| Type 2 diabetes mellitus is a common disease,cerebral infraction is one of macrovascular complications,which is one of the main causes of death and disability in patients with diabetes mellitus.UKPDS and ADVANCE report: the incidence rate of macrovascular complications in type 2 diabetes mellitus is high,intensive glucose therapy for macrovascular complications has no significant effect.We should pay attention to the prevention of macrovascular complication,it is necessary to prevent the occurrence of cerebral infraction with early screening and treatment for type 2 diabetes mellitus.Presently,it is recognized that the pathological changes of type 2 diabetes mellitus complicated with cerebral infraction is atherosclerosis,Vascular endothelial cells are damaged,leading to stenosis,resulting in the formation of local thrombosis.Atherosclerosis,especially carotid atherosclerosis,carotid atherosclerotic stenosis or plaque shedding is the main reason of ischemic stroke.The study found that,patients of type 2 diabetes mellitus complicated with cerebral infraction usually have abnormal changes in the vascular endothelial cell system,coagulation and fibrinolysis system.Currently,von Wille brand factor(vWF)is recognized as a marker of vascular endothelial injury and dysfunction,is closely related to the occurrence and prognosis of arterial thrombotic disease.A number of clinical studies have shown that the level of plasma vWF in patients with acute cerebral infarction was significantly higher,suggesting that elevated levels of vWF may be associated with pathologic status of ischemic stroke.According to the relevant literature,during the acute cerebral infarction,the body is in a state of high coagulation,Antithrombin(AT)is consumed in large quantities,resulting in intravascular coagulation hyperthyroidism.At the same time,AT synthesis is reduced.It is suggested that AT is involved in the pathophysiological process of coagulation disorder in cerebral infarction.At present,the mechanism oftype 2 diabetes mellitus complicated with cerebral infraction is still not entirely clear,Its pathogenesis is multi-factor,multi-link cross.Therefore,realizing the pathogenesis of type 2 diabetes mellitus complicated with cerebral infarction will be the key to targeted treatment.Objective:This study was to investigate the correlation between carotid atherosclerosis and vWF and AT in patients of type 2 diabetes mellitus complicated with cerebral infraction.To explore its role and clinical significance in the development and progression of type 2 diabetes mellitus complicated with cerebral.And to explore the mechanism of diabetic cerebral infarction.Thus,to provide a basis for the prevention and treatment of carotid atherosclerosis and cerebral infarction in patients with type 2 diabetes mellitus.Methods:A total of 125 patients were enrolled in the Central Hospital of Chengde from December 2015 to May 2016.Divided into three groups(1)type 2 diabetes mellitus complicated with cerebral infraction group(DMCI group),n=44;(2)type 2 diabetes mellitus group(DM group),n=51;(3)control group(CN group),n=30,health people who takes physical examination in the physical examination center.According to whether or not carotid atherosclerotic plaque,each group was divided into arterial plaque group(EAP group),no arterial plaque group(NAP group);then according to the character of the arterial plaque,the EAP group was divided into stable plaque group(SP group),no plaque group(USP group).All selectes did not take antiplatelet,anticoagulant and thrombolytic drugs for nearly a month.Three groups are comparable in age,gender and so on.Selectedthe history of all objects,measure and record height,weight,blood pressure,history of smoking,calculate body mass index(BMI).Extraction of fasting vein blood,plasma vWF levels were measured by immunoturbidimetry;Plasma AT level was measured by chromogenic substrate method;Glycosylated Hemoglobin(HbA1c)Levels were measured by liquid chromatography;triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(lDL-C),were measured by automatic biochemical analyzer;three groups of carotid plaques were detected by color Doppler ultrasonography.SPSS19.0 software was used for statistical analysis,metric data in accordance with the normal distribution are expressed as mean ± standard deviation(?),comparison between the two groups using t test,comparison between the three groups using variance analysis(multiple comparision using LSD method),count data using ?