脑梗死合并2型糖尿病颅内外动脉粥样硬化性狭窄的特征分析

白立炜 王 迪 尹清风 陈雪辉 徐 云

新乡医学院第一附属医院，河南卫辉 453000

作者简介：白立炜，Email：13937350567@163.com

 

【摘要】 目的 分析脑梗死合并2型糖尿病颅内外动脉粥样硬化性狭窄的特征。方法 回顾分析新乡医学院第一附属医院2014-01—2016-01治疗的174例脑梗死合并2型糖尿病患者的临床资料，所有患者符合2型糖尿病和脑梗死诊断标准，并接受DSA检查，对颅内外动脉粥样硬化性狭窄的特征进行分析。结果 颈内动脉颅外段和大脑前动脉是受累较多的血管，且后循环血管闭塞发生率明显低于前循环，颅外血管闭塞发生率明显低于颅内血管(P＜0.05)。前后循环血管狭窄情况比较差异有统计学意义(P＜0.05)。结论 脑梗死合并2型糖尿病患者存在明显的颅内外动脉粥样硬化性狭窄，针对相关危险因素采取相应措施，有助于治疗效果的改善。

【关键词】 脑梗死；脑卒中；2型糖尿病；动脉粥样硬化性狭窄；影响因素

【中图分类号】  R473.33    【文献标识码】  A    【文章编号】  1673-5110(2019)03-0273-08  DOI：10.12083/SYSJ.2019.03.052

 

BAI Liwei，WANG Di，YIN Qingfeng，CHEN Xuehui，XU Yun

The First Affiliated Hospital of Xinxiang Medical College，Weihui 453000，China

【Abstract】  Objective  To investigate the characteristics and influencing factors of intracranial and extracranial atherosclerotic stenosis in patients with cerebral infarction complicated with type 2 diabetes.Methods  The clinical data of 174 patients with cerebral infarction complicated with type 2 diabetes treated by the First Affiliated Hospital of Xinxiang Medical College from January 2014 to January 2016 were retrospectively analyzed.All patients met the diagnostic criteria for type 2 diabetes and cerebral infarction，and received DSA examination.The characteristics and influencing factors of intracranial and extracranial atherosclerotic stenosis were analyzed by regression analysis.Results  The extracranial segment of the internal carotid artery and the anterior cerebral artery were involved in many vessels，and the incidence of posterior circulation vascular occlusion was significantly lower than that of the anterior circulation.The incidence of extracranial vascular occlusion was significantly lower than that of intracranial vessels (P＜0.05)．There were significant differences in the circulatory stenosis before and after (P＜0.05)．Conclusion There are obvious intracranial and extracranial atherosclerotic stenosis in patients with cerebral infarction complicated with type 2 diabetes.Corresponding measures are taken for the related risk factors，which is helpful for the improvement of treatment effect.

【Key words】  Cerebral infarction；Stroke；Type 2 diabetes；Atherosclerotic stenosis；Influencing factors

 

        脑卒中是一种致残率和病死率较高的神经系统疾病，严重降低患者的生存质量，并给患者的家庭造成巨大的经济和心理负担^[1-2]。随着人们生活方式的改变、生活节奏及老龄化进程的加快，2型糖尿病的发生率明显升高，成为临床医师广泛关注的一项公共卫生问题^[3]。流行病学研究证实，脑梗死合并2型糖尿病呈现出逐年上升的趋势，对患者的身心健康造成严重影响^[4]。糖尿病的发生会增加心脑血管疾病风险，而心脑血管疾病的出现又会加重糖尿病症状，最终形成恶性循环^[5-6]。本研究对脑梗死合并2型糖尿病患者颅内外动脉粥样硬化性狭窄的特征进行分析。

 

