Department of Neurology The Third Affiliated Hospital of Sun Yat-Sen University Guangzhou China.
Guangdong Provincial Bioengineering Institute (Guangzhou Sugarcane Industry Research Institute) Guangzhou China.
Brain Behav. 2018 Feb 28;8(4):e00946. doi: 10.1002/brb3.946. eCollection 2018 Apr.
The association of branch atherosclerotic disease (BAD) and diabetes mellitus (DM) in the territory of posterior circulation is rarely discussed. Intracranial BAD was divided into two different types: paramedian pontine arteries (PPA) disease (PPD) and lenticulostriate arteries (LSA) disease. The goal of the study was to evaluate the clinical characteristics of PPD and its association with hemoglobinA1c (HbA1c) in China.
Radiologically confirmed PPD was defined as an isolated unilateral infarction extending to the ventral surface of the pons. Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: BAD and lipohyalinotic degeneration (LD). We compared the vascular risk factors between BAD and LD in PPA territory. A total of 159 stroke patients were analyzed (PPD, = 75; LD, = 84). Patients with PPD were also categorized into two groups according to follow-up modified Rankin Scale (FmRS) scores. Logistic regression analyses were used for the evaluation of independent risk factors of PPD and prognosis.
Comparison between PPD and LD revealed statistical significance in fasting glucose, HbA1c, estimated glomerular filtration rate (eGFR), and uric acid ( = .011, = .005, = .027, = .018, respectively). Compared with LD, PPD was only related to HbA1c ( = .011) in logistic regression analysis. There were statistically significant differences between the two groups based on the stratification of FmRS scores in fasting glucose, HbA1c, homocysteine, eGFR, and the occurrence of DM. After multivariate analysis, only HbA1c was related with poor prognosis of PPD ( = .002).
The subtypes and prognosis of small deep brain infarcts are significantly influenced by elevated HbA1c level in PPA territory. DM might play an important role in the pathogenesis of PPD.
后循环区域分支动脉粥样硬化（BAD）与糖尿病（DM）的相关性很少被讨论。颅内 BAD 分为两种不同类型：旁正中脑桥动脉（PPA）疾病（PPD）和纹状体动脉（LSA）疾病。本研究的目的是评估中国 PPD 的临床特征及其与糖化血红蛋白（HbA1c）的关系。
放射学确诊的 PPD 定义为单侧孤立性梗死延伸至脑桥腹侧表面。小的深部脑梗死通常由动脉的两种不同病理变化引起：BAD 和脂透明变性（LD）。我们比较了 PPA 区域 BAD 和 LD 的血管危险因素。共分析了 159 例脑卒中患者（PPD，n=75；LD，n=84）。根据随访改良 Rankin 量表（FmRS）评分，PPD 患者也分为两组。采用 logistic 回归分析评估 PPD 的独立危险因素及预后。
PPD 与 LD 比较，空腹血糖、HbA1c、估算肾小球滤过率（eGFR）和尿酸差异有统计学意义（=0.011、=0.005、=0.027、=0.018）。与 LD 相比，PPD 仅与 HbA1c 相关（=0.011）在 logistic 回归分析中。FmRS 评分分层后两组间空腹血糖、HbA1c、同型半胱氨酸、eGFR 和 DM 的发生率差异有统计学意义。多因素分析后，只有 HbA1c 与 PPD 的不良预后相关（=0.002）。
PPA 区域内升高的 HbA1c 水平显著影响小深部脑梗死的亚型和预后。DM 可能在 PPD 的发病机制中起重要作用。
