糖尿病和非糖尿病缺血性脑血管病患者血管病变的分布特征

目的探讨糖尿病（DM）和非糖尿病（NDM）缺血性脑血管病患者动脉病变的分布特征。方法连续纳入121例行全脑DSA检查的缺血性脑血管病患者，按是否有2型糖尿病史分为糖尿病（57例）和非糖尿病（64例）两组。采用双盲法对颅内外动脉（2662段）管腔进行评估。狭窄率I〉30％者纳入研究。结果①121例中，82．7％（100／121）有血管狭窄，其中DM组为89．5％（51／57），NDM组为76．6％（49／64），P〉0．05。@2662段动脉中，有狭窄的占14．0％（372／2662），其中颅外段动脉为11．3％（150／1331），颅内段动脉为16．7％（222／1331），P〈0．01。@372段有狭窄的动脉中，DM组为16．0％（201／1254），NDM组为12．1％（171／1408），P〈0．01。DM组颅内段动脉狭窄阳性率高于NDM组（22．3％对11．6％），P〈0．01；颅外段动脉狭窄阳性率，两组差异无统计学意义。④NDM组颈内动脉颅外段狭窄阳性率高于DM组（27．3％对14．0％），而DM组的颈内动脉颅内段（17．5％对4．7％）、椎动脉颅内段（22．8％对12．5％）、大脑后动脉狭窄阳性率（47．4％对12．5％）高于NDM组，P〈0．05或P〈0．01。⑤2型糖尿病使颈内动脉颅外段狭窄的危险性降低（OR=0．407，95％CI：0．209～0．792）；使颈内动脉颅内段（OR=4．326，95％CI：1．671～11．199）、椎动脉颅内段（OR=2．068，95％CI：1．045～4．093）及大脑后动脉狭窄（OR=6．230，95％CI：3．262～11．897）的危险性升高。结论与NDM患者比较，2型DM患者缺血性脑动脉病变多表现为多水平、多节段的动脉病变，且更多累及颈内动脉、大脑后动脉及椎动脉的颅内段。

Distributive characteristics of vascular lesions in patients with ischemic cerebrovascular disease complecated with or not of diabetes mellitus

Abstract： Objective To investigate the distributive characteristics of vascular lesions in patients with ischemic cerebrovascular disease complecated with diabetes mellitus （DM） or not （NDM）. Methods One hundred twenty-one consecutive patients with ischemic cerebrovascular disease whom per- formed cerebral DSA were enrolled in the study. They were divided into a diabetic group （n = 57） and a non-diabetic group （ n = 64） according to whether they had a history of type 2 DM or not. The double-blind method was used to evaluate the extracranial-intracranial arteries （2662 segments）. The stenosis rate ≥ 30% was considered as stenosis. Results （1）Of the 121 patients, 82.7% （ 100/121 ） had arterial steno- sis, among them,51 patients（89.5% ） in the DM group,49 patients（76. 6% ） in the NDM group, （P 〉 0. 05 ）. （2） Of the 2662 arterial segments, the overall stenotic rate were 14.0% （372/2662）, in which the extracranial arterial segments stenosis were 11.3 % （ 150/1331 ）, and the intracranial arterial segments ste- nosis were 16.7% （222/1331） （P 〈 0.01 ）. （3）Of the 372 segments of artery stenosis, 16.0% （201/ 1254） was in the DM group and 12.1% （171/1408） was in the NDM group （P 〈0.01 ）. The positive rate of arterial stenosis in intracranial segment in the DM group was higher than that in the NDM group （22.3% vs. 11.6% , P 〈0.01 ） ; there was no significant difference in the positive rate of arterial stenosis in extracranial segments between the 2 groups. （4）The positive stenosis rate of extracranial internal carotid artery in the NDM group was higher than that in the DM group （27.3% vs. 14.0% ） , while the intracrani- al internal carotid artery （ 17.5% vs. 4.7% ） , intracranial vertebral artery （22.8% vs. 12.5% ） , and the positive rate of posterior cerebral artery stenosis （47.4% vs. 12.5% ） in the DM group were higher than those in the NDM group （ P 〈 0.05 or P 〈 0.01 ）. （5）Type 2 DM made the risk of extracranial internal carotid artery stenosis reduce （ OR =0. 407, 95% CI： 0.209 -0.792） and made the risks of the intracranial internal carotid artery （ OR =4.326, 95% CI： 1. 671 - 11. 199） , intracranial vertebral artery （ OR =2. 068, 95% CI： 1.045-4.093） and posterior cerebral artery stenosis （OR =6. 230, 95% CI： 3. 262- 11. 897） increase. Conclusion Compared with the patients with NDM, most ischemic cerebral arterial lesions in patients with type 2 DM presented as multi-level, multi-segment arterial lesions, and most of them are involved in the intracranial internal carotid artery, posterior cerebral artery and intracranial vertebral artery.