1．1  一般资料 回顾性分析新乡医学院第一附属医院2014-01—2016-01治疗的174例脑梗死合并2型糖尿病患者的临床资料，男102例，女72例，年龄56～72岁，平均63.4岁。所有患者确诊为2型糖尿病和脑梗死，且符合《中国急性缺血性脑卒中诊治指南2010》及世界卫生组织制定的2型糖尿病诊断标准^[7]，即空腹血糖7.0 mmol/L以上或任意时间血清葡萄糖水平11.1 mmol/L以上。统计饮酒、吸烟、高脂血症、高血压、甘油三酯、血清胆固醇、性别和年龄等基本资料，18例(10.3%)有饮酒史，40例(23.0%)吸烟史。

1．2 方法 所有患者接受DSA检查，检查设备为德国西门子血管造影仪，按照北美症状性颈动脉内膜切除手术相关标准开展临床研究，分别接受头颈部两侧动脉检查，即颅外动脉和颅内动脉，颅外动脉狭窄情况评价标准：狭窄程度(%)＝[(狭窄远端动脉直径-最狭窄处的直径)/狭窄远端的动脉直径]×100%。按照阿司匹林和华法林等对于颅内动脉病变的相关诊断标准，评价颅内动脉狭窄程度：狭窄程度(%)＝(1-狭窄段最窄处的直径/同处正常的直径)×100%。

1．3  效果评价 计算颅内外动脉粥样硬化性狭窄率，血管狭窄的认定标准：100%为完全闭塞，70%以上为重度闭塞，50%～70%为中度闭塞，50%以下为轻度闭塞。

1．4  统计学方法 运用SPSS 17.0软件处理数据，计数资料采用χ²检验，计量资料以均数±标准差(x±s)表示，采用单因素方差分析，P＜0.05为差异有统计学意义。

 

2．1  脑血管闭塞和狭窄情况  颈内动脉颅外段和大脑前动脉是受累较多的血管，且后循环血管闭塞发生率明显低于前循环，颅外血管闭塞发生率明显低于颅内血管，前后循环颅内血管闭塞发生情况比较差异有统计学意义(P＜0.05)。见表1。

2．2  动脉狭窄特征 脑梗死合并2型糖尿病患者后循环脑血管病变分布明显少于前循环，前后循环血管狭窄情况比较差异有统计学意义(P＜0.05)。见表2。

表1  脑血管闭塞或狭窄情况  [n(%)]

Table 1  Cerebral vascular occlusion or stenosis  [n(%)]

表2  脑梗死合并2型糖尿病患者动脉狭窄特征  [n(%)]

Table 2  Characteristics of arterial stenosis in patients with cerebral infarction complicated with type 2 diabetes  [n(%)] 

        高血糖是诱发脑卒中神经功能恶化以及不良预后的一种高危因素^[8-15]。缺血性脑卒中是糖尿病的常见血管并发症类型^[16-28]，能够加快血管内皮功能障碍和动脉粥样硬化形成，进而加重糖尿病血管并发症。糖尿病增加心脑血管疾病风险，而心脑血管疾病又会加重糖尿病症状，最终形成恶性循环^[29-35]。脑血管结构和功能的改善有助于神经功能及脑灌注的维持，对于糖尿病血管并发症患者神经功能的影响较为显著^[36-44]。

        本研究对脑梗死合并2型糖尿病患者的颅内外动脉粥样硬化特征进行了分析，从动脉狭窄分布情况看，累及后循环32例，前循环92例，动脉同时累及前后循环50例，分析前后循环受累差异的主要原因：糖尿病患者发生小血管病变后，颅外静脉和颅内大动脉的障碍发生时间相对晚于颅内小动脉^[45-60]，同时患者通常缺少相应的侧支循环，一旦脑干和脑部白质发生深穿支动脉受累，则会出现脑组织缺血、缺氧坏死症状^[61-70]。从前后循环颅内外动脉粥样硬化性狭窄的基本特征来看，重度狭窄、中度狭窄和轻度狭窄的发病率相对更高，且颈内动脉颅外段和大脑前动脉段等部位血管容易受累^[71-80]。

