孤立性脑桥梗死合并2型糖尿病的临床及影像学分析

Clinical and imaging study of isolated pontine infarction complicated with type 2 diabetes mellitus

目的 研究急性孤立性脑桥梗死(IPI)合并2型糖尿病患者的临床资料及影像学特点。方法 回顾性研究2020年1月~2021年12月在苏州市立医院神经内科住院的IPI患者108例,将其分为糖尿病组45例和非糖尿病组63例,对2组患者的一般临床资料、血液生化数据、影像学特征进行比较。以发病3个月后结局不良为因变量,对相关资料进行多因素logistic回归分析。结果 糖尿病组入院美国国立卫生研究院卒中量表(NIHSS)评分、脑动脉狭窄、改良Rankin量表评分≥3分的比例显著高于非糖尿病组[4.0(1.5,5.5)分vs 3.0(1.0,5.0)分,P=0.028;57.8%vs 34.9%,P=0.030;37.8%vs 11.1%,P=0.002];糖尿病组以脑桥下部梗死比例最高(48.9%),非糖尿病组以脑桥中部梗死多见(49.2%),2组比较差异有统计学意义(P<0.05);糖尿病组为基底动脉分支动脉疾病最多,非糖尿病组主要为小动脉疾病多见。多因素logistic回归分析显示,糖尿病(OR=6.685,95%CI:1.351~33.102,P=0.020)、入院NIHSS评分(OR=1.381,95%CI:1.137~1.720,P=0.002)、脑动脉狭窄(OR=10.001,95%CI:3.118~32.032,P=0.001)为短期结局不良的危险因素。结论 糖尿病可能为IPI结局不良的危险因素,伴与不伴糖尿病的IPI患者病灶位置分布及病变责任血管分型上存在区别。

Objective To study the clinical data and imaging features of patients with acute isolated pontine infarction(IPI) complicated with type 2 diabetes mellitus.Methods A total of 108 IPI patients hospitalized in our department from January 2020 to December 2021 were retrospectively studied.They were divided into diabetic group(n=45) and non-diabetic group(n=63).The general clinical data, blood biochemical data and imaging features were compared between the 2 groups.The adverse outcomes in 3 months after onset were taken as the dependent variable, and multivariate logistic regression analysis was performed on the relevant data.Results The score of National Institutes of Health Stroke Scale(NIHSS),score of cerebral artery stenosis and proportion of modified Rankin Scale score≥3 were significantly higher in the diabetic group than the non-diabetic group [4.0(1.5,5.5) vs 3.0(1.0,5.0),P=0.028;57.8% vs 34.9%,P=0.030;37.8% vs 11.1%,P=0.002].In the diabetic group, the lower pons was mainly involved(48.9%),while in the non-diabetic group, the middle pons was mainly involved(49.2%).Statistically difference was seen between the 2 groups(P<0.05).The main responsible vessel type of IPI was basilar artery disease in the diabetic group, and was small artery disease in the non-diabetic group.Multivariate logistic regression analysis showed that diabetes mellitus(OR=6.685,95%CI:1.351-33.102,P=0.020),NIHSS score at admission(OR=1.381,95%CI:1.137-1.720,P=0.002) and cerebral artery stenosis(OR=10.001,95%CI:3.118-32.032,P=0.001) were the risk factors for adverse short-term outcomes.Conclusion Diabetes may be a risk factor for poor IPI outcome.There are differences in the distribution of lesion location and the classification of responsible vessels in IPI patients with and without diabetes mellitus.