2型糖尿病对急性脑梗死患者软脑膜侧支循环的影响  

Effect of type 2 diabetes mellitus on leptomeningeal collateral circulation in patients with acute cerebral infarction

作　　者：陈建军[1] 陈巧琼 梅志忠[1] 黄晓芸[1] 余映丽[1] 林菡[1] 黄益洪[1] 廖旺[3] Chen Jianjun;Chen Qiaoqiong;Mei Zhizhong;Huang Xiaoyun;Yu Yingli;Lin Han;Huang Yihong;Liao Wang(Department of Neurology,Houjie Hospital,Dongguan 523945,China;Department of Endocrinology,Binhaiwan Hospital,Dongguan 523905,China;Department of Neurology,Second Hospital,Guangzhou Medical University,Guangzhou 510250,China)

机构地区：[1]东莞市厚街医院神经科,东莞523945 [2]东莞市滨海湾中心医院内分泌科,东莞523905 [3]广州医科大学附属第二医院神经科,广州510250

出　　处：《国际医药卫生导报》2022年第7期902-907,共6页International Medicine and Health Guidance News

基　　金：国家自然科学基金青年科学基金项目(82101271);广东省基础与应用基础研究基金区域联合基金-青年基金项目(2020A1515110317);广东省自然科学基金面上项目(2021A1515010705);2020东莞市社会科技发展(一般)项目(202050715023717)。

摘　　要：目的探讨2型糖尿病对急性脑梗死患者软脑膜侧支循环的影响。方法选取2020年3月1日至2021年6月30日东莞市厚街医院收治的2型糖尿病合并急性缺血性脑梗死(大脑前动脉、大脑中动脉及颈内动脉颅内段闭塞或狭窄程度大于85%)患者作为研究对象(糖尿病脑梗死组),共94例,其中男51例,女43例,年龄(65.02±14.15)岁。配对选取94例脑血管闭塞或狭窄部位、程度相似、年龄相近的非糖尿病急性缺血性脑梗死患者作为对照组,其中男48例,女46例,年龄(68.20±12.63)岁。采用局部软脑膜侧支循环评分(rLMC)作为评价软脑膜侧支循环指标,对两组患者采用美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分(ASPECTS),相关因素如患者发病年龄、入院时的血压、血糖、胆固醇、低密度脂蛋白胆固醇(LDL-C)、吸烟史、饮酒史、既往脑梗死病史和冠心病等进行对比分析、相关回归分析等。结果糖尿病脑梗死组和对照组的rLMC分别为(11.55±5.22)分和(14.02±4.88)分,差异有统计学意义(P=0.001);入院时NIHSS评分分别为(11.99±8.57)分和(10.03±8.75)分,差异无统计学意义(P=0.123);ASPECTS分别为(5.26±2.45)分和(6.27±2.53),差异有统计学意义(P=0.006)。入院时血糖和饮酒史有差异外,其余与对照组相比差异均无统计学意义。rLMCS评分的Spearman相关性分析显示:rLMC与NIHSS评分(r=-5.790,P<0.001)和ASPECTS评分(r=0.556,P<0.001)显著相关。收缩压(r=0.207,P=0.045)和舒张压(r=0.213,P=0.040)、胆固醇(r=0.244,P=0.018)、LDL-C(r=0.215,P=0.037),差异均有统计学意义。年龄(r=-0.089,P=0.392)和血糖(r=-0.292,P=0.120)差异均无统计学意义。多元回归显示只有ASPECTS和NIHSS评分跟rLMC有显著相关。结论2型糖尿病不仅显著影响急性缺血性脑梗死软脑膜侧支循环的建立,而且还影响脑梗死体积和疾病的严重程度。除了2型糖尿病对软脑膜侧支循环的影响外,可能动脉�Objective To investigate the effect of type 2 diabetes mellitus on leptomeningeal collateral circulation in patients with acute cerebral infarction.Methods Ninety-four type 2 diabetes patients with acute ischemic cerebral infarction and occlusion or over 85%stenosis of anterior cerebral artery,middle cerebral artery,and internal carotid artery treated at Houjie Hospital from March 1,2020 to June 30,2021 were selected as a diabetes and cerebral infarction group,including 51 males and 43 females,and they were(65.02±14.15)years old.Ninety-four patients with acute ischemic cerebral infarction of similar occlusion or stenosis and of similar age were selected as a control group,including 48 males and 46 females,and they were(68.20±12.63)years old.Regional leptomeningeal collateral(rLMC)score was used as an indicator to evaluate the leptomeningeal collateral circulation.The scores of National Institute of Health Stroke Scale(NIHSS)and Alberta Stroke Program Early CT Score(ASPECTS)of the two groups were evaluated.The related factors,such as the age of onset,blood pressure,blood glucose,cholesterol,low-density lipoprotein cholesterol(LDL-C),smoking history,drinking history,and histories of cerebral infarction and coronary heart disease,were compared and analyzed.The correlation regression analysis was carried out.Results The rLMC score,NIHSS score at admission,and ASPECTS score were(11.55±5.22),(11.99±8.57),and(5.26±2.45)in the diabetes and cerebral infarction group,and were(14.02±4.88),(10.03±8.75),and(6.27±2.53)in the control group,with statistical differences(P=0.001,0.123,and 0.006).There were statistical differences in blood glucose,smoking history,and drinking history but not in the other indicators at admission between the two groups.Spearman correlation analysis of rLMC score showed that rLMC was significantly correlated with NIHSS score(r=-5.790,P<0.001)and ASPECTS score(r=0.556,P<0.001).Systolic pressure(r=0.207,P=0.045)and diastolic pressure(r=0.213,P=0.040),cholesterol(r=0.244,P=0.018),and LDL-C(r=0.21

关 键 词：2型糖尿病 软脑膜侧支循环 急性脑梗死 rLMC 

分 类 号：R587.1[医药卫生—内分泌] R743.33[医药卫生—内科学]