        研究报道，不同民族和种族人口的脑动脉粥样硬化的斑块分布情况存在较大差异^{[15-16，81-84]}，非美种族、西班牙、日本和中国地区人群颅内血管疾病发生率相对较高，而高加索人群的颅外血管疾病发生率相对较高。一项针对亚洲人群开展的研究证实，颅内粥样硬化性疾病是较为常见的缺血性脑卒中和TIA诱发因素^[17-18]。本研究也得出，颅内血管闭塞和血管狭窄发生率均显著高于颅外血管。糖尿病患者通常存在多发动脉粥样斑块和颈动脉狭窄，其中双侧颈内动脉床突段(C5)和海绵窦段(C4)是斑块发生率较高的部位，且以C4段发病率最高。同时，本研究还表明，eICAD和ACA是糖尿病患者脑动脉粥样硬化性狭窄发生率相对较高的部位，从脑血管狭窄病变的位置分布情况来看，后循环的发病率相对低于前循环，这一结果也与以往报道相似，小血管脑卒中及小脑、脑干和PCA等后循环的脑卒中发病率明显低于MCA和ACA等前循环血管^[19-20]。

        2型糖尿病患者通常存在多发动脉粥样斑块和颈动脉狭窄^[21]，且主要出现在双侧颈内动脉床突段和海绵窦段^[22-23]。由于2型糖尿病患者的动脉硬化症状会对较小的血管产生直接影响，因而其颅内小动脉血管内皮细胞作用受阻也通常早于颅外动脉以及颅内大动脉^[24-25]。2型糖尿病患者的小血管病变常累及脑干的深穿支动脉以及大脑深部的白质^[26]，因缺少充分的侧支循环，一旦发生血管病变，则会导致缺血缺氧性坏死，本研究中后循环颅内段血管闭塞的发生率最高^[27-29]。

        颈内动脉颅外段和大脑前动脉是受累较多的血管类型，且后循环血管闭塞发生率明显低于前循环，颅外血管闭塞发生率明显低于颅内血管，前后循环颅内血管闭塞发生情况有显著差异(P＜0.05)。脑梗死合并2型糖尿病患者后循环脑血管病变分布明显少于前循环，前后循环血管狭窄情况比较差异有统计学意义(P＜0.05)。依据诱发因素的不同，采取针对性的治疗和控制措施，才能有效改善患者预后。

 

[1]  PRABHAKARAN S，RUFF I，BERNSTEIN R A．Acute stroke intervention：a systematic review[J]．JAMA，2015，313(14)：1 451-1 462.

[2]  BENJAMIN E J，VIRANI S S，CALLAWAY C W，et al.Heart disease and stroke statistics-2018 update：a report from the American Heart Association[J]．Circulation，2018，137(12)：e67-e492.

[3]  DEFRONZO R A，FERRANNINI E，GROOP L，et al.Type 2 diabetes mellitus[J]．Nature reviews Disease primers，2015，1：15019.

[4]  UMEMURA T，KAWAMURA T，HOTTA N．Pathogenesis and neuroimaging of cerebral large and small vessel disease in type 2 diabetes：a possible link between cerebral and retinal microvascular abnormalities[J]．J Diabetes Invest，2017，8(2)：134-148.

[5]  DALE C E，FATEMIFAR G，PALMER T M，et al.Causal associations of adiposity and body fat distribution with coronary heart disease，stroke subtypes，and type 2 diabetes mellitus：a Mendelian randomization analysis[J]．Circulation，2017，135(24)：2 373-2 388.

[6]  MICHA R，PEALVO J L，CUDHEA F，et al.Association between dietary factors and mortality from heart disease，stroke，and type 2 diabetes in the United States[J]．JAMA，2017，317(9)：912-924.

[7]  American Diabetes Association.Classification and diagnosis of diabetes[J]．Diabetes Care，2017，40(Supplement 1)：S11-S24.

[8]  BOEHME A K，ESENWA C，ELKIND M S V．Stroke risk factors，genetics，and prevention[J]．Circ Res，2017，120(3)：472-495.

