高血压对2型糖尿病患者颅内外动脉粥样硬化性病变的影响

目的采用超声技术评估高血压对2型糖尿病患者颅内外动脉粥样硬化性病变进程的影响。方法连续纳入2009年9月—2010年8月在首都医科大学宣武医院内分泌科住院的2型糖尿病合并高血压患者203例。以收缩压升高5 mmHg为观察单位,将患者分组。采用彩色多普勒血流显像（CDFI）和经颅多普勒超声（TCD）测量每组颅内外动脉血流动力学参数,据此判断血管病变的程度。分析收缩压和舒张压、年龄,高血压病程、糖尿病病程与颈总动脉内-中膜厚度（CCA-IMT）、颈动脉及颅内动脉狭窄检出率的相关性。结果①203例患者CCA-IMT为0.62～1.36 mm,平均（1.04±0.14）mm。颅内动脉狭窄检出率为52.7%,其中中度及以上狭窄的检出率为21.2%;颈动脉狭窄检出率为28.1%,其中中度及以上狭窄的检出率为14.8%。颅内动脉狭窄总检出率及中度及以上狭窄的检出率均高于颈动脉,其中狭窄总检出率差异有统计学意义（P〈0.01）,中度及以上狭窄的检出率差异无统计学意义（P〉0.05）。②多因素逐步回归分析显示,CCA-IMT与收缩压、年龄呈线性关系,收缩压每升高5mmHg,CCA-IMT将增加0.015mm;年龄每增加1岁,CCA-IMT增加0.008 mm。③颅内动脉狭窄总检出率与年龄呈线性关系,年龄每增加1岁,狭窄总检出率增加2.8%;中度及以上狭窄的检出率与收缩压呈线性相关,收缩压每升高5 mmHg,狭窄检出率增加2%。结论高血压合并2型糖尿病患者CCA-IMT随血压升高而逐渐增加。高血压促使糖尿病患者颅内动脉狭窄病程的进展较颈动脉明显。

Effect of hypertension on intracranial and extracranial atherosclerotic lesions in patients with type 2 diabetes mellitus

Objective To investigate the effect of hypertension on the process of carotid atherosclerode lesions in patients with type 2 diabetes mellitus using ultrasound techniques. Methods A total of 203 consecutive type 2 diabetic patients with hypertension were enrolled into the study. The patients were grouped according to the increased systolic blood pressure for 5 mm Hg as an observation unit. The homody- namie parameters of intracranial and extracranial arteries in each group were measured by using color Doppler flow imaging （CDFI） and transcranial Doppler ultrasound （TCD） to identify the extent of vascular lesions. The correlations of systolic and diastolic blood pressure, age, hypertension, duration of diabetes with the detection rate of common carotid intimal medial thickness （CCA-IMT） , carotid and intracranial arterial stenosis were analyzed. Results ①The CCA-IMT in 203 patients was 0.62 - 1.36 mm （ mean 1.04 ±0.14 mm）. The detection rate of intracranial arterial stenosis was 52.7% , in which the detection rate of stenosis rate ≥ 50% was 21. 2% ; the detection rate of extracranial carotid artery stenosis was 28. 1%, in which the detection rate of stenosis rate ≥50% was 14.8%. The total detection rate of intracranial arterial stenosis and the detection rate of stenosis rate ≥ 50% were higher than extracranial ca-rotid artery, in which there were significant differences in total detection rate of stenosis （P 〈 0.01 ） , and there were no significant differences in the detection rate of stenosis rate i〉 50% （ P 〉 0.05 ）. ②Multiple stepwise regression analysis showed that there was a linear relationship between the CCA-IMT and systolic blood pressure and age. For each increase of 5 mm Hg in systolic blood pressure, the CCA-IMT would increase 0. 015 mm; for each increase of 1 year of age, the CCA-IMT would increase 0. 008 mm. ③The total detection rate of intracranial artery stenosis showed a linear relationship with age. For each increase of 1 year of age, the total detection rate of stenosis increased 2.8%; the detection rate of ≥50% stenosis showed a linear relationship with systolic blood pressure. For each increase of 5 mm Hg in systolic blood pressure, the detection rate of stenosis increased 2%. Conclusion the CCA-IMT increases with the increased blood pressure in hypertensive patients with type 2 diabetes. The progression of intracranial arterial stenosis in patients with diabetes mellitus promoted by hypertension is more apparent than carotid artery.