缺血性卒中合并2型糖尿病患者的颈动脉斑块的研究

Assessment of Carotid Artery Plaques in Patients with Ischemic Stroke and Type 2 Diabetes Mellitus

目的:研究缺血性卒中合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者的颈动脉斑块的临床特点和影响因素。方法:将2013年7月—12月收治的185例缺血性卒中患者分为T2DM组(n=72)及非T2DM组(n=113),用超声检查颈动脉斑块,其中22例患者行颈动脉CT血管造影(computed tomographic arteriography,CTA)检查;分析糖、脂代谢相关指标与颈动脉斑块大小的相关性。结果:T2DM组颈动脉斑块的发生率、性质、大小及颈动脉内中膜厚度(intima-media thickness,IMT)与非T2DM组比较差异有统计学意义(P<0.05)。影响颈动脉斑块大小的主要因素为是否患T2DM、餐后2 h血糖(2 h postprandial blood glucose,2 h PBG)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、空腹血糖(fasting blood glucose,FBG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C),P<0.05。超声和CTA对22例患者颈动脉管腔的狭窄程度的检查结果差异有统计学意义(P<0.05)。结论:缺血性卒中患者颈动脉斑块的大小与是否患T2DM、2 h PBG、HOMA-IR、FBG和LDL-C相关,合并T2DM时颈动脉斑块发生率升高,易损斑块比例升高。超声检查可作为颈动脉斑块筛查的首选方法,CTA更易于显示斑块的性质及管腔的狭窄程度。

Abstract Objective：To study the clinical characteristics and risk factors of carotid artery plaques in patients with type 2 dia- betes mellitus（T2DM） and ischemic stroke. Methods： A total of 185 patients with ischemic stroke from Jul 2013 to Dec 2013 were divided into T2DM group（n = 72） and non-T2DM group（n = 113）. All the patients underwent ultrasonic examination to confirm the incidence of carotid artery plaques. And 22 patients received computed tomographic arteriography（CTA） for further diagnosis of carotid artery plaques. The relationships of glucose metabolism and lipid metabolism with the size of carotid artery plaque were analyzed. Results： The incidence rate, nature and size of carotid artery plaque, intima-media thickness（IMT） of ca- rotid artery in T2DM group were significantly different from those in non-T2DM group（P〈0.05）. The main factors affecting the sizes of carotid artery plaques were T2DM,2 h postprandial blood glucose（2 h PBG）,homeostatic model assessment for in- sulin resistance（HOMA-IR）, fasting blood glucose（FBG）, low density lipoprotein-eholesterol（LDL-C）, P〈0.05. There was significant difference in the degree of lumen stenosis detected by ultrasound and CTA in the 22 patients（P〈0.05）. Conclu- sions： The size of carotid artery plaque in patients with ischemic stroke are influenced by T2DM,2 h PBG, HOMA-IR,FBG and LDL-C. The incidences of plaques as well as vulnerable plaques increases when patients suffer with T2DM simultaneously. Ul- trasound can be applied as the preferred method for carotid artery plaque screening. CTA manifests as a more promising manner to demonstrate the characteristics of the plaques and the severity of lumen stenosis.