CAJ | 학술논문

目的探讨脑干梗死与糖尿病的关系。方法纳入确诊急性脑梗死患者，首先分为脑干梗死组和非脑干梗死组，然后根据是否伴有糖尿病分为脑干梗死伴糖尿病组、脑干梗死不伴糖尿病组、非脑干梗死伴糖尿病组和非脑干梗死不伴糖尿病组。多普勒超声检测颈动脉内膜一中膜厚度（intima-media thickness，IMT）和确定颈动脉粥样硬化；弥散加权成像确定脑干梗死及其部位；磁共振血管造影（magnetic resonance angiophy，MRA）检测基底动脉粥样硬化。多变量logistic回归分析筛选影响脑干梗死的不同危险因素。改良Rankin量表(modified Rankin Scale，mRS)评分评价神经功能缺损。结果共纳入286例急性脑梗死患者：脑干梗死63例，其中34例伴有糖尿病；非脑干梗死223例，其中77例伴有糖尿病。脑干梗死组糖尿病（54.0％对34.5％，x2=7.816，P=0.005）、既往脑梗死（38.1％对24.2％,x2=4.771，P=0.029）、基底动脉粥样硬化（73.0％对57.4％，x2=5.028，P=0.025）比例以及糖化血红蛋白（hemoglobin AIC，HbA1c）[(7.30 ±2.42)％对(6.46±1.82)％，t=-2.531，P=0.011]和载脂蛋白B（apoproteinB，ApoB）[(0.97±0.33) mmol/L对(0.90±0.34) mmol/L，t=-2.180，P=0.029]水平均显著高于非脑干梗死组。多变量logistic回归分析表明，糖尿病（优势比2.150，95％可信区间1.214～3.808;P =0.009）和既往脑梗死(优势比1.835，95％可信区间1.004～3.352，P=0.048)是脑干梗死的独立危险因素。在伴糖尿病的脑干梗死组、不伴糖尿病的脑干梗死组、伴糖尿病的非脑干梗死组和不伴糖尿病的非脑干梗死组之间，HbA1c( P＜0.001)、空腹血糖（fasting blood glucose，FBG）(P＜0.001)、ApoB(P =0.007)和高密度脂蛋白一胆固醇(P=0.018)水平以及基底动脉粥样硬化比例(P=0.001)均存在显著差异，其中脑干梗死伴糖尿病组HbA1c[ (8.81±2.36)％]、FBG[ (8.23 ±3.12) mmol/L]和ApoB[(1.04±0.41) mmol/L]水平以及基底动脉粥样硬化比例(85.3％)最高。与非糖尿病脑干梗死相比，糖尿病脑干梗死患者脑桥梗死更为多见(79.4％，P =0.039)。结论糖尿病与脑干梗死关系密切，糖尿病更容易导致脑桥梗死。目的探討腦榦梗死與糖尿病的關繫。方法納入確診急性腦梗死患者，首先分為腦榦梗死組和非腦榦梗死組，然後根據是否伴有糖尿病分為腦榦梗死伴糖尿病組、腦榦梗死不伴糖尿病組、非腦榦梗死伴糖尿病組和非腦榦梗死不伴糖尿病組。多普勒超聲檢測頸動脈內膜一中膜厚度（intima-media thickness，IMT）和確定頸動脈粥樣硬化；瀰散加權成像確定腦榦梗死及其部位；磁共振血管造影（magnetic resonance angiophy，MRA）檢測基底動脈粥樣硬化。多變量logistic迴歸分析篩選影響腦榦梗死的不同危險因素。改良Rankin量錶(modified Rankin Scale，mRS)評分評價神經功能缺損。結果共納入286例急性腦梗死患者：腦榦梗死63例，其中34例伴有糖尿病；非腦榦梗死223例，其中77例伴有糖尿病。腦榦梗死組糖尿病（54.0％對34.5％，x2=7.816，P=0.005）、既往腦梗死（38.1％對24.2％,x2=4.771，P=0.029）、基底動脈粥樣硬化（73.0％對57.4％，x2=5.028，P=0.025）比例以及糖化血紅蛋白（hemoglobin AIC，HbA1c）[(7.30 ±2.42)％對(6.46±1.82)％，t=-2.531，P=0.011]和載脂蛋白B（apoproteinB，ApoB）[(0.97±0.33) mmol/L對(0.90±0.34) mmol/L，t=-2.180，P=0.029]水平均顯著高于非腦榦梗死組。多變量logistic迴歸分析錶明，糖尿病（優勢比2.150，95％可信區間1.214～3.808;P =0.009）和既往腦梗死(優勢比1.835，95％可信區間1.004～3.352，P=0.048)是腦榦梗死的獨立危險因素。在伴糖尿病的腦榦梗死組、不伴糖尿病的腦榦梗死組、伴糖尿病的非腦榦梗死組和不伴糖尿病的非腦榦梗死組之間，HbA1c( P＜0.001)、空腹血糖（fasting blood glucose，FBG）(P＜0.001)、ApoB(P =0.007)和高密度脂蛋白一膽固醇(P=0.018)水平以及基底動脈粥樣硬化比例(P=0.001)均存在顯著差異，其中腦榦梗死伴糖尿病組HbA1c[ (8.81±2.36)％]、FBG[ (8.23 ±3.12) mmol/L]和ApoB[(1.04±0.41) mmol/L]水平以及基底動脈粥樣硬化比例(85.3％)最高。與非糖尿病腦榦梗死相比，糖尿病腦榦梗死患者腦橋梗死更為多見(79.4％，P =0.039)。結論糖尿病與腦榦梗死關繫密切，糖尿病更容易導緻腦橋梗死。
목적 탐토뇌간경사여당뇨병적관계。방법 납입학진급성뇌경사환자，수선분위뇌간경사조화비뇌간경사조，연후근거시부반유당뇨병분위뇌간경사반당뇨병조、뇌간경사불반당뇨병조、비뇌간경사반당뇨병조화비뇌간경사불반당뇨병조。다보륵초성검측경동맥내막일중막후도（intima-media thickness，IMT）화학정경동맥죽양경화；미산가권성상학정뇌간경사급기부위；자공진혈관조영（magnetic resonance angiophy，MRA）검측기저동맥죽양경화。다변량logistic회귀분석사선영향뇌간경사적불동위험인소。개량Rankin량표(modified Rankin Scale，mRS)평분평개신경공능결손。결과 공납입286례급성뇌경사환자：뇌간경사63례，기중34례반유당뇨병；비뇌간경사223례，기중77례반유당뇨병。뇌간경사조당뇨병（54.0％대34.5％，x2=7.816，P=0.005）、기왕뇌경사（38.1％대24.2％,x2=4.771，P=0.029）、기저동맥죽양경화（73.0％대57.4％，x2=5.028，P=0.025）비례이급당화혈홍단백（hemoglobin AIC，HbA1c）[(7.30 ±2.42)％대(6.46±1.82)％，t=-2.531，P=0.011]화재지단백B（apoproteinB，ApoB）[(0.97±0.33) mmol/L대(0.90±0.34) mmol/L，t=-2.180，P=0.029]수평균현저고우비뇌간경사조。다변량logistic회귀분석표명，당뇨병（우세비2.150，95％가신구간1.214～3.808;P =0.009）화기왕뇌경사(우세비1.835，95％가신구간1.004～3.352，P=0.048)시뇌간경사적독립위험인소。재반당뇨병적뇌간경사조、불반당뇨병적뇌간경사조、반당뇨병적비뇌간경사조화불반당뇨병적비뇌간경사조지간，HbA1c( P＜0.001)、공복혈당（fasting blood glucose，FBG）(P＜0.001)、ApoB(P =0.007)화고밀도지단백일담고순(P=0.018)수평이급기저동맥죽양경화비례(P=0.001)균존재현저차이，기중뇌간경사반당뇨병조HbA1c[ (8.81±2.36)％]、FBG[ (8.23 ±3.12) mmol/L]화ApoB[(1.04±0.41) mmol/L]수평이급기저동맥죽양경화비례(85.3％)최고。여비당뇨병뇌간경사상비，당뇨병뇌간경사환자뇌교경사경위다견(79.4％，P =0.039)。결론 당뇨병여뇌간경사관계밀절，당뇨병경용역도치뇌교경사。