[9]  ROQUER J，GIRALT-STEINHAUER E，CERD G，et al.Glycated hemoglobin value combined with initial glucose levels for evaluating mortality risk in patients with ischemic stroke[J]．Cerebrovasc Dis，2015，40(5/6)：244-250.

[10]  ARBOIX A．Cardiovascular risk factors for acute stroke：Risk profiles in the different subtypes of ischemic stroke[J]．World J Clin Cases，2015，3(5)：418. 

[1`]  BERKHEMER O A，FRANSEN P S S，BEUMER D，et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J]．N Engl J Med，2015，372(1)：11-20.

[12]  CHEN R，OVBIAGELE B，FENG W．Diabetes and stroke：epidemiology，pathophysiology，pharmaceuticals and outcomes[J]．Am J Med Sci，2016，351(4)：380-386.

[13]  BECKMAN J A，CREAGER M A．Vascular complications of diabetes[J]．Circ Res，2016，118(11)：1 771-1 785.

[14]  VAN ELDEREN S G C，BRANDTS A，WESTENBERG J J M，et al.Aortic stiffness is associated with cardiac function and cerebral small vessel disease in patients with type 1 diabetes mellitus：assessment by magnetic resonance imaging[J]．Eur Radiol，2010，20(5)：1 132-1 138.

[15]  KIM J S，KIM Y J，AHN S H，et al.Location of cerebral atherosclerosis：why is there a difference between east and west？[J]．Int J Stroke，2018，13(1)：35-46.

[16]  GUTIERREZ J，ELKIND M S V，VIRMANI R，et al.A pathological perspective on the natural history of cerebral atherosclerosis[J]．Int J Stroke，2015，10(7)：1 074-1 080.

[17]  MEERWALDT R，LINKS T P，GRAAFF R，et al.Increased accumulation of skin advanced glycation end-products precedes and correlates with clinical manifestation of diabetic neuropathy[J]．Diabetologia，2005，48(8)：1 637-1 644.

[18]  MI D，ZHANG L，WANG C，et al.Impact of metabolic syndrome on the prognosis of ischemic stroke secondary to symptomatic intracranial atherosclerosis in Chinese patients[J]．PLoS One，2012，7(12)：e51421. 

[19]  North America Symptomatic Carotid Endarterectomy Trial Steering Committee.North America Symptomatic Carotid Endarterectomy Trial：methods，patient characteristics and progress[J]．Stroke，1991，22：711-720.

[20]  ALONSO N，TRAVESET A，RUBINAT E，et al.Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy[J]．Cardiovasc Diabetol，2015，14(1)：33.

[21]  TOTH C，MAWANI S，BRADY S，et al.An enriched-enrolment，randomized withdrawal，flexible-dose，double-blind，placebo-controlled，parallel assignment efficacy study of nabilone as adjuvant in the treatment of diabetic peripheral neuropathic pain[J]．PAIN，2012，153(10)：2 073-2 082.

[22]  YEOH S Y，CHANG Z P，SILIM A H，et al.Blinding ignorance：central retinal artery occlusion and orbital apex syndrome complicated with cavernous sinus thrombosis after tooth extraction[J]．Eye South East Asia，2018，13(2)：8-13.

[23]  OKON E B，CHUNG A W Y，RAUNIYAR P，et al.Compromised arterial function in human type 2 diabetic patients[J]．Diabetes，2005，54(8)：2 415-2 423.

[24]  WONG K S，LI H．Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis[J]．Stroke，2003，34(10)：2 361-2 366.

[25]  PUTAALA J，CURTZE S，HILTUNEN S，et al.Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke：the Helsinki Young Stroke Registry[J]．Stroke，2009，40(8)：2 698-2 703.

[26]  WANG M，NORMAN J E，SRINIVASAN V J，et al.Metabolic，inflammatory，and microvascular determin-ants of white matter disease and cognitive decline[J]．Am J Neurodegener Dis，2016，5(5)：171.

[27]  HERNNDEZ-PREZ M，PREZ DE LA OSSA N，ALEU A，et al.Natural history of acute stroke due to occlusion of the middle cerebral artery and intracranial internal carotid artery[J]．J Neuroimaging，2014，24(4)：354-358.

