糖尿病影响脑梗死的形成与颈动脉斑块相关

Diabetes mellitus contributes to cerebral infarction by promoting carotid artery plaque formation

目的 探讨糖尿病、颈动脉斑块与脑梗死形成之间的关系. 方法 选择南京大学医学院附属鼓楼医院神经内科住院的226例缺血性脑血管病患者,经头颅MRI明确有无新发脑梗死存在.根据颈动脉超声检查所示颈动脉内膜中膜厚度将其分成有或无斑块形成组,并记录其性别、年龄、生化指标及有或无高血压和糖尿病的存在.二分类法比较脑梗死、颈动脉斑块和糖尿病的阳性率,并经Logistic回归分析其相关危险度. 结果 脑梗死组较无脑梗死组有更高的斑块阳性率（84％、52％）,斑块组较无斑块组有更高的脑梗死发生率（66％、28％）; Logistic回归分析在其校正前后OR值、95％CI分别为5.019、2.694～9.354和4.459、2.061～9.647,差异均有统计学意义（P＜0.05）.斑块组较无斑块组有更高的糖尿病阳性率（38％、13％）,糖尿病组较无糖尿病组有更高的颈动脉斑块阳性率（87％、62％）; Logistic回归分析在其校正前后OR值、95％CI分别为4.010、1.854～8.672和4.272、1.565～11.662,差异均有统计学意义（P＜0.05）.脑梗死组较无脑梗死组有更高的糖尿病阳性率（38％、21％）,糖尿病组较无糖尿病组有更高的脑梗死发生率（68％、48％）; Logistic回归分析的OR值、95％CI为2.256、1.242～4.095,差异有统计学意义（P＜0.05）,在引入一般危险因素对其校正后OR值、95％CI为2.105、1.066～4.157,差异仍有统计学意义（P＜0.05）；而当在此基础上再引入颈动脉斑块进行校正后,其OR值、95％CI为1.696、0.833～3.452,差异无统计学意义（P.0.05）. 结论 糖尿病通过影响颈动脉斑块的形成而作用于脑梗死的发生.

Objective To investigate the relation between cerebral infarction and both diabetes mellitus and carotid artery plaque. Methods Two hunderd and twenty-six patients with ischemic cerebral vascular diseases were chosen in our study; MRI was employed to determine whether new infarction existed or not; carotid artery plaque positive group and negative group were divided according to the carotid artery intima-media thickness（IMT） examined by carotid ultrasound; the gender,age and biochemical markers of these patients,and their coexistence of hypertension and diabetes mellitus were recorded.The positive rates of cerebral infarction,carotid artery plaque and diabetes mellitus were noted and analyzed by binary comparison, and the level-risk relation were analyzed by logistic regression.Results The positive rate of carotid artery plaque in patients with cerebral infarction （84%） was significantly higher as compared with that in patients without cerebral infarction （52%）,and the positive rate of cerebral infarction in patients with carotid artery plaque （66%） was obviously higher as compared with that in patients without carotid artery plaque （28%）; correlation analysis between cerebral infarction and carotid artery plaque through logistic regression showed that the OR value and 95%CI were 5.019and （2.694-9.354） before adjustment,and 4.459 and （2.061-9.647） after adjustment （P〈0.05）.The positive rate of diabetes mellitus in patients with carotid artery plaque （38%） was significantly higher as compared with that in patients without carotid artery plaque （13%）,and the positive rate of carotid artery plaque in patients with diabetes mellitus （87%） was obviously higher as compared with that in patients without diabetes mellitus （62%） ; correlation analysis between diabetes mellitus and carotid artery plaque through logistic regression showed that the OR value and 95%CI were 4.010 and （1.854-8.672） before adjustment,and 4.272 and （1.565-11.662） after adjustment （P〈0.05）.The positive rate of diabetes mellitus in patients with cerebral infarction （38%） was significantly higher as compared with that in patients without cerebral infarction （21%）,and the positive rate of cerebral infarction in patients with diabetes mellitus （68%） was significantly higher as compared with that in patients without diabetes mellitus （48%,P〈0.05）; correlation analysis between diabetes mellitus and cerebral infarction through logistic regression showed that the OR value and 95% CI were 2.256 and （1.242-4.095） before adjustment,and 2.256 and （1.242-4.095） after adjustment; when the carotid artery plaque was added in procedure of adjustment （P〈0.05）,the results of OR value and 95%CI were 1.696 and （0.833-3.452）,and no significant difference in the positive rate of cerebral infarction was noted between patients with diabetes mellitus and cerebral infarction （P〉0.05）. Conclusion Diabetes mellitus contributes to cerebral infarction by promoting carotid artery plaque formation.