Huang Qin, Liu Wei, Sun Lili, Liu Lei, Zhang Shuo, Yang Yantong, Zhu Xianjin, Liu Zunjing
Department of Neurology, Peking University People's Hospital, Beijing, China.
Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
Eur J Radiol. 2025 Oct;191:112347. doi: 10.1016/j.ejrad.2025.112347. Epub 2025 Aug 6.
Intracranial vulnerable plaque, characterized by intraplaque hemorrhage (IPH), surface irregularity, positive remodeling, and plaque enhancement, is associated with cerebrovascular events. History of diabetes mellitus (DM) was reported to be a potential predictor of plaque vulnerability, but the predictive value of DM-related variables for it is still uncertain. The purpose of this study was to investigate the association of diabetes duration and glycemic control with symptomatic plaque vulnerability, in comparison to non-diabetic patients.
We retrospectively included a total of 220 patients who presented with ischemic stroke or transient ischemic attacks (TIA) underwent 3 T high-resolution magnetic resonance vessel wall imaging within 4 weeks of the onset of symptoms. The culprit plaque characteristics including morphology (positive remodeling and surface irregularity) and activation (IPH and plaque enhancement) were evaluated. We used multivariable logistic regression analyses to assess the differences of duration of diabetes (≥10 years compared with < 10 years) and glycemic control (HbA1c values ≥ 7.0 % compared with < 7.0 %) in plaque characteristics.
The sample (n = 220) had a mean age of 56.6 ± 11.9 years and was 46.4 % of diabetes. Of the 102 DM individuals, 58.8 % had been with DM duration < 10 years (Short-DM group) and 41.2 % with duration ≥ 10 years (Long-DM group). The well-controlled group (HbA1c values < 7.0 %) and poor-controlled DM group (HbA1c values ≥ 7.0 %) included 31 (30.4 %) and 71 (69.6 %) patients, respectively. We found significant difference in positive remodeling between patients with DM duration < 10 years and ≥ 10 years (adjusted odds ratio [OR] = 2.9 [95 % CI, 1.2-6.9]). Compared with patients who had HbA1c < 7.0 %, poor glycemic control was significantly associated with an increased rate of IPH (adjusted OR = 9.14 [95 % CI, 2.66-31.33]), plaque enhancement (adjusted OR = 3.09 [95 % CI, 1.02-9.34]), and surface irregularity (adjusted OR = 2.72 [95 % CI, 1.04-7.11]). Both patients with duration ≥ 10 years (adjusted OR = 3.84 [95 % CI, 1.31-11.24]) and patients HbA1c ≥ 7.0 % (adjusted OR = 3.41 [95 % CI, 1.33-8.76]) had more often coexistence of all vulnerable plaque characteristics compared with nondiabetic patients.
Increased durations of diabetes and poor glycemic control are both independently associated with existence and coexistence of intracranial atherosclerotic plaque vulnerability, which should be considered when stratifying risk among patients with intracranial atherosclerosis.
颅内易损斑块以斑块内出血（IPH）、表面不规则、正性重构和斑块强化为特征，与脑血管事件相关。据报道，糖尿病（DM）病史是斑块易损性的一个潜在预测因素，但其相关变量对斑块易损性的预测价值仍不确定。本研究旨在探讨糖尿病病程和血糖控制与有症状斑块易损性之间的关联，并与非糖尿病患者进行比较。
我们回顾性纳入了220例因缺血性卒中或短暂性脑缺血发作（TIA）就诊且在症状发作4周内接受3T高分辨率磁共振血管壁成像的患者。评估了责任斑块的特征，包括形态（正性重构和表面不规则）和活性（IPH和斑块强化）。我们使用多变量逻辑回归分析来评估糖尿病病程（≥10年与<10年）和血糖控制（糖化血红蛋白[HbA1c]值≥7.0%与<7.0%）在斑块特征方面的差异。
样本（n = 220）的平均年龄为56.6±11.9岁，糖尿病患者占46.4%。在102例糖尿病患者中，58.8%的患者糖尿病病程<10年（短病程糖尿病组），41.2%的患者病程≥10年（长病程糖尿病组）。血糖控制良好组（HbA1c值<7.0%）和血糖控制不佳的糖尿病组（HbA1c值≥7.0%）分别包括31例（30.4%）和71例（69.6%）患者。我们发现糖尿病病程<10年和≥10年的患者在正性重构方面存在显著差异（调整后的比值比[OR]=2.9[95%CI，1.2 - 6.9]）。与HbA1c<7.0%的患者相比，血糖控制不佳与IPH发生率增加（调整后的OR = 9.14[95%CI，2.66 - 31.33]）、斑块强化（调整后的OR = 3.09[95%CI，1.02 - 9.34]）和表面不规则（调整后的OR = 2.72[95%CI，1.04 - 7.11]）显著相关。糖尿病病程≥10年的患者（调整后的OR = 3.84[95%CI，1.31 - 11.24]）和HbA1c≥7.0%的患者（调整后的OR = 3.41[95%CI，1.33 - 8.76]）与非糖尿病患者相比，更常同时存在所有易损斑块特征。
糖尿病病程延长和血糖控制不佳均独立与颅内动脉粥样硬化斑块易损性的存在和并存相关，在对颅内动脉粥样硬化患者进行风险分层时应予以考虑。