[28]  CHIMOWITZ M I，LYNN M J，TURAN T N，et al.Design of the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis trial[J]．J Stroke Cerebrovasc Dis，2011，20(4)：357-358.

[29]  SHOBHA N，BHATIA R，BOYKO M，et al.Outcomes in acute ischemic strokes presenting with disabling neurologic deficits without intracranial vascular occlusion[J]．Int J Stroke，2011，6(5)：392-397.

[30]  周锦霞，郑丽芳，胡倩，等．LP-PLA2、hs-CRP、NLR预测动脉粥样硬化性脑梗死后患者预后转归的临床价值[J]．河北医药，2019，41(3)：379-383.

[31]  申越．高原地区动脉粥样硬化性脑梗死患者与颈动脉内中膜增厚的关系[J]．健康前沿，2019，28(3)：297.

[32]  杨静，史兆春，戚志强，等．急性脑梗死患者γ-谷氨酰转移酶与颅内外动脉狭窄的关系研究[J]．卒中与神经疾病，2019，26(1)：93-95.

[33]  葛永桂，郭婷婷，王玉洁．影响大脑中动脉狭窄后侧支循环建立的因素及其研究进展[J]．中华老年心脑血管病杂志，2019，21(2)：211-213.

[34]  陈苑，恽文伟，张敏，等．大脑中动脉粥样硬化性狭窄所致脑梗死的病损模式及预后的相关分析[J]．系统医学，2019，4(3)：34-37.

[35]  WEI M，MA Y，YIN L．Endovascular treatment for atherosclerotic stenosis within V3 segment of a hypoplastic vertebral artery：Case report[J]．Medicine (Baltimore)，2018，97(42)：e12048.DOI：10.1097/MD.0000000000012048.

[36]  LIANG J，GUO J，LIU D，et al.Application of High-Resolution CUBE Sequence in Exploring Stroke Mechanisms of Atherosclerotic Stenosis of Middle Cerebral Artery[J]．J Stroke Cerebrovasc Dis，2019，28(1)：156-162.DOI：10.1016/j.jstrokecerebrovasdis.2018.09.021. 

[37]  CAI H，FU F，WANG Y，et al.Correlation between the stenosis degree of aorto-iliac artery and superior mesenteric artery in patients with lower extremity atherosclerotic occlusive disease by CT angiography[J]．Zhonghua Wei Zhong Bing Ji Jiu Yi Xue，2018，30(7)：635-639.DOI：10.3760/cma.j.issn.2095-4352.2018.07.004.

[38]  QI P，WANG J J，WANG L J，et al.Sole angioplasty with tiny balloon for high-risk complex symptomatic intracranial atherosclerotic stenosis[J]．Zhonghua Wai Ke Za Zhi，2018，56(6)：458-463.DOI：10.3760/cma.j.issn.0529-5815.2018.06.014.

[39]  ZHANG Z，CHEN XY，BAUM L，et al.Association Between the Apolipoprotein E Gene Polymorphism and Atherosclerotic Middle Cerebral Artery Stenosis[J]．Neurologist，2018，23(2)：47-50.DOI：10.1097/NRL.0000000000000164. 

[40]  GAO B L，LI Z S，LI T X，et al.Endovascular Treatment of Intracranial Aneurysms Concomitant with Severe Adjacent Atherosclerotic Stenosis[J]．World Neurosurg，2018，111：e927-e932.DOI：10.1016/j.wneu.2018.01.027.

[41]  ZHOU Y，WANG W，SHI Y，et al.Substantial atherosclerotic celiac axis stenosis is a new risk factor for biliary fistula after pancreaticoduodenectomy[J]．Int J Surg，2018，49：62-67.DOI：10.1016/j.ijsu.2017.11.054.

[42]  MENDOZA-ELIAS N，SHAKUR S F，CHARBEL F T，et al.Cerebral arteriovenous malformation draining vein stenosis is associated with atherosclerotic risk factors[J]．J Neurointerv Surg，2018，10(8)：788-790.DOI：10.1136/neurintsurg-2017-013580.

