糖耐量异常与脑梗死患者颅内外动脉粥样硬化的相关性研究

目的探讨糖耐量异常的脑梗死患者颅内外动脉粥样硬化的程度及其相关危险因素。方法选择脑梗死患者131例,通过口服葡萄糖耐量试验（OGTT）将患者分为糖耐量正常组（NGT,n=41例）、糖耐量异常组（IGT,n=47例）、新诊断的2型糖尿病组（DM,n=43例）。测定各项生化指标,进行颈部血管彩色超声、经颅多普勒检查,记录颅内外动脉狭窄数、颈总动脉内中膜厚度（IMT）及其他指标。结果 IGT组及DM组的双侧颈动脉IMT平均值（MIMT）、阻力指数、斑块积分和内膜不连续比率、颅内外动脉狭窄率与NGT组相比差异均有统计学意义（P〈0.05）,而IGT组与DM组相比无统计学意义。Logistic回归显示,餐后2h血糖（2h-PG）（OR=1.995,P=0.004）、糖化血红蛋白（HbA1c）（OR=4.799,P=0.028）、甘油三酯（TG）（OR=7.439,P=0.012）及伴随疾病（高血压）（OR=8.639,P=0.042）均为异常IMT的独立危险因素。颅内外动脉闭塞性病变的多因素回归分析显示,2h-PG、低密度脂蛋白（LDL-C）及收缩压为其危险因素（OR值与P值分别为1.762、0.002,1.189、0.048,1.231、0.014）。结论餐后高血糖是动脉粥样硬化的独立危险因素,早在糖耐量异常阶段就已经发生了颅内和颅外大血管的动脉粥样硬化,提示糖耐量异常也是脑梗死的危险因素。

The relationship between impaired glucose tolerance and atherosclerosis of intracranial and carotid arteries in patients with cerebral infarction

Objective To investigate the degree of atherosclerosis in patients with cerebral infarction accompanied with impaired glucose tolerance（IGT）,and to explore the risk factors associated with atherosclerosis.Methods One hundred and thirty one patients who had cerebral infarction and had no conclusive medical records of diabetes mellitus（DM） ever before,received 75 g oral glucose tolerance test（OGTT） .According to the results of OGTT,patients were divided into normal glucose tolerance group（NGT,n = 41）,IGT group（n = 47）,and newly diagnosed type 2 DM group（DM,n = 43） .Some biochemical parameters were measured.Intima-media thickness（IMT） of the common carotid artery（CCA） and other indexs were measured by B type ultrasonography.The atherosclerotic stenosis are measured also.Results The differences of intima-media thickness（IMT）,resistent rate（RI）,plague score（PS） and atherosclerotic stenosis among DM group,IGT group and NGT group had statistic significance（P 〈 0.05）;but DM group and IGT group had no statistic significance（P 〉 0.05） .According to logistic regression analysis,2 h-PG（OR = 1.995,P = 0.004）,HbA1c（OR = 4.799,P = 0.028）,TG（OR = 7.439,P = 0.012） and hypertension（OR = 8.639,P = 0.042） were found to be independent risk factors of abnormal IMT,2 h-PG,LDL-C and contractive pressure were found to be independent risk factors of atherosclerotic stenosis.Conclusions Postprandial hyperglycemia is an independent risk factor of atherosclerosis,and the change of atherosclerosis might have started since early IGT stage,which shows that IGT might be the risk factor ofischemic stroke.