糖尿病患者颅颈部动脉狭窄与缺血性卒中的MRA评价

MRA Evaluation of Craniocervical Artery Stenosis in Diabetic Patients with Ischemic Stroke

目的:应用MRA评价糖尿病患者颅内外动脉狭窄与脑卒中的相关性,了解症状性糖尿病患者动脉狭窄的发生率、分布情况及狭窄程度。方法:176例无症状糖尿病患者、148例有症状糖尿病患者和144例有症状无糖尿病患者接受了头颅MRI、头颅3D TOF MRA和颈部CE MRA检查。比较各组间狭窄血管数和狭窄程度,并对卒中相关危险因素进行比较。结果:有症状糖尿病患者脑实质以腔隙性脑梗死和缺血灶多见,颅内、颅外血管狭窄的检出率最大,与其余两组比较差异有统计学意义(P<0.001)。三组之间的血管狭窄程度差异亦有统计学意义(P<0.001),以有症状的糖尿病组和无糖尿病组明显。卒中危险因素高血压、冠心病和C反应蛋白(CRP)在三组间的差异有统计学意义。结论:症状性糖尿病患者颅内外动脉狭窄的高发病率和病变的严重程度表明糖尿病是脑血管病变的危险因素,为预防脑卒中的发生,有必要应用MRA来全面评估患者的颅内外动脉状态。

Purpose： To investigate the association between craniocervical artery occlusive disease and ischemic events in patients with diabetes mellitus. Further investigation was performed for determining the prevalence and localization of stenotic atherosclerotic lesions of supra - aortic arteries in diabetic patients. Methods： This study involved 468 consecutive patients with cerebral ischemia or type 2 diabetes mellitus. All of them underwent MRI, 3DTOF MRA of the head and CEMRA of the neck. The prevalence and localization of the stenotic atherosclerotic lesions of intracranial and extracranial artery were com- pared between the patients with or without diabetes mellitus as well as the degree of the artery stenosis. Risk factors of ischemic stroke were analyzed among the groups. Results： Lacunar infarcts were more frequent in symptomatic people with diabetes. The detectable rate of intra - and extracranial artery stenosis in three groups was significantly different as well as the degree of the artery stenosis, P 〈 0. 001. The percentage of patients having hypertension, coronary artery disease, dyslipidaemia was significantly different among the groups. Male patients in symptomatic groups were more than that in asymptomatic group. C - reactive protein level（CBP） showed a statistically significant difference among the groups. Conclusion： Our results confirm that there is an increased incidence of intra- and extra- artey lesions in symptomatic patients with diabetes. As an increased risk of cerebrovascular disease, it is necessary to reduce the incidence of stroke in patients with diabetes by assessing overall artey status using MRA.