缺血性卒中并发2型糖尿病患者颈动脉斑块内新生血管分布特点的超声造影研究

The Distribution Characteristics of Neovascularization in Carotid Plaques in Type 2 DM Patients Complicated with Ischemic Stroke by CEUS

目的应用超声造影观察缺血性卒中并发2型糖尿病患者颈动脉斑块内新生血管分布情况,明确其斑块内新生血管分布特征。方法病例组选取因急性缺血性卒中住院的糖尿病患者40例(入组前未服用降糖药),卒中同侧颈动脉斑块形成;对照组为同期门诊就诊的颈动脉斑块形成患者,无卒中病史,性别及年龄匹配的非糖尿病患者32例。两组患者行弓上计算机断层扫描血管造影(computed tomography angiography,CTA)检查排除主动脉弓斑块及颅内动脉病变,排除卵圆孔未闭及心房颤动等。对所有患者均行常规超声及超声造影检查。常规超声观察斑块厚度及内部回声,超声造影观察斑块增强情况,横切面多角度观察,将超声造影结果分为近内膜处有增强(代表新生血管)及近内膜处无增强两种。结果两组患者颈动脉斑块厚度及回声情况差异无统计学意义。超声造影结果显示病例组颈动脉斑块近内膜处增强者34例(85%),对照组近内膜处增强12例(37.5%),差异有统计学意义(χ~2=17.38,P<0.01)。结论未服用降糖药的2型糖尿病并发急性缺血性卒中的患者颈动脉粥样硬化斑块内近内膜处新生血管增生多于无糖尿病患者,提示血糖升高与颈动脉斑块内血管新生有关。

Objective To determine the distribution characteristics of neovascularization in carotid plaques in type 2 DM patients complicated with acute ischemic stroke（AIS） by contrast-enhanced ultrasound（CEUS）.Methods The case group included 40 hospitalized AIS patients diagnosed with type 2 diabetes in our hospital（not taking hypoglycemic drugs）, with ipsilateral carotid plaque formation. The control group consisted of 32 sex-age-matched patients without DM and stroke history and with carotid plaque, selected from the outpatients in the same period. The patients diagnosed with aortic arch plaque and intracranial arterial lesions by CTA and those with patent foramen ovale（PFO） and atrial fibrillation（AF） were all excluded from this study. All patients were examined by conventional ultrasound（US） and CEUS, with plaque surface morphology, size and plaque echo observed by conventional US, and neovascularization in plaque by CEUS. The CEUS imaging results were divided into two groups： echo enhancement（neovascularization） and no echo enhancement near the intima in plaques.Results The thickness and echo of carotid plaques between two groups had no statistical difference. The results of CEUS showed that echo enhancement near the intima in carotid plaques were found in 34 cases（85%） in case group and 12 cases（37.5%） in control group. There was statistically significant difference between two groups（χ~2=17.38, P0.01）.Conclusion Neovascularization near the intima in carotid atherosclerotic plaques in type 2 DM patients with AIS and without taking antihyperglycemic drugs was more than that in nondiabetic patients, which indicates neovascularization in carotid plaque is related to hyperglycemia.