Association of Type 2 Diabetes Mellitus and Glycemic Control With Intracranial Plaque Characteristics in Patients With Acute Ischemic Stroke
Association of Type 2 Diabetes Mellitus and Glycemic Control With Intracranial Plaque Characteristics in Patients With Acute Ischemic Stroke
复制标题
2 型糖尿病和血糖控制与急性缺血性中风患者颅内斑块特征的关系
DOI：
10.1002/jmri.27614
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发表时间：
2021-03-31
影响因子：
4.4
通讯作者：
Zhu, Chengcheng
中科院分区：
文献类型：
--
作者：
Li, Xiao;Sun, Beibei;Zhu, Chengcheng
背景2型糖尿病（T2 DM）已被证明与颈动脉斑块易损性相关。然而，在这方面，2型糖尿病对颅内动脉粥样硬化的影响尚不清楚。目的评价急性缺血性卒中后患者的糖尿病和血糖控制与通过三维对比增强MR血管壁成像确定的颅内动脉粥样硬化斑块特征的相关性。研究类型前瞻性。8名有症状的颅内动脉粥样硬化斑块所致急性缺血性中风患者。场强/序列T1 WI容积各向同性快速自旋回波采集序列在3.0T。评估临床特征，血液生物标志物，颅内斑块数量、斑块强化评分及斑块特征（位置、管腔狭窄率、斑块内出血、长度、负荷、增强等级和比率）统计检验方差分析（ANOVA），Shapiro-Wilk正态性检验，Levene检验，ANOVA与Bonferroni事后检验，Kruskal沃利斯H检验与随后的成对比较，卡方与Bonferroni事后检验，广义线性回归，Pearson相关性检验，Kendall's W和组内相关系数。T2 DM组颅内斑块多于非T2 DM组（4.80 ± 2.22 vs. 3.60 ± 1.78，P < 0.05）。与控制良好的T2 DM和非T2 DM患者相比，控制不良的T2 DM患者表现出更高的罪犯斑块增强率（分别为2.32 +/- 0.61 vs. 1.60 +/- 0.62和1.39 +/- 0.39; P < 0.05）。多因素分析显示，调整其他临床变量后，T2 DM与颅内斑块数量增加独立相关（β = 0.269，P < 0.05），HbA 1c水平与罪犯斑块增强率独立相关（β = 0.641，P < 0.05）。较高的HbA 1c与较强的斑块增强相关。3D对比增强MR血管壁成像可能有助于更好地了解T2 DM和血糖控制与颅内斑块的相关性。证据等级1技术有效性阶段3
Background Type 2 diabetes mellitus (T2DM) has shown to be associated with carotid plaque vulnerability. However, the impact of T2DM on intracranial artery atherosclerosis is not well-understood.Purpose To evaluate the association of diabetes and glycemic control with intracranial atherosclerotic plaque characteristics identified by three-dimensional contrast enhanced MR vessel wall imaging in patients after acute ischemic stroke.Study Type Prospective.Population Two hundred and eighty-eight symptomatic patients with acute ischemic stroke due to intracranial atherosclerotic plaque.Field Strength/Sequence T1WI volume isotropic turbo spin-echo acquisition sequence at 3.0 T.Assessment Clinical profiles, blood biomarkers, the number of intracranial plaques, plaque enhanced score, and the features (location, luminal stenotic rate, intraplaque hemorrhage, length, burden, enhancement grade, and ratio) of culprit plaque (defined as the most stenotic lesion ipsilateral to the ischemic event) and nonculprit plaque were analyzed by three radiologists.Statistical Tests Analysis of variance (ANOVA), Shapiro-Wilk normality test, Levene's test, ANOVA with Bonferroni post-hoc test, Kruskal Wallis H test with subsequent pairwise comparisons, chi-square with Bonferroni post-hoc test, generalized linear regression, Pearson correlation test, Kendall's W and intra-class correlation coefficient.Results Two hundred and twenty-five participants (age 60 +/- 10 years, 58.7% male) with 958 intracranial plaques were included. More intracranial plaques were found in the T2DM group than the non-T2DM group (4.80 +/- 2.22 vs. 3.60 +/- 1.78, P < 0.05). Patients with poorly-controlled T2DM exhibited higher culprit plaque enhancement ratio than patients with well-controlled T2DM and non-T2DM (2.32 +/- 0.61 vs. 1.60 +/- 0.62 and 1.39 +/- 0.39; respectively, P < 0.05). After adjusting for other clinical variables, T2DM was independently associated with increased intracranial plaque number (beta = 0.269, P < 0.05), and HbA1c level was independently associated with culprit plaque enhancement ratio (beta = 0.641, P < 0.05) in multivariate analysis.Data Conclusion T2DM is associated with an increased intracranial plaque number. Higher HbA1c is associated with stronger plaque enhancement. 3D contrast enhanced MR vessel wall imaging may help better understand the association of T2DM and glycemic control with intracranial plaque.Level of Evidence 1Technical Efficacy Stage 3