经颅多普勒超声和颈动脉超声检测无脑缺血症状的2型糖尿病患者颅内外动脉粥样硬化病变

目的 分析无脑缺血症状的2型糖尿病患者颅内动脉粥样硬化性狭窄和颅外颈动脉粥样硬化病变的发生频率及分布特征,并探讨其危险因素.方法 对94例无脑缺血症状的2型糖尿病住院患者用经颅多普勒超声(TCD)和颈动脉超声判断颅内外动脉粥样硬化病变,颅内动脉只分析狭窄,颅外动脉病变包括颈动脉斑块及狭窄.分析各危险因素的影响.结果 55例(58.5%)有颅内外动脉粥样硬化病变.22例(23.4%)发现有颅内动脉狭窄,明显高于颅外颈动脉狭窄或闭塞(3/94,3.2%,χ~2=16.66,P＜0.01).大脑中动脉是颅内最常受累的动脉(狭窄率17.0%),占狭窄动脉数的58.5%.48例(51.0%)有颅外颈动脉粥样斑块或狭窄.Logistic多元回归分析显示糖尿病病程和合并高血压是颅内外动脉粥样硬化病变的独立危险因素.结论 无脑缺血症状的2型糖尿病住院患者,半数以上有颅内外动脉粥样硬化改变,且与糖尿病病程及合并高血压有关,提示对上述高危患者应常规进行超声检测.

Using transcranial Doppler ultrasonography and carotid duplex ultrasound for evaluation of intracranial and extracranial atherosclerosis in asymptomatic Chinese patients with type 2 diabetes mellitus

Objective To detect the distribution of cervicocerebral atherosclerosis and evaluate its risk factors in asymptomatic patients with type 2 diabetes mellitus (T2DM).Methods A total of 94 inpatients with T2DM but without history of cerebral ischemic stroke and transient ischemic attack were enrolled.All patients were examined with transcranial Doppler ultrasonography (TCD) and carotid duplex ultrasound to detect intracranial arterial stenosis (≥ 50%) and extracranial carotid atherosclerotic lesions.Potential risk factors for vascular disease in each patient were evaluated based on their medical records.Fasting blood glucose,glycosylated hemoglobin (HbAlc) and blood lipids level were measured upon admission to the hospital.Results Cervicocerebral atherosclerosis was found in 55 out of 94 patients (58.5%).Intracranial cerebral stenosis was found in 22 patients (23.4%).The middle cerebral artery (MCA) was affected in 16 patients (17.0%),which is the most frequently affected intracranial artery,accounting for 58.5% in all intracranial stenotic arteries.48 patients (51.0%) had extracranial carotid arterial plaques.Incidence of intracranial cerebral stenosis (22/94,23.4%) was significantly higher than extracranial carotid artery stenosis or occlusion (3/94,3.2%,χ~2 = 16.66,P <0.01＝.Multivariate logistic regression analysis showed that the duration of diabetes and concomitant hypertension were independent factors significantly associated with cervicocerebral atherosclerosis.Conclusions Intracranial and extracranial atherosclerosis are detectable in more than half of the asymptomatic T2DM patients.Duration of diabetes and concomitant hypertension are significant risk factors for developing cervicocerebral atherosclerosis.TCD and carotid ultrasonography examinations should be performed in these patients routinely.