[43]  TROISI N，ERCOLINI L，CHISCI E，et al.Carbon-coated self-expandable stents in patients with atherosclerotic iliac artery disease[J]．Int Angiol，2018，37(1)：46-51.DOI：10.23736/S0392-9590.17.03885-8.

[44]  WANG J，WANG Y，CHAI Z，et al.Stenosis length of middle cerebral artery and branch atheromatous disease associated infarct[J]．Int J Neurosci，2018，128(2)：133-139.DOI：10.1080/00207454.2017.1377710.

[45]  LIU X，DORNBOS D 3rd，PU Y，et al.Collateral circulation alters downstream hemodynamic stress caused by intracranial atherosclerotic stenosis[J]．Neurol Res，2017，39(6)：498-503.DOI：10.1080/01616412.2017.1315483. 

[46]  HALPIN D，ERBEN Y，JAYASURIYA S，et al.Management of Isolated Atherosclerotic Stenosis of the Common Femoral Artery：A Review of the Literature[J]．Vasc Endovascular Surg，2017，51(4)：220-227.DOI：10.1177/1538574417702773.

[47]  CHE W Q，JIANG X J，DONG H，et al.Effect of stenting for the proximal atherosclerotic extracranial vertebral artery stenosis[J]．Zhonghua Xin Xue Guan Bing Za Zhi，2017，45(1)：34-38.DOI：10.3760/cma.j.issn.0253-3758.2017.01.007.

[48]  XU Y，L J H，MA L，et al.Quantitative Measurement of Cerebral Blood Flow in Enhanced Psedo-continuous Arterial Spin Labeling Perfusion Imaging in Patients with Intracranial Atherosclerotic Stenosis[J]．Zhongguo Yi Xue Ke Xue Yuan Xue Bao，2016，38(6)：679-685.DOI：10.3881/j.issn.1000-503X.2016.06.009. 

[49]  COGSWELL P M，DAVIS T L，STROTHER M K，et al.Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease[J]．J Magn Reson Imaging，2017，46(4)：1 167-1 176.DOI：10.1002/jmri.25602. 

[50]  ZHANG Q，DONG K，SONG H．Comparison of stent versus medical therapy for symptomatic patients with intracranial atherosclerotic stenosis：A meta-analysis[J]．J Neurol Sci，2017，372：272-278.DOI：10.1016/j.jns.2016.11.064.

[51]  AL SAID Y，KURDI K，BAEESA S S，et al.Outcome of intracranial arterial stenting of symptomatic atherosclerotic disease：A single center experience from Saudi Arabia[J]．Neurosciences (Riyadh)，2016，21(4)：366-371.DOI：10.17712/nsj.2016.4.20160199.

[52]  JIANG Y，PENG W，TENG Z，et al.Local blood pressure associates with the degree of luminal stenosis in patients with atherosclerotic disease in the middle cerebral artery[J]．Biomed Eng Online，2016，15(1)：67.DOI：10.1186/s12938-016-0202-1.

[53]  REHWALD R，PETERSEN J，GRATL A，et al.Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories[J]．BMJ Open，2016，6(6)：e010704.DOI：10.1136/bmjopen-2015-010704.

[54]  ZHANG F，LIU L．Complication of Stenting in Intracranial Arterial Stenosis[J]．Arch Iran Med，2016，19(5)：317-322.DOI：0161905/AIM.004.

[55]  ZHAO Y，JIN M，LIU Q，et al.A long-term follow-up results of Enterprise stent in treatment of severe symptomatic basilar artery atherosclerotic stenosis[J]．Zhonghua Nei Ke Za Zhi，2016，55(5)：372-376.DOI：10.3760/cma.j.issn.0578-1426.2016.05.008.

[56]  KIM G E，YOON W，KIM S K，et al.Incidence and Clinical Significance of Acute Reocclusion after Emergent Angioplasty or Stenting for Underlying Intracranial Stenosis in Patients with Acute Stroke[J]．AJNR Am J Neuroradiol，2016，37(9)：1 690-1 695.DOI：10.3174/ajnr.A4770.

