Wei Li-Ming, Zhu Yue-Qi, Bao Yu-Qian, Lu Hai-Tao, Zhang Pei-Lei, Zhao Yu-Wu, Li Mei, Zhao Jun-Gong
Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Department of Endocrinology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Quant Imaging Med Surg. 2019 Jun;9(6):960-967. doi: 10.21037/qims.2019.04.17.
Diabetes mellitus (DM) is associated with increased prevalence and severity of atherosclerosis. This study aimed to assess the prevalence and location of atherosclerosis in intracranial and extracranial vessels in diabetic patients and to investigate their association with ischemic stroke subtype.
Diabetes patients (n=128) and nondiabetic patients (n=195) were enrolled. Brain MRI, MR angiography, and digital subtraction angiography (DSA) imaging findings in the two groups were retrospectively compared. The characteristics of atherosclerosis (prevalence, location, severity) and collateral flow in diabetic and nondiabetic patients and their association with stroke subtype were analyzed.
Atherosclerosis in extracranial vessels was more common in diabetes patients than in nondiabetic patients (43.8% . 23.1%; P<0.001). Symptomatic stenoses were commonly in the proximal internal carotid artery (ICA) and proximal vertebral artery (pVA). Diabetes patients were more likely to have lacunar infarction (49.2% . 32.3%; P=0.002) and less likely to have large artery infarct (36.7% . 48.2%; P=0.042). DM (OR, 2.03; 95% CI, 1.96-4.30; P=0.006) and age >65 years (OR, 2.55; 95% CI, 1.24-5.22; P=0.011) were independent risk factors for lacunar infarct. Diabetes patients with symptomatic extracranial stenosis or occlusion, combined with good collateral circulation, had significantly higher risk of lacunar infarction than nondiabetic patients (47.8% . 30.5%; P=0.045).
DM aggravates the severity of extracranial atherosclerosis. Lacunar stroke is relatively common in diabetic patients and could even be due to large artery disease (LAD).
糖尿病（DM）与动脉粥样硬化的患病率增加和严重程度相关。本研究旨在评估糖尿病患者颅内和颅外血管中动脉粥样硬化的患病率和位置，并调查其与缺血性卒中亚型的关联。
纳入糖尿病患者（n = 128）和非糖尿病患者（n = 195）。回顾性比较两组的脑部MRI、磁共振血管造影和数字减影血管造影（DSA）成像结果。分析糖尿病和非糖尿病患者动脉粥样硬化的特征（患病率、位置、严重程度）和侧支循环及其与卒中亚型的关联。
糖尿病患者颅外血管动脉粥样硬化比非糖尿病患者更常见（43.8% 对23.1%；P < 0.001）。有症状的狭窄常见于颈内动脉（ICA）近端和椎动脉（pVA）近端。糖尿病患者更易发生腔隙性梗死（49.2% 对32.3%；P = 0.002），而大动脉梗死的可能性较小（36.7% 对48.2%；P = 0.042）。糖尿病（OR，2.03；95% CI，1.96 - 4.30；P = 0.006）和年龄>65岁（OR，2.55；95% CI，1.24 - 5.22；P = 0.011）是腔隙性梗死的独立危险因素。有症状的颅外狭窄或闭塞且侧支循环良好的糖尿病患者发生腔隙性梗死的风险显著高于非糖尿病患者（47.8% 对30.5%；P = 0.045）。
糖尿病加重颅外动脉粥样硬化的严重程度。腔隙性卒中在糖尿病患者中相对常见，甚至可能由大动脉疾病（LAD）引起。
