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目的观察糖尿病肾病患者脑血管特点及其危险因素。方法将l35例2型糖尿病患者,根据尿蛋白水平分为正常蛋白尿组(DM)、微量蛋白尿组(DN-Ⅲ)、大量蛋白尿组(DN-IV)、肾衰竭组(DN-V)四组。用经颅多普勒超声检测各组患者颈内动脉及椎基底动脉系统的搏动指数(PI)、平均血流速度(Vm)。结果 DN-V组左右大脑中动脉、大脑后动脉及基底动脉的反映血管弹性的搏动指数高于其余各组(P<0.05)。随着肾病进展,大脑后动脉平均血流速度明显下降(P<0.05)。多元逐步回归分析显示年龄、血肌酐、收缩压、糖尿病病程是PI值的独立危险因素(P<0.05)。年龄、尿蛋白是Vm的独立危险因素(P<0.05)。结论随着糖尿病肾病进展,尿蛋白的增加,糖尿病患者脑血管弹性减弱,脑血流速度减慢。年龄、血肌酐、收缩压、糖尿病病程、尿蛋白是糖尿病肾病患者脑血管异常的独立危险因素。
Objective To observe the characteristics of cerebrovascular and its risk factors in patients with diabetic nephropathy. Methods Thirty-five patients with type 2 diabetes mellitus (T2DM) were divided into four groups according to urinary protein levels: normal proteinuria group (DM), microalbuminuria group (DN-Ⅲ), massive proteinuria group )Four groups. The transcatheter Doppler echocardiography was used to detect the pulsatility index (PI) and mean blood flow velocity (Vm) of the internal carotid artery and vertebrobasilar artery in each group. Results The pulsatility index reflecting the elasticity of blood vessels in the middle cerebral artery, posterior cerebral artery and basilar artery in DN-V group was higher than those in other groups (P <0.05). With the progression of nephropathy, the average velocity of posterior cerebral artery blood flow decreased significantly (P <0.05). Multivariate stepwise regression analysis showed that age, serum creatinine, systolic blood pressure, and diabetes duration were independent risk factors for PI (P <0.05). Age, urinary protein was an independent risk factor for Vm (P <0.05). Conclusion With the progress of diabetic nephropathy and the increase of urinary protein, the cerebral vascular elasticity of diabetic patients is weakened and the cerebral blood flow velocity is slowed down. Age, serum creatinine, systolic blood pressure, duration of diabetes and urinary protein were independent risk factors of cerebrovascular abnormalities in patients with diabetic nephropathy.