[57]  SURI M F，QIAO Y，MA X，et al.Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population：The Atherosclerosis Risk in Communities Study[J]．Stroke，2016，47(5)：1 187-1 193.DOI：10.1161/STROKEAHA.115.011292.

[58]  METHAWASIN K，SUWANWELA N C，PHANTHUMCHINDA K．The 2-Year Outcomes Comparison between Ischemic Stroke Patients with Intracranial Arterial Stenosis without Significant Extracranial Carotid Stenosis and Patients with Extracranial Carotid Stenosis[J]．J Med Assoc Thai，2015，98 Suppl 9：S98-S105.

[59]  TURAN T N，LEMATTY T，MARTIN R，et al.Characterization of intracranial atherosclerotic stenosis using high-resolution MRI study--rationale and design[J]．Brain Behav，2015，5(12)：e00397.DOI：10.1002/brb3.397.eCollection 2015 Dec.

[60]  WANG X，WANG Z，WANG C，et al.Application of the Enterprise Stent in Atherosclerotic Intracranial Arterial Stenosis：A Series of 60 Cases[J]．Turk Neurosurg，2016，26(1)：69-76.DOI：10.5137/1019-5149.JTN.13350-14.1.

[61]  LI T X，GAO B L，CAI D Y，et al.Wingspan Stenting for Severe Symptomatic Intracranial Atherosclerotic Stenosis in 433 Patients Treated at a Single Medical Center[J]．PLoS One，2015，10(9)：e0139377.DOI：10.1371/journal.pone.0139377.

[62]  TENG Z，PENG W，ZHAN Q，et al.An assessment on the incremental value of high-resolution magnetic resonance imaging to identify culprit plaques in atherosclerotic disease of the middle cerebral artery[J]．Eur Radiol，2016，26(7)：2 206-2 214.DOI：10.1007/s00330-015-4008-5.

[63]  CHATTERJEE A R，DERDEYN C P．Stenting in Intracranial Stenosis：Current Controversies and Future Directions[J]．Curr Atheroscler Rep，2015，17(8)：48.DOI：10.1007/s11883-015-0527-4.

[64]  YOON W，KIM S K，PARK M S，et al.Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke[J]．Neurosurgery，2015，76(6)：680-686; discussion 686.DOI：10.1227/NEU.0000000000000694.

[65]  KIM S K，YOON W，HEO T W，et al.Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion[J]．AJNR Am J Neuroradiol，2015，36(7)：1 266-1 271.DOI：10.3174/ajnr.A4280.

[66]  ZHAO D L，DENG G，XIE B，et al.High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery[J]．J Clin Neurosci，2015，22(4)：700-704.DOI：10.1016/j.jocn.2014.10.018.

[67]  AHN S H，LEE J，KIM Y J，et al.Isolated MCA disease in patients without significant atherosclerotic risk factors：a high-resolution magnetic resonance imaging study[J]．Stroke，2015，46(3)：697-703.DOI：10.1161/STROKEAHA.114.008181.

[68]  JIA Z J，ZHAO R，YANG Z G，et al.Intracranial atherosclerotic middle cerebral arterial stenosis research based on 3.0 Tesla high-resolution magnetic resonance imaging：recent progress[J]．Nan Fang Yi Ke Da Xue Xue Bao，2015，35(1)：154-159.

[69]  LEUNG T W，WANG L，SOO Y O，et al.Evolution of intracranial atherosclerotic disease under modern medical therapy[J]．Ann Neurol，2015，77(3)：478-486.DOI：10.1002/ana.24340.

[70]  LIU C Y，CHEN C Q．Intra-and extracranial atherosclerotic stenosis in China：epidemiology，diagnosis，treatment and risk factors[J]．Eur Rev Med Pharmacol Sci，2014，18(22)：3 368-3 379.

