低血糖脑病和短暂性脑缺血发作的临床和影像特征分析

目的探讨低血糖脑病(HE)和短暂性脑缺血发作(TIA)的临床和影像特征。方法比较HE组(29例)和TIA组(43例)的临床症状、生化和影像学结果。结果 HE组在半球神经功能损害症状包括意识障碍(69.0%)和反应迟钝(24.1%)高于TIA组(27.9%和16.3%)。TIA组局灶神经功能缺损症状包括肢体无力(62.8%)和感觉障碍(69.7%)高于HE组(24.1%和13.8%)。HE组糖化血红蛋白、总胆固醇和低密度脂蛋白较TIA组高,差异有统计学意义(P0.05或P0.01)。HE组颈动脉内膜增厚、轻度狭窄和中度狭窄比例较TIA组高;HE组内-中膜厚度和斑块总积分较TIA组高,差异有统计学意义(P0.05)。头颅CT血管造影显示HE组较TIA组血管狭窄受累多(82.8%vs.51.2%);中度狭窄(24.1%vs.14.0%)、重度狭窄(17.2%vs.7.0%)和闭塞(13.8%vs.7.0%)比例高;累及2支血管(24.1%vs.11.6%)和3支以上血管(24.1%vs.11.6%)比例高,差异有统计学意义(P0.05或P0.01)。结论HE以半球神经功能损害为主,TIA以局灶神经功能缺损为主,HE患者代谢紊乱更严重,颅内血管狭窄受累多,中度、重度狭窄和闭塞比例高。

Clinical and imaging features of hypoglycemic encephalopathy and transient ischemic attack

Objective To investigate the clinical and imaging features of hypoglycemic encephalopathy (HE) and transient ischemic attack (TIA).Methods A total of 29 HE patients (HE group) and 43 TIA patients (TIA group) were enrolled, and the two groups were compared in terms of clinical symptoms, biochemical results, and imaging findings.Results As for the symptoms of hemispheric neurological impairment, compared with the TIA group, the HE group had a higher proportion of patients with disturbance of consciousness (69.0% vs 27.9%, P<0.01) or slow response (24.1% vs 16.3%, P<0.05). As for the symptoms of focal neurological impairment, compared with the HE group, the TIA group had a higher proportion of patients with weakness (62.8% vs 24.1%, P<0.01) or sensory disturbance (69.7% vs 13.8%, P<0.01). Compared with the TIA group, the HE group had significantly higher levels of glycosylated hemoglobin, total cholesterol, and low-density lipoprotein (P<0.05 or P<0.01). Compared with the TIA group, the HE group had a significantly higher proportion of patients with carotid intimal thickening, mild stenosis, or moderate stenosis, as well as significantly higher carotid intima-media thickness and total carotid plaque score (P<0.05). Head CT angiography showed that compared with the TIA group, the HE group had a significantly higher proportion of patients with vascular stenosis (82.8% vs 51.2%, P<0.05), as well as a significantly higher proportion of patients with moderate stenosis (24.1% vs 14.0%, P<0.05), severe stenosis (17.2% vs 7.0%, P<0.01), or occlusion (13.8% vs 7.0%, P<0.05); the HE group also had a significantly higher proportion of patients with the involvement of two blood vessels (24.1% vs 11.6%, P<0.05) or three or more vessels (24.1% vs 11.6%, P<0.05).Conclusions HE mainly manifests as hemispheric neurological impairment, while TIA mainly manifests as focal neurological impairment. Compared with TIA patients, HE patients have severer metabolic disorders, greater intracranial vascular stenosis and involvement, and a higher proportion of moderate stenosis, severe stenosis, or occlusion.