2型糖尿病无症状性颅内动脉狭窄及其相关因素

Prevalence, Distribution and Risk Factors of Asymptomatic

目的 通过病例对照研究探索2型糖尿病人群无症状性颅内动脉狭窄的分布特征及相关因素.方法 选取195例2型糖尿病住院患者,通过头颅MRA检测颅内动脉狭窄情况,比较无症状颅内动脉狭窄阳性与阴性患者之间的临床指标差异,并通过多因素回归的方法筛选其独立相关因子.结果 195例2型糖尿病患者中,无症状性颅内动脉狭窄检测阳性者35例（17.9%）,狭窄部位最多出现在大脑后动脉（29.7%）和大脑中动脉（20.3%）.Logistic回归分析结果显示糖尿病病程、高血压病、LDL-C、尿微量白蛋白/肌酐比值（ACR）与2型糖尿病无症状性颅内动脉狭窄发生独立相关,其中,ACR水平与颅内动脉狭窄数相关.结论 2型糖尿病患者可能存在较高的无症状性颅内动脉狭窄发生率,控制血压、血糖,降低LDL-C及尿微量白蛋白水平可能降低狭窄发生风险,ACR对颅内动脉狭窄程度其有一定的预测作用.

Objective The study was designed to investigate the prevalence, characteristics and factors related to asymptomatic intracranial artery stenosis in patients with type 2 diabetes mellitus. Methods We randomly selected the diabetic inpatients without history of cerebrovascular events and used magnetic resonance angiography to detect the stenosis within the cerebral arteries. The clinical data including anthropometric and biochemical measurements were recorded to compare the difference between the stenosis-positive and -negative patients. We also established a multiple-way regression model to screen the independent factors related to intracranial artery stenosis. Results One hundred and ninety five diabetic patients were en- rolled to the analysis within whom 35 （17.9%） were detected positive of intracranial arteries stenosis. The posterior and middle cerebral artery took up the most incidence of stenosis（29.7% and 20.3%, respectively）. The binary Logistic regression shown that diabetic duration, hypertension, low-dense lipoprotein and urine microalbumin/creatinine ratio （ACR） were the independent covariates that possibly determined the risk of asymptomatic intracranial artery stenosis. Besides, ACR was closely in relation with the magnitude of cranial artery stenosis. Conclusion Patients with type 2 diabetic background has higher incidence of asymptomatic intracranial artery stenosis, of which the risk can possibly be down-regulated by LDL-c and ACR lowering therapies in addition to a desirable glucose and blood pressure control. ACR is expected to be a promising predictor of the involvement of cerebral arteries.