糖尿病肾病患者脑血管病变特点及危险因素分析

目的观察糖尿病肾病患者脑血管特点及其危险因素。方法将135例2型糖尿病患者，根据尿蛋白水平分为正常蛋白尿组（DM）、微量蛋白尿组（DN—Ⅲ）、大量蛋白尿组（DN～Ⅳ）、肾衰竭组（DN—Ⅴ）四组。用经颅多普勒超声检测各组患者颈内动脉及椎基底动脉系统的搏动指数（PI）、平均血流速度（Vm）。结果DN-Ⅴ组左右大脑中动脉、大脑后动脉及基底动脉的反映血管弹性的搏动指数高于其余各组（P〈0．05）。随着肾病进展，大脑后动脉平均血流速度明显下降（P〈0．05）。多元逐步回归分析显示年龄、血肌酐、收缩压、糖尿病病程是PI值的独立危险因素（P〈0．05）。年龄、尿蛋白是Vm的独立危险因素（P〈0．05）。结论随着糖尿病肾病进展，尿蛋白的增加，糖尿病患者脑血管弹性减弱，脑血流速度减慢。年龄、血肌酐、收缩压、糖尿病病程、尿蛋白是糖尿病肾病患者脑血管异常的独立危险因素。

Characteristics and Risk Factors of Cerebrovascular Disease in Patients with Diabetic Kidney Disease

Objective To observe the characteristics of cerebrovascular and its risk factors in patients with diabetic nephropathy. Methods 135 of type 2 diabetes patients were divided into four groups according to urine protein： normal albuminuria group （DIM）, microalbuminufia group （DN-Ⅲ）, macroalbuminufia group （DN-Ⅳ）, renal failure group （DN-Ⅴ）. The pulsatility index （PI） and mean flow velocity （Vm） of carotid artery and the vertebrobasilar artery were detected by transcranial Doppler ultrasound in each groups. Results PI values of middle cerebral artery, posterior cerebral artery and basilar artery in DN-V group were higher than those in other groups （P〈0.05）. With the progress of kidney disease, the mean flow velocity （Vm） of cerebral artery was significantly decreased （P〈0.05）. Multiple stepwise regression analysis showed that age, serum ereatinine, systolic blood pressure and duration of diabetes were independent risk factors for PI values （P〈0.05）. Age and urinary protein （UTP） were independent risk factors for Vm, （P〈0.05）. Conclusion With the progress of diabetic nephropalhy and increase of urinary protein, cerebral vascular elasticity reduced and cerebral blood flow slowed in diabetes. Age, serum creatinine, systolic blood pressure, diabetes duration and urinary protein were independent risk factors for cerebral vascular abnormalities in patients with diabetic nephropathy.