新诊断糖尿病脑梗死患者血管病变特征的研究  

Characteristics of vascular lesions in patients with newly diagnosed diabetic cerebral infarction

作　　者：余爱勇 赵玉武[2] 张瑜[1] 都爱莲[1] YU Aiyong;ZHAO Yuwu;ZHANG Yu;DU Ailian(Department of Neurology,Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201699,China;Department of Neurology,Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属松江医院神经内科,上海201699 [2]上海交通大学医学院附属第六人民医院神经内科,上海200233

出　　处：《国际神经病学神经外科学杂志》2024年第4期8-15,共8页Journal of International Neurology and Neurosurgery

基　　金：上海市松江区科学技术攻关项目(15SJGG30)。

摘　　要：目的探讨新诊断糖尿病性脑梗死患者的血管病变特征。方法搜集2017年1月至2024年6月在上海交通大学医学院附属松江医院神经内科住院的急性脑梗死患者(4172例)的临床资料。其中,合并糖尿病的患者716例,分为新诊断糖尿病脑梗死组(359例)和伴糖尿病史脑梗死组(357例)。测定两组患者的随机血糖、糖化血红蛋白、糖化白蛋白、果糖胺、肌酐、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸。两组患者均进行头颅磁共振成像、磁共振血管造影、CT血管造影、全脑血管造影检查。结果新诊断糖尿病脑梗死组患者症状性脑梗死病史次数低于伴糖尿病史脑梗死组(P=0.002)。新诊断糖尿病脑梗死组的血糖水平低于伴糖尿病史脑梗死组(P=0.001)。新诊断糖尿病脑梗死组肌酐水平低于伴糖尿病史脑梗死组(P=0.044)。新诊断糖尿病脑梗死组发生前循环脑梗死的比例高于伴糖尿病史脑梗死组(P=0.016)。新诊断糖尿病脑梗死组发生后循环脑梗死的比例低于伴糖尿病史脑梗死组(P=0.002)。新诊断糖尿病脑梗死组多发性脑梗死发生率高于伴糖尿病史脑梗死组(P=0.002)。新诊断糖尿病脑梗死组多发性血管狭窄发生率高于伴糖尿病史脑梗死组(P=0.005)。新诊断糖尿病脑梗死组颅内狭窄或闭塞血管总数高于伴糖尿病史脑梗死组(P<0.001)。新诊断糖尿病脑梗死组前循环狭窄或闭塞血管数高于伴糖尿病史脑梗死组(P<0.001)。新诊断糖尿病脑梗死组大脑中动脉狭窄或闭塞数高于伴糖尿病史脑梗死组(P<0.001)。新诊断糖尿病脑梗死组颈内动脉颅外段狭窄或闭塞数高于伴糖尿病史脑梗死组(P=0.004)。新诊断糖尿病脑梗死组颅外动脉狭窄或闭塞总数高于伴糖尿病史脑梗死组(P=0.006)。多因素Logistic回归分析显示,新诊断糖尿病发生脑梗死的影响因素有:多支血管狭窄(P=0.045)�Objective To investigate the characteristics of vascular lesions in patients with newly diagnosed diabetic cerebral infarction.Methods Related clinical data were collected from 4172 patients with acute cerebral infarction who were admitted to Department of Neurology,Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,from January 2017 to June 2024.Among whom 716 patients with diabetes were divided into newly diagnosed diabetic cerebral infarction group with 359 patients and cerebral infarction+diabetes history group with 357 patients.The patients in both groups were measured in terms of random blood glucose,glycated hemoglobin,glycated albumin,fructosamine,creatinine,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and homocysteine,and all patients underwent cranial magnetic resonance imaging,magnetic resonance angiography,CT angiography.And whole brain angiography.Results Compared with the cerebral infarction+diabetes history group,the newly diagnosed diabetic cerebral infarction group had significantly lower number of symptomatic cerebral infarction attacks(P=0.002)and levels of blood glucose(P=0.001)and creatinine(P=0.044).Compared with the cerebral infarction+diabetes history group,the newly diagnosed diabetic cerebral infarction group had a significantly higher proportion of patients with precirculating cerebral infarction(P=0.016)and a significantly lower proportion of patients with postcirculating cerebral infarction(P=0.002),as well as a significantly higher proportion of patients with multiple cerebral infarction(P=0.002)or multiple vascular stenosis(P=0.005).Compared with the cerebral infarction+diabetes history group,the newly diagnosed diabetic cerebral infarction group had a significantly higher total number of intracranial blood vessels with stenosis or occlusion(P<0.001),as well as a significantly higher number of blood vessels with stenosis or occlusion in the anterior circulation(P<0.001),the middle cerebral arte

关 键 词：脑梗死 糖尿病 血管狭窄 大脑中动脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]