血糖水平、颈动脉粥样硬化与缺血性脑血管病的相关性研究

目的探讨血糖水平的波动对颈动脉粥样硬化(CAS)发生发展的作用及其与缺血性脑血管疾病(ICVD)的相互关系。方法用彩色多普勒超声诊断仪对136例2型糖尿病患者及14例正常者双侧颈动脉粥样硬化进行检测,根据颈动脉内中膜厚度(IMT)及观察颈动脉有无斑块,分T2DM伴颈动脉硬化(CAC)组96例,T2DM无颈动脉硬化(NCAC)组40例和正常对照(NC)组14例;采用动态血糖监测系统(CGMS)监测3组72 h血糖变化,计算日内平均血糖波动幅度(MAGE)和血糖波动系数(BGFC);出院后并随访12个月,观察脑梗死的复发率,A组脑梗死复发22例,B组脑梗死复发5例,C组新发1例,比较3组患者颈动脉粥样硬化的特征,同时检查头颅CT或头颅MRI证实。结果各组间年龄、性别差异及BMI比较差异无统计学意义(P>0.05);A、B组的HbA1c及颈内动脉中层内膜的厚度均高于对照组(P<0.05或P<0.01);同样A组与B组HbA1c比较均差异有统计学意义(P<0.01);A组与B组及正常对照组相比,颈内动脉硬化的发生率及内膜增加均明显增加(P<0.001)。2组DMMG、BGFC、MAGE均明显高于对照组(P<0.01),A组与B组比较,各指标差异显著(P<0.05)。同时研究还发现:BGFC、MAGE与IMT的相关性强(r=0.251,P<0.01)。A、B、C组随访12个月,A组脑梗死复发率均高于其他2组(P<0.01)。结论 2型糖尿病患者血糖波动可能促进了颈动脉硬化的发生与发展,动脉粥样硬化与脑梗死的复发密切相关,动脉粥样硬化的严重程度是脑梗死复发的危险因素,故血糖波动水平与脑梗死复发率有相关性。

Correlative study between carotid atherosclerosis and blood glucose level in ischemic cerebrovascular disease with type 2 diabetes mellitus

Objective To investigate whether carotid atherosclerosis(CAC) and the range of blood glucose excursion are association to ischemic cerebrovascular event in patients with type 2 diabetes mellitus(T2DM).Methods Total 14 controls and 136 diabetics with carotid artery color Doppler ultrasound examination were divided into A group(T2DM with CAC,n=96) and B group(T2DM without CAC,n=40),and both of them were compared with controls(C group,n=14).The fluctuating feature of 72 hours blood glucose were recorded by continuous glucose monitoring systems(CGMS) and the blood glucose fluctuant coefficient(BGFC).The duration of follow-up was 12 months,and the characteristics of carotid atherosclerosis were compared in the group of A,B and C,and were examined by computerized tomography(CT) or magnetic resonance imagine(MRI).Results There were no differences in age,gender and BMI of three groups(P>0.05).There were significant differences in HbA1c and IMT between group A compared with group B and C(P<0.05 or P<0.01).DMMG,BGFC and MAGE in type 2 diabetes mellitus were significantly higher than those of controls.BGFC and MAGE were positively correlated with IMT in A group(P<0.05).The recurrence rate was significantly higher in CAC group than that in the normal group.Conclusion There is a correlation between the blood glucose fluctuation and CAC in patients with T2DM.There is a positive correlation between carotid atherosclerosis and cerebral infarction recurrence.The severity of carotid atherosclerosis is a risk factor for cerebral infarction recurrence.