腔隙性脑梗死合并视网膜病变与糖脂代谢异常的临床意义

Clinical significance of abnormality of glucose and lipid metabolism to lacunar infarct with retinopathy

目的回顾分析并探讨腔隙性脑梗死(LI)合并视网膜病变(RP)的发生与发病因素尤其是糖脂代谢异常之间的临床意义。方法 265例符合中国急性缺血性脑卒中诊治指南2010版标准和Toast分型条件,经神经影像学确诊的急性LI住院患者入组,男性187例,女性78例,平均年龄(65.10±14.93)岁。患者伴有高血压、糖尿病、冠心病的比例分别为89.40%、42.38%和19.20%,均接受眼底照相、颈动脉超声、血压、血糖、胆固醇三项、同型半胱氨酸测定等检查。统计采用SPSS18.0软件完成。结果 LI患者中合并RP发生率为22.64%。LI患者合并RP组或非合并组的梗死灶数没有显著性差别,但血糖水平的高低和颈动脉斑块面积的大小对合并RP的发生有明显的影响(P=0.005,P=0.029)。并且二者的风险水平远高于其他指标,分别达到OR 6.61(95%CI 3.43~12.72)和OR 4.11(95%CI 1.72~9.82)。其他风险较高指标还有颈动脉狭窄[OR 1.96(95%CI 1.27~4.46)]、年龄[OR 1.61(95%CI 0.99~2.91)]、平均动脉压[OR 1.30(95%CI 0.57~2.96)]和颈动脉中膜增厚[OR 1.27(95%CI 0.55~2.95)]。结论糖尿病和颈动脉斑块大小均是LI和RP的共同高风险因素,而且对RP形成影响度更大。有必要把眼底检查列为常规,对眼底观察所见结合颈动脉斑块和血糖水平进行风险分级管理,将有利于有效防控脑血管事件的发生。

Objective To investigate the clinical significance of abnormality of glucose and lipid metabolism to lacunar infarct with retinopathy. Methods 265 hospitalized patients with lacunar infarct(LI), who met with the classifications of Chinese Guides for Acute Ischemic Stroke and TOAST, and who were 187 males, 46 females, mean age(65.10±14.93) years, had been retrospectively analyzed. All patients were examined with CT/MRI, fundoscopy, color vascular ultrasonograph, laboratory tests, respectively. Those enrolled patients also accompanied with hypertension(89.40%), type 2 diabetes mellitus(42.38%), and coronary vascular disease(19.20%). All data were dealt statistically via SPSS 18.0 software package. Results The incidence of LI with retinopathy(RP) was 22.64%, and there were remarkably significant differences of blood glucose and carotid plaque area between the group LI with RP and group LI without RP(P=0.005, P=0.029). The data showed there was, however, no significant difference to LI focus numbers between two groups. The data also showed some indices like age, MBP, carotid stenosis, IMT, high blood glucose and carotid plaque area in particular, had independently high risk. The odds ratio values were 1.61(95% CI 0.99-2.91), 1.30(95% CI 0.57-2.96), 1.96(95% CI 1.27-4.46), 1.27(95% CI 0.55-2.95), 6.61(95% CI 3.43-12.72) and 4.11(95% CI 1.72-9.82) respectively. Conclusions The study indicates that diabetes and carotid plaque size are common higher risk factors to LI and RP, and impact on RP more obviously. Therefore routine fundoscopy with carotid and glucose check is a necessary way to monitor and prevent the onset of cerebral vascular events.