糖尿病无症状性颅内动脉狭窄分布特征及危险因素的研究
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摘要
目的
以经颅多普勒超声(TCD)为研究手段，探讨糖尿病患者无症状颅内动脉狭窄的分布特征，并探讨其相关危险因素。
方法
收集347例糖尿病住院患者的病历资料，排除合并中风或中风史以及其他颅内疾病患者。用TCD诊断颅内动脉狭窄和评价动脉狭窄严重程度。观察无症状颅内动脉狭窄的分布特征，用SPSS10.0统计分析颅内动脉狭窄与患者年龄、糖尿病病程、血糖、血压、血脂和血尿酸之间的相关性。
结果
1、347例糖尿病患者中有颅内动脉狭窄108例，患病率为31.1％。共检查动脉2611条，狭窄动脉265条，总动脉狭窄率为10.15％。大脑中动脉(MCA)狭窄率最高，其他依次为大脑前、基底动脉等。ICA系统狭窄率明显高于椎基底动脉(VBA)系统。2．狭窄组病人年龄、病程、收缩压、血低密度脂蛋白和尿酸水平、合并高血压和心电图异常率明显高于非狭窄组；Logistic回归分析显示糖尿病病人的年龄，病程以及合并高血压是无症状颅内动脉狭窄的独立危险因素。3．颅内动脉狭窄严重程度与患者收缩压、血尿酸水平、年龄和病程呈正相关。
结论
糖尿病患者ICA系统无症状性颅内动脉狭窄较VBA系统常见，MCA发生率最高。年龄，病程以及合并高血压是无症状颅内动脉狭窄的独立危险因素。病人收缩压增高、高低密度脂蛋白、高尿酸血症和心电图异常可作为颅内动脉狭窄的预测因子。
Objective: To investigate the characteristics of distribution and risk factors of asymptomatic intracranial arterial stenosis in patients with diabetes mellitus (DM). Methods: Inpatients (347 cases) with diabetes mellitus examined with transcranial Doppler sonography (TCD) were included. Those with all kinds of stroke, stroke history, or other intracranial diseases were excluded. Intracranial arterial stenosis and the stenosis-grade were evaluated with TCD. The characteristics of distribution and the correlation of asymptomatic intracranial arterial stenosis to age, duration of disease, blood pressure, hyperlipidemia, hyperuriemia and ECG abnormities were analyzed with SPSS 10.0 software.
Results: 1. The prevalence of intracranial arterial stenosis was 31.1% (108/347); among 2611 arteries checked, 265 arteries with stenosis were detected, the rate of stenotic artery was 10.15%. The stenosis in internal carotid arterial (ICA) system was more common than that in vertebro-basilar arterial (VBA) system, the most common site of stenosis was in middle cerebral artery (MCA). 2. Age, duration of DM, concomitant hypertension, ECG abnormities, systolic pressure (SP), plasma low density lipoprotein (LDL-C) and uric acid (UA) in patients with arterial stenosis were statistically different from those in patients without stenosis; Logistic regression analysis showed that age, duration and concomitant hypertension were independent risk factors for asymptomatic intracranial arterial stenosis. 3. The grade of intracranial arterial stenosis was correlated to age, duration of DM, SP and plasma UA level.
Conclusions: The stenosis in ICA system is more common than in VBA system, the most common involved artery is MCA. Age, duration of DM and concomitant hypertension are independent risk factors for intracranial arterial stenosis in diabetics. Meanwhile, increased SP, high LDL-C level, hyperuriemia and ECG abnormities may as well function as prediction factors for intracranial artery stenosis in diabetics.
