Tkác I, Troscák M, Javorský M, Petrík R, Tomcová M
Department of Internal Medicine IV, Medical Faculty of P.J. Safárik University, Kosice, Slovakia.
Wien Klin Wochenschr. 2001 Nov 15;113(22):870-3.
The majority of the studies investigating risk factors for stroke have focused on the atherosclerosis of extracranial carotid arteries. Risk factors for the involvement of intracranial arteries in patients with stroke have not been widely investigated so far. The pulsatility index reflects the vascular resistance of intracranial arteries and could therefore be used as an estimate of the severity of vascular damage.
The present study aimed to examine the influence of type 2 diabetes mellitus and some other atherosclerosis risk factors on intracranial vascular resistance in patients with a previous stroke or transient ischemic attack.
Transcranial doppler investigations were performed in 103 patients with previous stroke (31 with diagnosis of type 2 diabetes, 72 without diabetes), at least 3 months after stroke occurred. Blood flow velocities of anterior cerebral arteries, middle cerebral arteries, the intracranial part of vertebral arteries and the basilar artery, as well as of the extracranial part of the internal carotid artery were measured, and Gosling's pulsatility index was calculated. The maximal pulsatility index of intracranial arteries was defined to express the most pronounced damage.
Diabetic patients had a significantly higher pulsatility index than non-diabetic patients in all examined intracranial arteries. The maximal pulsatility index was also significantly higher in diabetic patients than in non-diabetic patients (1.24 +/- 0.25 vs. 1.00 +/- 0.23; p < 0.0001). There was no significant difference in the pulsatility index between men and women and between groups of patients with or without hypertension. In the multivariate analysis, the presence of diabetes (p < 0.0001) and the age of patients (p < 0.0001) were the only factors significantly predicting maximal pulsatility index, and this relationship was independent on the presence of hypertension.
Diabetic patients with previous stroke have a higher pulsatility index than non-diabetic patients with previous strokes, which indicates a higher increase in intracranial arterial resistance and more severe damage to cerebral blood flow in diabetes mellitus.
大多数研究中风危险因素的研究都集中在颅外颈动脉的动脉粥样硬化上。迄今为止，中风患者颅内动脉受累的危险因素尚未得到广泛研究。搏动指数反映了颅内动脉的血管阻力，因此可用于估计血管损伤的严重程度。
本研究旨在探讨2型糖尿病和其他一些动脉粥样硬化危险因素对既往有中风或短暂性脑缺血发作患者颅内血管阻力的影响。
对103例既往有中风的患者（31例诊断为2型糖尿病，72例无糖尿病）在中风发生至少3个月后进行经颅多普勒检查。测量大脑前动脉、大脑中动脉、椎动脉颅内段和基底动脉以及颈内动脉颅外段的血流速度，并计算戈斯林搏动指数。定义颅内动脉的最大搏动指数以表示最明显的损伤。
在所有检查的颅内动脉中，糖尿病患者的搏动指数明显高于非糖尿病患者。糖尿病患者的最大搏动指数也明显高于非糖尿病患者（1.24±0.25对1.00±0.23；p<0.0001）。男性和女性之间以及有或无高血压的患者组之间的搏动指数没有显著差异。在多变量分析中，糖尿病的存在（p<0.0001）和患者年龄（p<0.0001）是显著预测最大搏动指数的唯一因素，并且这种关系独立于高血压的存在。
既往有中风的糖尿病患者的搏动指数高于既往有中风的非糖尿病患者，这表明糖尿病患者颅内动脉阻力增加更高，对脑血流的损伤更严重。
