经颅多普勒检测糖尿病大血管和微血管病变的应用价值

The application of transcranial Doppler in detecting diabetic cerebral macroangiopathy and microangiopathy

目的 探讨经颅多普勒 (TCD)在 2型糖尿病患者脑部大血管、微血管病变中的临床应用价值。方法 用TCD比较糖尿病组与正常对照组、糖尿病组中糖尿病微血管并发症组与糖尿病无并发症组间检测动脉的脉动指数 (PI)、平均血流速度值 (Vm)。结果 糖尿病患者各检测动脉的PI值及颈内动脉颅外起始段 (ICA)、大脑中动脉 (MCA)、基底动脉的Vm值明显高于对照组 (P <0 0 0 1) ,微血管并发症组ICA、MCA的PI值显著高于无并发症组 (P <0 0 0 1)。结论 PI、Vm对糖尿病脑部大血管病变有良好的敏感性 ;ICA、MCA的PI值异常增高可作为糖尿病脑部微血管病变的一项指标。

Objective To evaluate the application of transcranial Doppler (TCD) in the detection of cerebral hemodynamic changes in diabetic macroangiopathy and microangiopathy. Methods 81 of diabetic patients and 62 age ,gender matched healthy controls were monitored with TCD in this study. The pulsatility index (PI) and mean flow velocities (Vm) between the patients and healthy controls, between the patients with microangiopathic complications and patients without complication, were analyzed respectively. Results The PIs of arteries and Vms of the extracranial internal carotid artery (ICA), middle cerebral artery(MCA) and basilar artery (BA) were significantly higher in diabetic patients than those in healthy controls ( P <0 001), while PIs of ICA and MCA but not BA were significantly increased in patients with complications than those in noncomplicaed patients( P <0 001). Conclusions It indicated that PI and Vm might be two useful markers for the detection of diabetic cerebrovascular changes. Marked increase of PIs of ICA and MCA might reflect the microangiopathic changes of cerebral vessels in diabetic patients.