~2 test,P<0.05 was statistically significant.Result:1.Comparison of general information between the three groups(1)There was no significant difference in age,history of smoking and BMI between the three groupsP=0.522 ? P=0.1(P > 0.05);There was no significant difference in gender and history of smoking between the three groups,?~2=3.56,P=0.169(P>0.05)??~2=2.688,P=0.1261(P>0.05).(2)The duration of DM in DMCI group was longer than that in DM groupP=0.043(P<0.05);2.Comparison of biochemical indexes between the three groupsThe difference of vWF,AT,HbA1 c,TC and HDL-C between the three groups was statistically significant(P<0.05);The difference ofTG,LDL-C between the three groups was not significant(P>0.05);Comparison between groups:The levels of vWF,HbA1 c and TC in DMCI group were higher than those in DM group and CN group(P<0.05 ? P<0.01),and DM group was higher than CN group(P<0.05 ? P<0.01);The AT and HDL-C of DMCI group were lower than DM group and CN group(P<0.05 ? P<0.01),and DM group was lower than CN group(P<0.05).3.Comparison of ultrasound indexes between three groups(1)Comparison of carotid plaque detection rates in three groups of patients The difference of carotid plaque detection rate between the three groups was statistically significant(P<0.01);Comparison between groups:The detection rate of carotid plaque in DMCI group and DM group was higher than that in CN group(?~2=27.81,P<0.01??~2=4.67,P<0.05);The detection rate of carotid plaque in DMCI group was higher than that in DM group(?~2=13.44,P <0.01).(2)Comparison of detection rate of carotid plaques with different propertiesin three groups of patientsThe difference of the detection rate of carotid arteries in three groups was statistically significant(P<0.01);Comparison between groups:The detection rate of carotid artery instability in DMCI group was higher than that in DM group and CN group(?~2=5.77,P<0.05??~2=8.51,P<0.01);The detection rate of carotid artery instability in DM group was higher than that in CN group,but the difference was not statistically significant(?~2=1.59,P> 0.05).4.The relevance of the indicators in patients of DMCI group(1)The relationship between vWF level and carotid plaque in DMCI group(?)The level of vWF in DMCI group was significantly higher than that in DM group(P<0.05).DMCI group of patients with unstable plaque vWF levels were significantly higher than the stable plaque,plaque-free patients with vWF levels,the difference was statistically significant(P=0.023,P<0.05 ?P=0.016,P<0.01);there was no significant difference in vWF level between patients with stable plaque and vWF level in plaque-free patients(P =0.129,P> 0.05).(2)The relationship between AT level and carotid plaque in DMCI group(?)The level of AT in DMCI group was significantly lower than that in DM group(P<0.05).The AT level of patients with unstable plaque in DMCI group was lower than that in stable plaque and plaque-free patients(P=0.038,P<0.05?P=0.02,P<0.05).There was no significant difference in AT level between patients with stable plaque and AT level without plaque(P =0.129,P> 0.05).Conclusion:1 The rate of carotid atherosclerotic plaque in patients with type 2 diabetes mellitus complicated with cerebral infarction was significantly higher.2 Plasma vWF levels in patients with type 2 diabetes mellitus complicated with cerebral infarction were associated with carotid atherosclerosis,and plasma vWF levels were significantly higher in patients with unstable plaque.To a certain extent,plasma vWF levels can reflect the nature of carotid atherosclerotic plaques.3 Plasma AT levels in patients with type 2 diabetes mellitus complicated with cerebral infarction were associated with carotid atherosclerosis,and plasma AT levels were significantly reduced in patients with unstable plaque,To a certain extent,plasma AT levelscan reflect the nature of carotid atherosclerotic plaques.Plasma AT reduction in type 2 diabetes may contribute to the progression of atherosclerosis,leading to the occurrence of cerebral infarction.4 The more severe vascular endothelial injury in type 2 diabetes mellitus with acute cerebral infarction,the more unstable the carotid atherosclerotic plaque.Reduce the level of vWF,increase the level of AT,is a great significancefor the prevention and treatment of type 2 diabetes in patients with carotid atherosclerosis and cerebral infarction. |
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