脑干梗死与糖尿病的相关性

摘要

目的 探讨脑干梗死与糖尿病的关系。方法 纳入确诊急性脑梗死患者，首先分为脑干梗死组和非脑干梗死组，然后根据是否伴有糖尿病分为脑干梗死伴糖尿病组、脑干梗死不伴糖尿病组、非脑干梗死伴糖尿病组和非脑干梗死不伴糖尿病组。多普勒超声检测颈动脉内膜一中膜厚度（intima-media thickness，IMT）和确定颈动脉粥样硬化；弥散加权成像确定脑干梗死及其部位；磁共振血管造影（magnetic resonance angiophy，MRA）检测基底动脉粥样硬化。多变量logistic回归分析筛选影响脑干梗死的不同危险因素。改良Rankin量表(modified Rankin Scale，mRS)评分评价神经功能缺损。结果 共纳入286例急性脑梗死患者：脑干梗死63例，其中34例伴有糖尿病；非脑干梗死223例，其中77例伴有糖尿病。脑干梗死组糖尿病（54.0％对34.5％，x2=7.816，P=0.005）、既往脑梗死（38.1％对24.2％,x2=4.771，P=0.029）、基底动脉粥样硬化（73.0％对57.4％，x2=5.028，P=0.025）比例以及糖化血红蛋白（hemoglobin AIC，HbA1c）[(7.30 ±2.42)％对(6.46±1.82)％，t=-2.531，P=0.011]和载脂蛋白B（apoproteinB，ApoB）[(0.97±0.33) mmol/L对(0.90±0.34) mmol/L，t=-2.180，P=0.029]水平均显著高于非脑干梗死组。多变量logistic回归分析表明，糖尿病（优势比2.150，95％可信区间1.214～3.808;P =0.009）和既往脑梗死(优势比1.835，95％可信区间1.004～3.352，P=0.048)是脑干梗死的独立危险因素。在伴糖尿病的脑干梗死组、不伴糖尿病的脑干梗死组、伴糖尿病的非脑干梗死组和不伴糖尿病的非脑干梗死组之间，HbA1c( P＜0.001)、空腹血糖（fasting blood glucose，FBG）(P＜0.001)、ApoB(P =0.007)和高密度脂蛋白一胆固醇(P=0.018)水平以及基底动脉粥样硬化比例(P=0.001)均存在显著差异，其中脑干梗死伴糖尿病组HbA1c[ (8.81±2.36)％]、FBG[ (8.23 ±3.12) mmol/L]和ApoB[(1.04±0.41) mmol/L]水平以及基底动脉粥样硬化比例(85.3％)最高。与非糖尿病脑干梗死相比，糖尿病脑干梗死患者脑桥梗死更为多见(79.4％，P =0.039)。结论 糖尿病与脑干梗死关系密切，糖尿病更容易导致脑桥梗死。%Objective To investigate the correlation between diabetes and brainstem infarction. Methods The diagnozed patients with acute cerebral infarction were recruited in the study. Firstly, they were divided into brainstem infarction group and non-brainstem infarction group, and then they were redivided into brainstem infarction with diabetes, brainstem infarction without diabetes, non-brainstem infarction with diabetes and non-brainstem infarction without diabetes groups according to whether they had diabetes or not. Carotid artery intima-media thickness (IMT) and carotid atherosclerosis were detected and identified with Doppler ultrasound; brain stem infarction and its location were identified with diffusion-weighted imaging; basilar artery atherosclerosis was detected with magnetic resonance angiography (MRA). A multivariate logistic regression analysis was used to screen the different risk factors impacting brainstem infarction. Neurological deficit was evaluated with the modified Rankin Scale (mRS)scores. Results A total of 286 patients with acute cerebral infarction were recruited: brain stem infarction in 63, and 34 of them with diabetes; non-brain stem infarction in 223, and 77 of them with diabetes. The proportions of diabetes (54. 0％ vs. 34. 5%, x2 = 7. 816, P = 0. 005),previous cerebral infarction (38. 1％ vs. 24. 2％ ,x2 =4. 771, P =0. 029), basilar artery atherosclerosis (73.0％ vs. 57. 4％,x2 =5. 028, P =0. 025), as wall as the levels of hemoglobin A1C (HbA1c) (7. 30 ± 2. 42％ vs. 6. 46 ± 1.82％, t = - 2. 531, P = 0. 011 ) and apolipoprotein B (ApoB) (0. 97 ± 0. 33 mmol/L vs. 0. 90 ± 0. 34 mmol/L, t = -2. 180, P = 0. 029) in the brainstem infarction group were significantly higher than those in the non-brainstem infarction group. Multivariate logistic regression analysis showed that diabetes (odds ratio [ OR] 2. 150, 95％confidence interval [ CI] 1. 214-3. 808; P =0. 009) and previous cerebral infarction (OR 1. 835, 95％ CI 1.004-3. 352, P = 0. 048) were the independent risk factors for brainstem infarction. There were significant differences in the levels of HbA1c (P ＜ 0. 001 ), fasting blood glucose (FBG) (P ＜0. 001), ApoB (P =0. 007) and high-density lipoprotein cholesterol (P =0. 018) as well as the proportion of basilar artery atherosclerosis (P = 0. 001 ) among the brainstem infarction with diabetes, without diabetes, non-brainstem infarction with diabetes and without diabetes groups. The levels of HbA1c (8. 81 ±2. 36％), FBG (8. 23 ±3. 12 mmol/L andApoB (1.04 ± 0. 41 mmol/L) as well as the proportion of basilar artery atherosclerosis (85. 3％ )were the highest in the brainstem infarction with diabetes group. Conclusions Diabetes is closely associated with brainstem infarction. Diabetes is more likely to result in pontine infarction.