%. The annual ipsilateral ischaemic event risk was 1.8% in patients with good VMRs, whilst it was 7.1% in patients with impaired VMRs. An impaired VMR was significantly correlated with ipsilateral IS (Kaplan–Meier log rank statistic, P = 0.04). Conclusions: Our results support the value of VMR assessment for identifying asymptomatic patients with carotid occlusion who belong to a high‐risk subgroup for IS. New trials using extracranial‐to‐intracranial bypass surgery in patients with asymptomatic ICA occlusion and impaired VMRs are warranted.     

高同型半胱氨酸血症与2型糖尿病脑梗死的关系及其影响因素的研究

目的　研究高同型半胱氨酸血症(HHcy)与2型糖尿病脑梗死之间的关系及其影响因素。方法　应用高效液相色谱分析方法测定2型糖尿病脑梗死组(DS组)、2型糖尿病无并发症组(DNC组)患者和正常对照组血Hcy浓度,放免方法测定各组的叶酸、维生素B12水平。结果　DS组、DNC组的Hcy水平和HHcy的发生率均显著高于正常对照组(均P<0 .05);DS组的Hcy水平及HHcy发生率显著高于DNC组(均P<0. 05)。单因素相关分析显示2型糖尿病患者血中Hcy水平与体质量指数、尿素氮、肌酐(Cr)、糖化血红蛋白(HbAlc)、Cr清除率呈正相关(r=0 .455、0. 36、0. 48、0. 4,P<0 .05 ~0 .01),与叶酸、维生素B12水平呈负相关(r=-0. 21、-0 .34,均P<0 .05);多元逐步回归分析示维生素B12、HbAlc、Cr清除率和叶酸是影响Hcy水平的因素。结论　HHcy是2型糖尿病脑梗死的一个危险因素。2型糖尿病患者Hcy水平受维生素B12、叶酸、肾功能以及代谢紊乱程度的影响。     

2型糖尿病合并急性腔隙性脑梗死患者颅内动脉搏动指数的临床意义

目的 探讨2型糖尿病合并急性腔隙性脑梗死患者的颅内动脉搏动指数(PI)的临床意义.方法 应用经颅多普勒(TCD)分别检测48例2型糖尿病合并急性腔隙性脑梗死者(DM-L组)、65例2型糖尿病无脑梗死患者(DM-N组)及59例健康对照者(正常对照组)的大脑中动脉(MCA),记录其血流速度及PI.对检查结果进行比较.结果 排除颞窗探测失败和平均流速明显增高并提示有显著大动脉狭窄的患者18例,其中DM-L组7例、DM-N组5例、正常对照组6例.DM-L组和DM-N组双侧PI均显著高于正常对照组(均P ＜0.001).DM-L组双侧PI显著高于DM-N组(均P＜0.05).结论 颅内动脉PI增高可以反映2型糖尿病患者微血管病变程度.PI可以作为2型糖尿病并发急性腔隙性脑梗死的预测指标.     

伴有抑郁的2型糖尿病患者生活质量及家庭功能

目的:探讨伴有抑郁的2型糖尿病患者生活质量及家庭功能特征。方法:采用生活质量量表(QLESQ)、家庭功能量表(FAD)以及贝克抑郁量表(BDI)对50例2型糖尿病患者(糖尿病组)及50名正常人(正常对照组)进行调查。结果:38%(19/50例)的2型糖尿病患者伴有抑郁。糖尿病组FAD评分中情感卷入及行为控制维度在不健康家庭功能范围内;QLESQ总分(32.49±5.86)分明显低于正常对照组(37.76±5.38)分(P<0.01)。糖尿病组FAD的问题解决、角色和情感卷入维度与抑郁症状呈正相关(r分别=0.426、0.339、0.454,P<0.05或P<0.01);QLESQ总分与家庭功能的角色和行为控制维度呈负相关(r分别=-0.292、-0.344,P<0.01)。结论:伴发抑郁的2型糖尿病患者生活质量差且家庭功能有缺陷。     

2型糖尿病患者视觉诱发电位改变及其相关因素分析

目的探讨2型糖尿病患者视觉诱发电位(pattern visual evoked potential,P-VEP)改变的特点及其与各临床因素之间的关系。方法对109例2型糖尿病患者及40例健康体检者进行P-VEP的检测,病例组按病程分为病程<5年组、5年≤病程<10年组、病程≥10年组。回顾性分析各组生化指标、肌电图等临床资料与P-VEP改变的相关性。应用SPSS统计软件进行统计学处理。结果病例组P-VEP总异常率为27.52%,病程<5年组P-VEP异常8例(20.00%),5年≤病程<10年组P-VEP异常8例(25.81%),病程≥10年组P-VEP异常14例(36.84%),各组间其异常率比较差异无统计学意义(P>0.05)。P100潜伏期的改变:病程≥10年组的P100潜伏期较对照组明显延长(P<0.05),病程<5年组、5年≤病程<10年组的P100潜伏期较对照组无明显变化(P>0.05)。P100枕中波幅改变:5年≤病程<10年组,病程≥10年组的枕中波幅较对照组明显降低(P<0.05),病程<5年组的枕中波幅较对照组无明显变化(P>0.05)。周围神经病变严重组(病变神经数>4条)的枕中波幅较周围神经病变较轻组(病变神经数≤4条)明显降低(P<0.05)。非条件Logistic逐步回归分析显示病程和糖化血红蛋白是2型糖尿病患者视力损害的相关因素。结论 P-VEP是早期发现2型糖尿病患者视神经病变的无创检测手段。病程和糖化血红蛋白是2型糖尿病患者视神经病变的相关因素。     

