2型糖尿病患者颅内、颈部、下肢动脉粥样硬化性病变的超声研究

Evaluation of the atherosclerostic characteristics in intracranial arteries, carotid arteries, and lower extremity arteries by ultrasonography in patients with type 2 diabetes

目的评估2型糖尿病患者同一个体颅内动脉、颈动脉、下肢动脉病变的超声检测特征。方法收集2008年9月至2009年8月确诊为2型糖尿病的住院患者354例,应用经颅多普勒(TCD)、CDFI对颅内动脉、颈动脉、下肢动脉进行检测,分析糖尿病患者动脉内-中膜厚度、斑块的形成、管腔狭窄及闭塞的发生率、发病特征,观察单一个体不同部位发病的差异。结果糖尿病患者同一个体不同部位动脉硬化病变特点:(1)颈动脉内中膜增厚发生率、斑块发生率均高于下肢动脉,两者差异有统计学意义。但斑块形成特点一致,均以多发斑块居多,以钙化性强回声斑块为主,形态以规则型为主。(2)动脉狭窄以颅内动脉最高发,颅内动脉与颈部动脉、下肢动脉病变的发生率比较均有显著性差异,而颈部动脉与下肢动脉狭窄率比较,差异无统计学意义。(3)颅内动脉狭窄特点以多支动脉的轻度狭窄为主,前循环狭窄发生率高于后循环,并以大脑中动脉最为高发。(4)下肢动脉斑块的发生率以股总动脉最常见,而管腔狭窄、闭塞则以膝以下末梢动脉受累最为明显。结论联合应用CDFI与TCD能对2型糖尿病血管病变进行形态学评价,对预测和预防糖尿病患者脑血管、下肢血管并发症的发生有临床实际意义。

Objective To evaluate the characteristics of atherosclerosis and its occurrence profiles for intracranial arteries, carotid arteries, and lower extremity arteries in patients with type 2 diabetes mellitus by Color Doppler flow imaging（CDFI） and Transcranial Doppler （TCD ）. Methods A total of 354 patients diagnosed as type 2 diabetes from September 2008 to April 2010 were recruited into this study. Hemodynamic characteristics in intracranial arteries were examined by TCD. The morphological features and hemodynamic characteristics of carotid arteries, lower extremity arteries were examined by CDFI. Intima-media thickness （IMT）, plaque characteristics, vessel stenosis and occlusion were evaluated. The occurrences of atherosclerosis at different locations in the same subject were compared. Results The incidence of IMT increasing, plaque formation in carotid arteries was significantly higher than those in lower extremity arteries. However, the plaque characteristics at these two locations were similar, i.e. most plaques were multiple, regular shapes with calcified echoes. The incidence of vascular stenosis in the intracranial arteries was much higher than that in carotid arteries and lower extremity arteries. And there was no difference in the incidence between the latter two locations. The characteristics of intracranial arterial stenosis were multiple vessels involved and most of them were mild stenosis. The incidence of stenosis in anterior circulation was higher than that in posterior circulation. The middle cerebral artery was the most serious vulnerable vessel. Most of the plaques in lower arterial extremity was located at common femoral artery, while stenosis and occlusion were mainly observed in the distal arteries. Conclusion Combination of CDFI and TCD can evaluate atherosclerosis at different locations in patients with type 2 diabetes, which have clinic significance to predict and prevent the occurrence of vascular complications in cerebrovasculature and lower extremity.