糖尿病对颈内动脉狭窄介入治疗患者脑血管储备功能的影响

Cerebrovascular reserve changes after carotid angioplasty and stenting in diabetes mellitus patients

摘要:

目的 探讨糖尿病对颈内动脉狭窄患者颈动脉支架置入术（CAS）前后脑血管储备功能的影响。方法 颈动脉狭窄≥70%的无症状性或狭窄≥50%的症状性颈动脉狭窄患者55例, 分为糖尿病组（16例）和无糖尿病组（39例）。患者吸入5%CO2和95%O2混合气体诱发高碳酸血症, 通过经颅多普勒超声检查, 计算大脑中动脉（MCA）血流速度差值的百分比, 得出脑血管储备（CVR）值, 比较两组患者在颈动脉支架置入术前后, CVR变化的百分比。结果 糖尿病组CAS前CVR显著低于无糖尿病组[（18.43±12.80）% vs（29.65±18.23）%, P＜0.05], CAS术后两组间CVR差异无统计学意义[（36.46±15.32）% vs（45.68±13.17）%, P＞0.05]; 糖尿病组狭窄侧和狭窄对侧CVR在CAS术后较术前均显著提高[狭窄侧:（36.46±15.32）% vs（18.43±12.80）%, P＜0.05; 狭窄对侧:（38.28±15.00）% vs（30.40± 16.48）% , P＜0.05]; 非糖尿病组和糖尿病组狭窄侧较狭窄对侧CVR改善明显（P＜0.01 P＜0.05）。结论 糖尿病是导致重度颈内动脉系统狭窄患者CVR异常的危险因素, 糖尿病患者从支架术中获益相同于无糖尿病患者, 糖尿病并不能作为是否行支架治疗的预测因素。

Abstract:

Objective To investigate cerebrovascular reserve(CVR) changes after carotid angioplasty and stenting(CAS) in patients with diabetes mellitus(DM). Methods Fifty-five patients with asymptomatic carotid artery stenosis(≥70%) or symptomatic carotid artery stenosis(≥50%) were divided into DM group(n=16) and non-DM group(n=39). Hypercapnia was induced by inhaling a mixture gas of 5% CO2 and 95% O2, and the changes of blood velocity were recorded in both sides of middle cerebral artery(MCA) before and after CAS. CVR was compared between the two groups before and after CAS. Results CVR was significantly lower in DM group than in non-DM group preoperatively [(8.43±12.80)% vs (29.65±18.23)%, P＜0.05]. After CAS, there was no significant difference in CVR between the two groups[(36.46±15.32)% vs (45.68±13.17)%, P＞0.05]. After CAS, CVR was significantly increased on both the stenosis side [(18.43±12.80)% vs (36.46±15.32)%, P＜0.05] and contralateral side in DM group[(30.40±16.48)% vs (38.28±15.00)%, P＜0.05]. In both two groups, CVR was improved more significantly in stenosis side than in the contralateral side(P＜0.01; P＜0.05). Conclusions DM worsens CVR of the patients with severe carotid artery stenosis. The DM patients and non-DM patients benefit equally from CAS. So, DM can not be a predictive factor for stent placement.