中华临床医师杂志（电子版） 2010年8月,4卷8期

论　著

糖耐量异常与脑梗死患者颅内外动脉粥样硬化的相关性研究

赵蕾，李文伦，钟春玖，夏金花，张芳芹，钟池

赵蕾、钟春玖，上海，复旦大学附属中山医院神经内科，200032；李文伦、夏金花、张芳芹，潍坊市人民医院超声科，200032；钟池，神经内科，200032

摘要:目的　探讨糖耐量异常的脑梗死患者颅内外动脉粥样硬化的程度及其相关危险因素。方法　选择脑梗死患者131例，通过口服葡萄糖耐量试验(OGTT)将患者分为糖耐量正常组(NGT，n＝41例)、糖耐量异常组(IGT，n＝47例)、新诊断的2型糖尿病组(DM，n＝43例)。测定各项生化指标，进行颈部血管彩色超声、经颅多普勒检查，记录颅内外动脉狭窄数、颈总动脉内中膜厚度(IMT)及其他指标。结果　IGT组及DM组的双侧颈动脉IMT平均值(MIMT)、阻力指数、斑块积分和内膜不连续比率、颅内外动脉狭窄率与NGT组相比差异均有统计学意义(P<0.05)，而IGT组与DM组相比无统计学意义。Logistic回归显示，餐后2 h血糖(2 h-PG)(OR＝1.995，P＝0.004)、糖化血红蛋白(HbA1c)(OR＝4.799，P＝0.028)、甘油三酯(TG)(OR＝7.439，P＝0.012)及伴随疾病(高血压)(OR＝8.639，P＝0.042)均为异常IMT的独立危险因素。颅内外动脉闭塞性病变的多因素回归分析显示，2 h-PG、低密度脂蛋白(LDL-C)及收缩压为其危险因素(OR值与P值分别为1.762、0.002,1.189、0.048,1.231、0.014)。结论　餐后高血糖是动脉粥样硬化的独立危险因素，早在糖耐量异常阶段就已经发生了颅内和颅外大血管的动脉粥样硬化，提示糖耐量异常也是脑梗死的危险因素。

关键词:脑梗死；　动脉粥样硬化；　颈总动脉；　血管中膜；　糖耐量异常

The relationship between impaired glucose tolerance and atherosclerosis of intracranial and carotid arteries in patients with cerebral infarction

ZHAO Lei，LI Wen-lun，ZHONG Chun-jiu，XIA Jin-hua，ZHANG Fang-qin，ZHONG Chi*.

*Department of Neurology，Weifang Medical College，Weifang 261041，China

Abstract:Objective　To investigate the degree of atherosclerosis in patients with cerebral infarction accompanied with impaired glucose tolerance(IGT)，and to explore the risk factors associated with atherosclerosis.Methods　One hundred and thirty one patients who had cerebral infarction and had no conclusive medical records of diabetes mellitus(DM) ever before，received 75 g oral glucose tolerance test (OGTT).According to the results of OGTT，patients were divided into normal glucose tolerance group (NGT，n＝41)，IGT group (n＝47)，and newly diagnosed type 2 DM group (DM，n＝43).Some biochemical parameters were measured.Intima-media thickness(IMT) of the common carotid artery(CCA) and other indexs were measured by B type ultrasonography.The atherosclerotic stenosis are measured also.Results　The differences of intima-media thickness(IMT)，resistent rate(RI)，plague score(PS) and atherosclerotic stenosis among DM group，IGT group and NGT group had statistic significance (P<0.05)；but DM group and IGT group had no statistic significance (P>0.05).According to logistic regression analysis,2 h-PG(OR＝1.995，P＝0.004)，HbA1c(OR＝4.799，P＝0.028)，TG(OR＝7.439，P＝0.012) and hypertension(OR＝8.639，P＝0.042)were found to be independent risk factors of abnormal IMT,2 h-PG，LDL-C and contractive pressure were found to be independent risk factors of atherosclerotic stenosis.Conclusions　Postprandial hyperglycemia is an independent risk factor of atherosclerosis， and the change of atherosclerosis might have started since early IGT stage，which shows that IGT might be the risk factor of ischemic stroke.

Keywords:Brain infarction；　Atherosclerosis；　Carotid artery， common；　Tunica media； Impaired glucose tolerance

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(编辑：宋澍清 收稿日期：2010-01-27)