[71]  XIONG Y，ZHOU Z，LIN H，et al.The safety and long-term outcomes of angioplasty and stenting in symptomatic intracranial atherosclerotic stenosis[J]．Int J Cardiol，2015，179：23-24.DOI：10.1016/j.ijcard.2014.10.081.

[72]  SUN D J，ZHUANG A X，ZENG Q H，et al.A study of microemboli monitoring of atherosclerotic thrombotic cerebral infarction and artery stenosis[J]．Genet Mol Res，2014，13(3)：6 734-6 745.DOI：10.4238/2014.August.28.17.

[73]  RYU C W，JAHNG G H，SHIN H S．Gadolinium enhancement of atherosclerotic plaque in the middle cerebral artery：relation to symptoms and degree of stenosis[J]．AJNR Am J Neuroradiol，2014，35(12)：2306-2310.DOI：10.3174/ajnr.A4038.

[74]  PARK J H，KWON H M，LEE J，et al.Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities[J]．Eur J Neurol，2015，22(1)：44-52，e2-3.DOI：10.1111/ene.12431.

[75]  HOLMSTEDT C A，TURAN T N，CHIMOWITZ M I．Atherosclerotic intracranial arterial stenosis：risk factors，diagnosis，and treatment[J]．Lancet Neurol，2013，12(11)：1 106-1 114.DOI：10.1016/S1474-4422(13)70195-9.

[76]  YANG F，LIU L，LI M，et al.Pattern of cerebrova-scular atherosclerotic stenosis in older Chinese patients with stroke[J]．J Clin Neurosci，2013，20(7)：979-983.DOI：10.1016/j.jocn.2012.09.017.

[77]  TANG H，VAN WALSUM T，HAMEETEMAN R，et al.Lumen segmentation and stenosis quantification of atherosclerotic carotid arteries in CTA utilizing a centerline intensity prior[J]．Med Phys，2013，40(5)：051721.DOI：10.1118/1.4802751.

[78]  BOATENG F K，GRECO B A．Renal artery stenosis：prevalence of，risk factors for，and management of in-stent stenosis[J]．Am J Kidney Dis，2013，61(1)：147-160.DOI：10.1053/j.ajkd.2012.07.025.

[79]  CHUNG S，VAFAI K．Low-density lipoprotein transport within a multi-layered arterial wall--effect of the atherosclerotic plaque/stenosis[J]．J Biomech，2013，46(3)：574-585.DOI：10.1016/j.jbiomech.2012.09.022.

[80]  DUMONT T M，KAN P，SNYDER K V，et al.Revisiting angioplasty without stenting for symptomatic intracranial atherosclerotic stenosis after the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) study[J]．Neurosurgery，2012，71(6)：1 103-1 110.DOI：10.1227/NEU.0b013e318271bcb8.

[81]  SHI M C，WANG S C，ZHOU H W，et al.Compensa-tory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis：a high-resolution MRI and microemboli monitoring study[J]．Neurol Res，2012，34(2)：153-158.DOI：10.1179/1743132811Y.0000000065.

[82]  常悦悦，余传庆，张梅，等．白细胞端粒长度与动脉粥样硬化性脑梗死患者脑动脉狭窄的相关性研究[J]．中国临床神经科学，2018，26(1)：15-24.

[83]  叶慧茸，王玉洁，仇建婷，等．动脉粥样硬化性颈内动脉狭窄与脑白质高信号关系分析[J]．中华老年心脑血管病杂志，2018，20(9)：949-952.

[84]  韩新生，张洪阳，韩苗，等．脑梗死患者血清Cat S及Cys C水平与颈动脉狭窄程度的相关性[J]．中国临床新医学，2018，11(9)：855-858.

(收稿2018-01-20)

本文责编：夏保军

本文引用信息：白立炜，王迪，尹清风，陈雪辉，徐云．脑梗死合并2型糖尿病颅内外动脉粥样硬化性狭窄的特征分析[J]．中国实用神经疾病杂志，2019，22(3)：273-280.DOI：10.12083/SYSJ.2019.03.052