颈动脉斑块LRNC特征可诊断2型糖尿病患者急性脑梗死的风险

2型糖尿病可能加重颈动脉斑块的易损性并增加缺血性中风的风险,关于2型糖尿病患者伴有颈动脉斑块特征的急性中风亚型鲜有研究报道。本研究旨在探讨2型糖尿病患者颈动脉斑块特征与MRI确定的急性脑梗死病变特征之间的关系。本研究以颈内动脉区急性脑血管病患者为研究对象,所有患者分为2型糖尿病组和非2型糖尿病组,分别行颈动脉和脑部MRI扫描,测定同侧颈动脉斑块的形态和特征,以及颅内和颅外颈动脉狭窄。基于中风亚型和急性脑梗塞病变模式对患者进行评估。研究结果表明,与非2型糖尿病患者相比,2型糖尿病患者颈动脉型IV-VI病变的患病率更高,斑块负荷更大,以及富脂质坏死核(LRNC)更大。在有症状的颈动脉LRNC患者中,与非2型糖尿病组相比,2型糖尿病组颈内动脉区出现较多的伴有大穿孔动脉梗塞形态和较大的急性脑梗塞。LRNC%>23.5%的颈动脉斑块是2型糖尿病患者存在颈动脉狭窄的急性脑梗塞病变的独立危险因素。颈动脉斑块特征的量化,尤其是MRI诊断的富脂质坏死核对中风风险具有潜在应用价值。

LRNC Feature of Carotid Artery Plaque might Diagnose the Risk of Acute Cerebral Infarction of Type 2 Diabetic Patients

Type 2 diabetes may aggravate the vulnerability of carotid plaque and increase the risk of ischemic stroke.There were few studies reported on the acute stroke subtype of type 2 diabetes patients with carotid artery plaque.The purpose of this study was to investigate the relationship between carotid arterial plaque features in patients with type 2 diabetes and the morbid characteristics of acute cerebral infarction identified by MRI.We studied patients with acute cerebral vascular disease in the area of internal carotid artery.All patients were divided into type 2 diabetes group and non-type 2 diabetes group,and the carotid artery and brain MRI scans were performed respectively to determine the morphology and characteristics of ipsilateral carotid artery plaques,as well as intracranial and extracranial carotid artery stenosis.Patients were assessed on the basis of stroke subtype and acute cerebral infarction disease patterns.The results showed that patients with type 2 diabetes had higher prevalence of carotid IV-VI lesions,greater plaque load,and larger lipid necrotic nucleus(LRNC)than those with non-type 2 diabetes.Among the symptomatic patients with carotid LRNC,there were more cases of large perforated artery infarction and larger acute cerebral infarction in the area of internal carotid artery in the type 2 diabetes group,compared with the non-type 2 diabetes group.Carotid plaque with LRNC%>23.5% is an independent risk factor for acute cerebral infarction lesions with carotid stenosis in type 2 diabetes.Quantification of carotid atherosclerotic plaque features,especially MRI diagnosis of lipid-rich necrotic nuclei has potential application value to stroke risk.