糖尿病前期及糖尿病患者合并颅内外血管狭窄的对比研究

Comparison of incidence of extracranial and intracranial stenosis between patients complicated with pre-diabetes and diabetes

目的比较不同糖代谢异常患者颅内外动脉粥样硬化狭窄的患病率，探讨糖代谢异常相关性脑血管狭窄的早期防治方法。方法收集自2011年12月至2012年11月在广州中医药大学中山附属医院内分泌科及健康体检中心就诊的糖代谢异常患者及健康体检者635例。分为糖尿病前期组132例f包括空腹血糖异常及糖耐量异常）、糖尿病组268例及健康对照组235例。登记3组对象的相关危险因素并测定血脂、空腹血糖、餐后2h血糖、空腹胰岛素水平，进行颈部血管彩色多普勒、经颅血管彩色多普勒检查并比较3组对象颅内外血管狭窄率、单支及多支血管狭窄率以及前后循环血管狭窄率。结果健康对照组、糖尿病前期组及糖尿病组患者颅内外总的血管狭窄率分别为5．5％（13／235）、7．6％（10／132）及22．4％（60／268），差异有统计学意义（P〈0．05）；3组颅外血管狭窄、颅内血管狭窄发病率逐渐增加，差异有统计学意义（P〈0．05）；3组颅内血管狭窄率均高于颅外血管狭窄率。3组多支血管狭窄率逐渐增加，差异有统计学意义（P〈0．05）；糖尿病前期组及糖尿病组主要表现为多支血管狭窄。3组颅内血管狭窄均表现为前循环狭窄的发病率较高，且发病率逐渐增加，差异有统计学意义（P〈0．05）。结论糖代谢异常导致的脑动脉粥样硬化性狭窄可能从糖尿病前期已开始。应重视早期对血管狭窄的监测及早期治疗。

Objective To compare the incidence of intracranial and extracranial artery stenosis between patients with different degrees of dysglycemia, and investigate early curative methods of diabetes-related stenosis. Methods One hundred and thirty two consecutive pre-diabetes patients, 268 diabetes and 235 healthy controls, collected in our hospital f^om December 2011 to November 2012, were enrolled; and risk factors, including blood fat, fasting glucose, 2-h glucose and fasting insulin, were recruited and analyzed; neck vascular color Doppler and transcranial vascular color Doppler ultrasounds were performed on these patients and compared the incidences of intracranial and extracranial stenoses, single- and multi-branches, and anterior and posterior circulation vascular stenoses among three groups. Results The incidences of intracranial and extracranial stenoses in the control, pre-diabetes and diabetes groups were 5.5% （13/235）, 7.6% （10/132） and 22.4% （60/268）, respectively, with statistical differences （X2=35.738, P=0.000）; the incidences of extracranial stenosis, intracranial stenosis, and intracranial and extmcranial stenoses in control, pre-diabetes and diabetes groups increased with significant difference （P〈0.05）; the incidence of intracranial stenosis of all groups were higher than that of extracranial stenosis. The incidence of multi-branches stenosis in the dysglycemia group were higher than that in the controlgroup with statistical difference （P〈0.05）. The incidence of multi-branches stenosis was higher than that of single-branch stenosis in the dysglycemia group. The incidence of anterior circulation stenosis in control, pre-diabetes and diabetes groups increased with significant difference （P〈0.05）. Conclusions Dysglycemia related atherosclerotic stenosis maybe stemmed from early stage ofpre-diabetes, and early measurement and administration of atherosclerotic stenosis should be taken from the early stage.