Objective To investigate the correlation between diabetes and brainstem infarction. Methods The diagnozed patients with acute cerebral infarction were recruited in the study. Firstly, they were divided into brainstem infarction group and non-brainstem infarction group, and then they were redivided into brainstem infarction with diabetes, brainstem infarction without diabetes, non-brainstem infarction with diabetes and non-brainstem infarction without diabetes groups according to whether they had diabetes or not. Carotid artery intima-media thickness (IMT) and carotid atherosclerosis were detected and identified with Doppler ultrasound; brain stem infarction and its location were identified with diffusion-weighted imaging; basilar artery atherosclerosis was detected with magnetic resonance angiography (MRA). A multivariate logistic regression analysis was used to screen the different risk factors impacting brainstem infarction. Neurological deficit was evaluated with the modified Rankin Scale (mRS)scores. Results A total of 286 patients with acute cerebral infarction were recruited: brain stem infarction in 63, and 34 of them with diabetes; non-brain stem infarction in 223, and 77 of them with diabetes. The proportions of diabetes (54. 0％ vs. 34. 5%, x2 = 7. 816, P = 0. 005),previous cerebral infarction (38. 1％ vs. 24. 2％ ,x2 =4. 771, P =0. 029), basilar artery atherosclerosis (73.0％ vs. 57. 4％,x2 =5. 028, P =0. 025), as wall as the levels of hemoglobin A1C (HbA1c) (7. 30 ± 2. 42％ vs. 6. 46 ± 1.82％, t = - 2. 531, P = 0. 011 ) and apolipoprotein B (ApoB) (0. 97 ± 0. 33 mmol/L vs. 0. 90 ± 0. 34 mmol/L, t = -2. 180, P = 0. 029) in the brainstem infarction group were significantly higher than those in the non-brainstem infarction group. Multivariate logistic regression analysis showed that diabetes (odds ratio [ OR] 2. 150, 95％confidence interval [ CI] 1. 214-3. 808; P =0. 009) and previous cerebral infarction (OR 1. 835, 95％ CI 1.004-3. 352, P = 0. 048) were the independent risk factors for brainstem infarction. There were significant differences in the levels of HbA1c (P ＜ 0. 001 ), fasting blood glucose (FBG) (P ＜0. 001), ApoB (P =0. 007) and high-density lipoprotein cholesterol (P =0. 018) as well as the proportion of basilar artery atherosclerosis (P = 0. 001 ) among the brainstem infarction with diabetes, without diabetes, non-brainstem infarction with diabetes and without diabetes groups. The levels of HbA1c (8. 81 ±2. 36％), FBG (8. 23 ±3. 12 mmol/L andApoB (1.04 ± 0. 41 mmol/L) as well as the proportion of basilar artery atherosclerosis (85. 3％ )were the highest in the brainstem infarction with diabetes group. Conclusions Diabetes is closely associated with brainstem infarction. Diabetes is more likely to result in pontine infarction.