摘要： 目的   探讨2 型糖尿病无症状性颅内动脉狭窄与颈动脉颅外段粥样硬化病变之间的关系。方法   采用经颅多普勒超声和颈动脉超声检测无脑卒中2 型糖尿病患者颅内外动脉，分别判断颅内动脉狭窄及颈动脉颅外段内中膜厚度、斑块形成和狭窄程（狭窄程度≥ 50%或完全闭塞），分析颅内动脉狭窄与颈动脉粥样硬化病变之间的关系及危险因素。结果   194 例患者中42 例（21.65%）发生颅内动脉狭窄，其中大脑中动脉受累者30 例（15.46%）；123 例（63.40%）存在颈动脉粥样硬化性病变。颅内动脉狭窄组患者高龄（t = -3.054，P = 0.003）、长糖尿病病程（U = 2172.500，P = 0.002）、合并高血压（χ2 = 9.986，P = 0.002）及颈动脉病变（χ2 = 14.086，P = 0.000）比例明显高于无狭窄组（均P < 0.01）。单因素分析提示，颅内动脉和大脑中动脉狭窄与颈动脉粥样硬化病变程度相关（U = 1929.000，1519.000；均P = 0.000）。多因素Logistic 回归分析显示，合并高血压（OR = 2.849，95%CI：1.247 ~ 6.508；P = 0.013）和颈动脉病变（OR = 4.838，95%CI：1.778 ~ 13.167；P = 0.002）为2 型糖尿病无症状性颅内动脉狭窄的独立危险因素。结论   2 型糖尿病无症状性颅内动脉狭窄与颈动脉粥样硬化病变相关，颈动脉颅外段粥样硬化可能是国人2型糖尿病无症状性颅内动脉狭窄的独立预测因素。

关键词: 糖尿病, 2型, 动脉闭塞性疾病, 动脉硬化, 颈动脉, 超声检查, 多普勒, 经颅

Abstract: Objective To evaluate the correlation between asymptomatic intracranial arterial stenosis and extracranial carotid atherosclerosis in patients with Type 2 diabetes mellitus (DM). Methods Transcranial Doppler ultrasonography (TCD) and carotid ultrasonography were performed in 194 consecutive Type 2 DM patients who had no history of stroke to determine intracranial arterial stenosis and extracranial carotid atherosclerotic lesions. Extracranial carotid atherosclerotic lesions were divided into increased intima-media thickness (IMT), plaque and stenosis (≥ 50% stenosis or occlusion). The correlation between intracranial arterial stenosis and carotid atherosclerosis were assessed. Risk factors were also evaluated in the presence of intracranial arterial stenosis. Results Intracranial arterial stenosis (≥ 50% stenosis or occlusion) was found in 42 patients (21.65%). The middle cerebral artery (MCA) was involved in 30 patients (15.46%), which was the most affected intracranial artery. One hundred and twenty-three of 194 patients (63.40%) had extracranial carotid atherosclerosis. Age (t = -3.054, P = 0.003), duration of DM (U = 2172.500, P = 0.002) and concomitant hypertension (χ2 = 9.986, P = 0.002) and carotid artery lesion (χ2 = 14.086, P = 0.000) in patients with intracranial arterial stenosis were significantly higher than those without intracranial arterial stenosis. The prevalence of intracranial arterial stenosis and middle cerebral artery (MCA) stenosis were correlated with the severity of carotid atherosclerosis (U = 1929.000, 1519.000, respectively; P = 0.000, for all). After adjustment for cerebrovascular risk factors, multivariate Logistic regression analysis showed that concomitant hypertension (OR = 2.849, 95% CI: 1.247-6.508; P = 0.013) and carotid artery lesion (OR = 4.838, 95% CI: 1.778-13.167; P = 0.002） were significant independent risk factors associated with asymptomatic intracranial arterial stenosis in Type 2 DM patients. Conclusion Asymptomatic intracranial arterial stenosis is correlated with carotid atherosclerosis in Type 2 DM patients, and extracranial carotid atherosclerosis may be an independent predictive factor for asymptomatic intracranial arterial stenosis in Chinese patients with Type 2 DM.

Key words: Diabetes mellitus, Type 2, Arterial occlusive diseases, Arteriosclerosis, Carotid arteries, Ultrasonography, Doppler, transcranial