Clinical determinants of carotid intima-media thickness in patients with diabetes mellitus type 2

Background and purposeEarly atherosclerotic changes in carotid arteries can be detected using ultrasound examination. The aim of this study was to assess correlations between intima-media thickness (IMT) and gender, age and clinical features of diabetes mellitus (DM).Material and methodsThe study group consisted of 73 patients with type 2 DM (mean age: 63.6 ± 7.5 years), and 74 controls without DM (mean age 62.2 ± 7.5 years). Analysed clinical features of diabetes included disease duration, anti-diabetic treatment, glycaemic control (HbA_1c level), presence of metabolic syndrome, and complications of macroand microangiopathy. IMT was measured using ultrasonography in the carotid arteries (common – CCA, bifurcation, internal – ICA) bilaterally.ResultsMean and maximum IMT in the CCA was greater in diabetic patients than in controls. Age and male sex, but not vascular risk factors, were independent predictors of increased IMT in all segments. Macroangiopathy correlated with IMT within both CCA in univariate analysis. After adjusting for age and gender, this relationship remained significant in the right CCA in middle-aged patients (59–67 years; p = 0.01 for mean IMT, p = 0.02 for maximum IMT). In patients without metabolic syndrome, IMT in the right CCA bifurcation correlated with HbA_1c level (p = 0.05). Patients treated simultaneously with insulin and oral antidiabetic drugs had smaller IMT in the right ICA than those treated with insulin only (0.471 ± 0.105 vs. 0.678 ± 0.209 mm; p = 0.04).ConclusionsIn diabetic patients, ultrasound IMT measurement can be used to assess the cardiovascular risk and to determine indications for intensified anti-diabetic treatment. IMT is a sensitive marker of early carotid atherosclerosis, particularly on the right side.     

TCD对小动脉病变为主的腔隙性脑梗死脑血流动力学评价

目的探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变。方法利用颈部血管彩超和MRA等排除伴有显著大血管病变的患者后,利用TCD观察115例腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等进行相关分析。同时以同年龄阶段、头颅影像学检查正常的30例健康体检者作为对照。结果腔隙性脑梗死组大脑中、前、后动脉的平均血流速度均低于对照组、脉动指数均高于对照组[分别为(1．05±0．26)、(1．01±0．24)、(1．05±0．23)和(0．87±0．12)、(0．88±0．20)、(0．88±0．16),均P＜0．05]。其中大脑中、前、后动脉的脉动指数均与年龄呈正相关(r=0．394、0．299、0．352,均P＜0．05),大脑前动脉脉动指数与收缩压和脉压差呈正相关(r=0．338、0．353,P＜0．05),大脑中动脉脉动指数与脉压差呈正相关(r=0．220,P＜0．05)。结论以小动脉为主要发病机制的腔隙性脑梗死患者脑血流动力学表现为血流速度轻度减慢,脉动指数显著升高,其中脉动指数与年龄和动脉血压有一定的关系。     

2型糖尿病患者大脑中动脉狭窄与肾素-血管紧张素系统基因多态性的关系

目的 探讨大脑中动脉(MCA)狭窄与肾素-血管紧张素系统(renin angiotensin system,RAS)基因多态性的关系。方法 对2202个汉族2型糖尿病人用经颅多普勒(transcranial Doppler,TCD)筛选,MCA狭窄者为病例组,其余为对照组,然后经年龄、性别、糖尿病病程配对后选择病例组218例,对照组489例,用PCR、PCR-RFLP检测ACE、ATIR、AGT基因型。结果 病例组和对照组的三种基因的基因型、等位基因频率分布无差异;但在AGT基因的基因型为TT时,病例组的ACE基因的ID、DD基因型比例较高(P<0.1,OR=1.40),而在ACE基因的基因型为ID、DD时,病例组的AGT基因的TT基因型比例也较高(P<0.05,OR=1.71);在ATIR基因的基因型为AA时,病例组的AGT基因的TT基因型比例较高(P<0.1,OR=1.66)。结论 RAS单个基因的多态性与MCA狭窄不相关,但RAS的几个基因之间的相互作用与MCA狭窄有关。