老年糖尿病合并急性脑梗死临床影像特点

Clinical and imaging features of elderly diabetic patients with acute cerebral infarction

目的研究老年糖尿病合并急性脑梗死的临床影像特点。方法选择老年糖尿病合并急性脑梗死患者80例（老年糖尿病合并急性脑梗死组）,其中男性40例,女性40例;年龄60~88岁,平均年龄69.69岁。另选择非糖尿病的老年急性脑梗死患者80例（老年急性脑梗死组）,其中男性42例,女性38例;年龄60~90岁,平均年龄70.55岁。做实验室检查,行颈部血管超声和头部MRI,分析两组患者影像特点。结果老年糖尿病合并急性脑梗死组高血脂史比例、甘油三酯、空腹血糖、糖化血红蛋白、纤维蛋白原水平高于老年急性脑梗死组（P〈0.05）。老年糖尿病合并急性脑梗死组不稳定斑块发生率高于老年急性脑梗死组（63.75%vs 47.50%;P〈0.05）。两组患者颈动脉粥样硬化斑块大部分位于颈总动脉窦部,斑块呈强回声、混合回声或低回声。两组头部MRI病灶均以单发病灶为主,病灶空间分布差异无统计学意义（P〉0.05）。结论老年糖尿病合并急性脑梗死患者的血脂代谢异常明显,不稳定斑块增多,血脂检测及颈动脉颅外段超声对糖尿病患者预防急性脑梗死具有一定临床价值。

Objective To study the clinical image features of elderly diabetic patients with acute cerebral infarction. Methods A total of 80 elderly diabetic patients with acute cerebral infarctions were recruited as elderly diabetic with acute cerebral infarction group, included 40 males and 40 females, aged 60 - 88 years old with mean age of 69.69 years old. A total of 80 nondiabetic elderly patients with acute cerebral infarction as elderly acute cerebral infarction group, included 42 males and 38 females, aged 60 - 90 years old with mean age of 70.55 years old. The imaging features of 2 groups were analyzed by laboratory tests, cervical ultrasound and brain MRI. Results The elderly diabetic with acute cerebral infarction group showed higher proportion of hyperlipidemia history, triglyceride ,fasting glucose, glyeosylated hemoglobin, fibrinogen than those of elderly acute cerebral infraction group（P 〈 0.05）. There were more unstable plaques in elderly diabetic with acute cerebral infarction group than that of elderly acute cerebral infarction group（63.75 % vs 47.50 %; P 〈 0.05）. The carotid atherosclerotic plaques of 2 groups were mostly in carotid artery sinus, and plaques with hyperechoic, hypoechoic or mixed echo. The lesion patterns in brain MRI of 2 groups were mainly solitary lesions, there was no significant difference between 2 groups（P 〉 0.05）. Conclusion It is demonstrated that elderly diabetic patients with acute cerebral infarction showed obvious dyslipidemia and more unstable plaques, the blood lipid detection and extracranial carotid ultrasound could provide clinical value in preventing acute cerebral infarction in diabetic patients.