以经颅多普勒超声(TCD)为研究手段，探讨糖尿病患者无症状颅内动脉狭窄的分布特征，并探讨其相关危险因素。
方法
收集347例糖尿病住院患者的病历资料，排除合并中风或中风史以及其他颅内疾病患者。用TCD诊断颅内动脉狭窄和评价动脉狭窄严重程度。观察无症状颅内动脉狭窄的分布特征，用SPSS10.0统计分析颅内动脉狭窄与患者年龄、糖尿病病程、血糖、血压、血脂和血尿酸之间的相关性。
结果
1、347例糖尿病患者中有颅内动脉狭窄108例，患病率为31.1％。共检查动脉2611条，狭窄动脉265条，总动脉狭窄率为10.15％。大脑中动脉(MCA)狭窄率最高，其他依次为大脑前、基底动脉等。ICA系统狭窄率明显高于椎基底动脉(VBA)系统。2．狭窄组病人年龄、病程、收缩压、血低密度脂蛋白和尿酸水平、合并高血压和心电图异常率明显高于非狭窄组；Logistic回归分析显示糖尿病病人的年龄，病程以及合并高血压是无症状颅内动脉狭窄的独立危险因素。3．颅内动脉狭窄严重程度与患者收缩压、血尿酸水平、年龄和病程呈正相关。
结论
糖尿病患者ICA系统无症状性颅内动脉狭窄较VBA系统常见，MCA发生率最高。年龄，病程以及合并高血压是无症状颅内动脉狭窄的独立危险因素。病人收缩压增高、高低密度脂蛋白、高尿酸血症和心电图异常可作为颅内动脉狭窄的预测因子。
Objective: To investigate the characteristics of distribution and risk factors of asymptomatic intracranial arterial stenosis in patients with diabetes mellitus (DM). Methods: Inpatients (347 cases) with diabetes mellitus examined with transcranial Doppler sonography (TCD) were included. Those with all kinds of stroke, stroke history, or other intracranial diseases were excluded. Intracranial arterial stenosis and the stenosis-grade were evaluated with TCD. The characteristics of distribution and the correlation of asymptomatic intracranial arterial stenosis to age, duration of disease, blood pressure, hyperlipidemia, hyperuriemia and ECG abnormities were analyzed with SPSS 10.0 software.
Results: 1. The prevalence of intracranial arterial stenosis was 31.1% (108/347); among 2611 arteries checked, 265 arteries with stenosis were detected, the rate of stenotic artery was 10.15%. The stenosis in internal carotid arterial (ICA) system was more common than that in vertebro-basilar arterial (VBA) system, the most common site of stenosis was in middle cerebral artery (MCA). 2. Age, duration of DM, concomitant hypertension, ECG abnormities, systolic pressure (SP), plasma low density lipoprotein (LDL-C) and uric acid (UA) in patients with arterial stenosis were statistically different from those in patients without stenosis; Logistic regression analysis showed that age, duration and concomitant hypertension were independent risk factors for asymptomatic intracranial arterial stenosis. 3. The grade of intracranial arterial stenosis was correlated to age, duration of DM, SP and plasma UA level.
Conclusions: The stenosis in ICA system is more common than in VBA system, the most common involved artery is MCA. Age, duration of DM and concomitant hypertension are independent risk factors for intracranial arterial stenosis in diabetics. Meanwhile, increased SP, high LDL-C level, hyperuriemia and ECG abnormities may as well function as prediction factors for intracranial artery stenosis in diabetics.
引文
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10. Gorelick PB. Distribution of atherosclerotic cerebrovascular lesions. Effects of age, race, and sex. Stroke. 1993;24(12 suppl):16-19
11. Qureshi AI, Safdar K, Patel M, Janssen RS, Frankel MR. Stroke in young black patients. Risk factors, subtypes, and prognosis. Stroke. 1995;26:1995-1998.
12. Craig DR; Meguro K; Watridge C; Robertson JT; Barnett HJ; Fox AJ. Intracranial internal carotid artery stenosis. Stroke. 1982; 13(6): 825-828
13. Wechsler LR, Kistler JP, Davis KR, Kaminski MJ. The prognosis of carotid siphon stenosis. Stroke. 1986;17:714-718.
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Atherosclerotic disease of the middle cerebral artery. Stroke. 1986;17:1112-1120.
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24．汪波，高山，刘俊艳．无症状人群颅内动脉狭窄的调查．中华流行病学杂志，1998，19：344-347
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2．徐安定，陈明星．脑血管病三级预防．广东医学．2002；23(6)：564-565
3. A Statement for Healthcare Professionals From the Stroke Council of the American Heart association. Primary Prevention of Ischemic Stroke. Stroke. 2001; 32: 280.
4. Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med. 1986;315:860-865
5. Wolf PA, Kannel WB, Sorlie P, McNamara P. Asymptomatic carotid bruit and risk of stroke: the Framingham study. JAMA. 1981;245:1442-1445.
6. Bogousslavsky J, Despland PA, Regli E Asymptomatic tight stenosis of the internal carotid artery: long-term prognosis. Neurology. 1986;36:861-863.
7. Nadareishvili ZG; Rothwell PM; Beletsky V; Pagniello A; Norris JW, Long-term risk of stroke and other vascular events in patients with asymptomatic carotid artery stenosis. Arch Neurol. 2002; 59 (7): pp. 1162-6
8. Jander S, Sitzer M, Wendt A, Schroeter M; Buchkremer M; Siebler M; M(?)ller W; Sandmann W; Stoll G Expression of tissue factor in high-grade carotid artery stenosis: association with plaque destabilization. Stroke. 2001;32(4):850-854
9. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Fergnson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sacker DL, Thorpe KE, Meldrum HE, Spenee JD. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;339:1415-25
10. Gorelick PB. Distribution of atherosclerotic cerebrovascular lesions. Effects of age, race, and sex. Stroke. 1993;24(12 suppl):16-19
11. Qureshi AI, Safdar K, Patel M, Janssen RS, Frankel MR. Stroke in young black patients. Risk factors, subtypes, and prognosis. Stroke. 1995;26:1995-1998.
12. Craig DR; Meguro K; Watridge C; Robertson JT; Barnett HJ; Fox AJ. Intracranial internal carotid artery stenosis. Stroke. 1982; 13(6): 825-828
13. Wechsler LR, Kistler JP, Davis KR, Kaminski MJ. The prognosis of carotid siphon stenosis. Stroke. 1986;17:714-718.
14. Borozan PG, Schuler JJ, LaRosa MP, Ware MS, Flanigan DP. The natural history of isolated carotid siphon stenosis. J Vasc Surg. 1984;1(6):744-749.
15. Corston RN, Kendall BE, Marshall J. Prognosis in middle cerebral artery stenosis. Stroke.1984;15:237-241
16. Bogousslavsky J, Barnett HJM, Fox AJ, Hachinski VC, Taylor W. EC/IC Bypass Study Group.
Atherosclerotic disease of the middle cerebral artery. Stroke. 1986;17:1112-1120.
17. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group: Prognosis of patients with symptomatic vertebral or basilar artery stenosis.. Stroke,1998; 29(7): 1389-92
18. Wang KS, Li H, Chao YL, Ahuja A, Lam WW, Wong A, Kay R. Use of transcranial Doppler to predict outcome in patients with intracranial large-artery occlusive disease. Stroke, 2000, 31: 2641-2647
19. Kutler L, Reisler DM. An explanation for variations in distribution of stroke and arteriosclerotic heart disease among populations and racial groups. Am J Epidemiol, 1971;93:1-9
20. Feldmann E; Daneault N; Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR. Chinese-white differences in the distribution of occlusive cerebrovaseular disease. Neurology, 1990; 40(10): 1541-5
21. Suh DC, Lee SH, Kim KR, Park ST, Lim SM, Kim SJ, Choi CG, Lee HK. Pattern of atherosclerotic carotid stenosis in Korean patients with stroke: different involvement of intracranial versus extraeranial vessels. Am J Neuroradiol, 2003; 24 (2): 239-44
22. Wong KS; Huang YN; Gao S, Lam WW, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke, Neurology, 1998; 50 (3): 812-3
23. Huang NY, Gao S, Li SW, Huang Y, Li JF, Wong KS, Kay R. Vascular lesions in Chinese patients with transient ischamic attacks. Neurology, 1997, 48:524-525
24．汪波，高山，刘俊艳．无症状人群颅内动脉狭窄的调查．中华流行病学杂志，1998，19：344-347
25. Centers for Disease Control and prevention. National diabetes: fact sheet, 2000.
26．刘尊永．控制糖尿病上升趋势刻不容缓．中华预防医学杂志，1999；33(4)：198-199．
27．翁建平．2型糖尿病对社会造成的负担不容忽视．广东医学，2003：24(10)：1025-1026
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