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目的研究老年糖尿病合并急性脑梗死的临床影像特点。方法选择老年糖尿病合并急性脑梗死患者80例(老年糖尿病合并急性脑梗死组),其中男性40例,女性40例;年龄60~88岁,平均年龄69.69岁。另选择非糖尿病的老年急性脑梗死患者80例(老年急性脑梗死组),其中男性42例,女性38例;年龄60~90岁,平均年龄70.55岁。做实验室检查,行颈部血管超声和头部MRI,分析两组患者影像特点。结果老年糖尿病合并急性脑梗死组高血脂史比例、甘油三酯、空腹血糖、糖化血红蛋白、纤维蛋白原水平高于老年急性脑梗死组(P<0.05)。老年糖尿病合并急性脑梗死组不稳定斑块发生率高于老年急性脑梗死组(63.75%vs 47.50%;P<0.05)。两组患者颈动脉粥样硬化斑块大部分位于颈总动脉窦部,斑块呈强回声、混合回声或低回声。两组头部MRI病灶均以单发病灶为主,病灶空间分布差异无统计学意义(P>0.05)。结论老年糖尿病合并急性脑梗死患者的血脂代谢异常明显,不稳定斑块增多,血脂检测及颈动脉颅外段超声对糖尿病患者预防急性脑梗死具有一定临床价值。
Objective To study the clinical features of senile diabetes mellitus complicated with acute cerebral infarction. Methods 80 elderly patients with diabetes mellitus and acute cerebral infarction were selected, including 40 males and 40 females, aged from 60 to 88 years (mean age 69.69 years). Another 80 non-diabetic elderly acute cerebral infarction patients (elderly acute cerebral infarction group), including 42 males and 38 females; aged 60 to 90 years, mean age 70.55 years. To do laboratory tests, neck and neck ultrasound and head MRI, analysis of the characteristics of the two groups of patients. Results The ratio of hyperlipidemia, triglyceride, fasting blood glucose, glycosylated hemoglobin and fibrinogen in aged patients with diabetes mellitus and acute cerebral infarction group were higher than those in the elderly acute cerebral infarction group (P <0.05). The incidence of unstable plaque in elderly diabetic patients with acute cerebral infarction was higher than that in the elderly patients with acute cerebral infarction (63.75% vs 47.50%; P <0.05). The majority of carotid atherosclerotic plaques in both groups were located in the common carotid artery. The plaques were hyperechoic, mixed echogenic or hypoechoic. The two groups of head MRI lesions were mainly single lesions, the distribution of lesions was not statistically significant (P> 0.05). Conclusion The elderly patients with diabetes mellitus and acute cerebral infarction have abnormal lipid metabolism and unstable plaque. The serum lipids and carotid extracranial ultrasonography have certain clinical value in the prevention of acute cerebral infarction in diabetic patients.