2型糖尿病患者脑血管血流动力学的变化及其并发脑血管疾病的相关因素分析

Analysis of the cerebral vascular hemodynamics indexes in type 2 diabetic patients and the high risk factors for cerebrovascular diseases

目的探讨2型糖尿病患者脑血管血流动力学指标(CVHI)的变化,并分析其发生脑血管疾病的高危因素。方法采用随机对照,选取本院2010年5月至2012年5月收治的90例糖尿病患者作为病例组,对照组为本院其他科室同年龄段的非糖尿病患者90例,比较两组患者的CVHI各项检测指标及总分的差异,并对合并脑血管疾病与未合并脑血管疾病的糖尿病患者进行危险因素分析。结果病例组患者的左右侧脑平均脑血流速度(Vmean)、最大血流速度(Vmax)、最小血流速度(Vmin)、脉搏波波速(WV)、特异性阻抗(Zcv)、外周阻力(RV)、动态阻力(DR)和临界压水平(CP)分别与对照组比较,差异均有统计学意义(P<0.05);病例组的CVHI总积分中位数为85分,大于75分者53例,对照组患者总积分中位数为95分,大于75分者75例,两组比较差异有统计学意义(P<0.01),而两组的CVHI总积分分布差异也有统计学意义(χ2=14.148,P=0.003);合并脑血管病与未合并脑血管病的糖尿病患者的病程、吸烟史、高血压、空腹血糖水平(FPG)浓度、糖化血红蛋白(HbA1C)及肌酐(Cr)浓度差异均有统计学意义(P<0.05),而糖尿病病程和FPG浓度是2型糖尿病患者合并脑血管疾病的独立危险因素[OR=1.13,P=0.025,95%CI(0.281,4.102);OR=0.809,P=0.006,95%CI(0.142,1.072)]。结论脑血管血液动力学指标能够反映出2型糖尿病患者可能存在的脑血管病变和功能异常,可以作为糖尿病患者防治脑血管疾病的观察指标,而控制病程和FPG浓度可能是降低糖尿病患者患脑血管病的有效途径。

Objective To investigate the changes of the cerebral vascular hemodynamics indexes （CVHI） in type 2 diabetes patients and the high risk factors for cerebrovascular disease. Methods Ninety diabetic patients were randomly selected in the hospital from May 2010 to May 2012, and 90 cases of non-diabetic patients with the same age from other departments in the same period were enrolled as the control group. The CVHI and the total score in the two groups were compared, and the high risk factors of cerebrovascular disease were analyzed. Results There were statistically significant differences in brain mean cerebral blood flow velocity （Vmean）, the maximum flow velocity （Vmax）, the minimum flow velocity （Vmin）, pulse wave velocity （WV）, specific impedance （Zcv）, peripheral resistance （RV）, dynamic resistance （DR） and the critical pressure level （CP） between the two groups （P〈0.05）. There were statis-tically significant differences in the median score and the amount of patients with more than 75 points between the CVHI group and the control group （85 points vs 95 points, 53 cases vs 75 cases, P〈0.01）. Meanwhile, there was also a statistically significant difference in the CVHI total score distribution between the two groups （χ2=14.148, P=0.003）. There were statistically significant differences in duration of diabetes, smoking, high blood pressure, fasting blood glu-cose levels （FPG）, the existence of concentration, glycosylated hemoglobin （HbA1C） and creatinine （Cr） between type 2 diabetes without cerebrovascular disease and type 2 diabetes combined with cerebrovascular disease （P〈0.05）, while duration of diabetes and FPG concentration were disease independent risk factors in type 2 diabetic patients combined with cerebrovascular disease [OR=1.13, P=0.025, 95% CI （0.281, 4.102）; OR=0.809, P=0.006, 95% CI （0.142, 1.072）]. Conclusion Cerebral vascular hemodynamic indexes can reflect the lesions and functional abnormalities which existed type 2 diabetes and could be used as an indicator to prevent cerebrovascular disease in diabetes. Control-ling the course and FPG concentrations might be an effective way to reduce the risk of cerebrovascular disease in diabe-tes patients.