| With the development of life leve and the aging of the society, morbility of diabetes mellitus is increasing year by year.Type 2 diabetes mellitus is a globally epidemic non-infectious disease now, and has become the third leading cause of death following heart disease and cancer. Especial its chronic complications of diabetesis is a main factor increasing the mortality,the mutilation and high treatment outlay. In our country, cerebrovascular disease is the second causes of death in the town and the first in the coutry. The morbility of cerebrovascular disease with type 2 diabetes is obviously step up. Patients who have cerebrovascular disease with type 2 diabetes do not have typical symptom. Those who with asymptomatic cerebrovascular disease are occasionally overlooked, so it is often at their median or late stages of the dsease when be diagnosed.Objective:Type 2 diabetic patients complicated with cerebrovascular disease is more often than the non-diabetic patients, whose clinical symptom are not typical. cerebrovascular disease with type 2 diabetes often recurrent attacks and has poor prognosis. Thus, this papar study the clinical characteristics of the cerebral infarction in diabetic patients and find out the high-risk factors for acknowledging the high-risk people and guiding the clinical work.Materials and methods1. Subjects: Two hundred subjects with type 2 diabetes (100 patients with and 100 patients without cerebrovascular disease), as well as 100 nondiabetic cerebrovascular disease subjects, were recruited for this study.All of them were selected from Jilin University First Clinical Hospital from November,2005 to April,2006. Daibetes mellitus(A):100 patients (61 male and 39 female)who was han people and live in north,average aged 51.9 year old.Cerebral infarction(B): 100 patients (70 male and 30 female),average aged 59.95 year old.Daibetes mellitus with cerebral infarction(C): 100 patients (56male and 44 female),average aged 61.28 year old.2.Criteria of diagnosis:(1) The diagnosis of type 2 diabetes mellitus accorded with the new diagnostic criteria of WHO in 1999. (2)The diagnosis of cerebral infarction was defined according to the CT or MRI.. Excluding criteria:exclude type 1 diabetes and the irritability hyperglycaemia caused by cerebral infarction was excluded.3. Observation:We recorded observation including age, sex, course of disease, smoking (more then ten and continuous 3 month), drinking(more then 10 g/one day), history of coronary artery disease, cerebral infarction or hypertension, body mass index(BMI, BMI≥25kg/m2 is fate ), blood lipid, blood glucose (fasting blood glucose,postprandial blood sugar), urine protein, CT or MRI of head.4. Procedure of analysis: (1) Compare the differences of the common conditions, clinical manifestations, blood lipid between the A group and the C group. (2) Compare the differences of the common conditions, clinical manifestations, blood lipid, position of the pathological changes, complications between the B group and the C group.Results:1. Comparing the cases of the A group with the C group, it was different that they respectively aged 51.90±11.24 and 61.28±1.44 years old, course of disease (6.62±5.38 versus 8.51±6.32) also has significant statistical difference. Proportion(20%versus 36%) of smoking was also different (P<0.05), the patients who complicated with hypertension were 45% versus 67% (P<0.05) and complicated with coronary artery disease were 16% versus 32% (P<0.05). There were no different betwent A and C group in sex, BMI and drinking (P>0.05).Comparing the cases of the A group with the C group, percentage of cholesterol was 19.6% versus34.7%(P<0.05), very low density lipoprotein was 36.7% versus 45.7% (P<0.01), LP-A was 4.7% versus 14.0% (P<0.05). Postprandial blood sugar (13.34±4.0 versus 16.23±8.39) (P<0.01). Triglycerides, high-density lipoprotein, low-density lipoprotein, fasting blood glucose and urine protein had no significant statistical difference (P>0.05).After multivariate analysis, diabetes with cerebral infarction were associated with age (odds ratio [95% CI]: 1.101 (1.044 to 1.162); p<0.000),smoking (8.654 [2.518 to 29.750]; p<0.001),hypertension (3.023[1.111 to 8.230]; p=0.030),triglycerides (3.258[1.247 to 8.512]; P<0.016).2. Comparing the cases of the C group with B the group: Proportion (44% versus 30%) of female was alse different (P<0.05). the patients who complicated with coronary artery disease were 32% versus 14% , who complicated with fate were 63.8% versus 45.7%(P<0.05). Some parts such as age, waist circumference, BMI, smoking, drinking and hypertension were no different betwent C group and B group (P>0.05).Comparing the cases of the C group with the B group, percentage of cholesterol was 34.7% versus 11.2%, triglycerides was 47.9% versus 24.2%, low-density lipoprotein was 22.9% versus 8.1%, very low density lipoprotein was 45.7% versus19.8% (P<0.01). It was different that fasting blood glucose is respective 9.55±4.75mmol versus 5.62±0.66mmol/L (P<0.01), postprandial blood sugar (16.23±8.39 versus 8.57±1.94) also has significant statistical difference (P<0.01). Urine protein was 23% versus 11% (P<0.05). high-density lipoprotein and LP-A were no different betwent C group and B group (P>0.05).Comparing the cases of the C group with the B group, the rate ofthe symptomless cerebral infarction (some only dizziness or headache) is 41% versus23% (P<0.01). The other symptom such as disorders of consciousness, aphasia, TIA and paralysis are no difficutle between C goup and B goup. There were 51 (51%) cases that suffered from CI after cerebrovascular diseases in C group versus 20 (20%) cases in B group (P<0.01). The patients who complicated with infection were 29% versus 15% (P<0.05).Subcortical cerebral infarction was sorted according cerebral artery distribution: comparing the cases of the C group with the B group, the rate of lacunar infarction in deep cerebral artery is 69% versus 42% (P<0.01), the rate of no-lacunar infarction in deep cerebral artery is 19% versus 18% (P>0.05), the rate of watershed infarction (WI) and the rate of superficial cerebral artery is no different (P>0.05). Percentage of multiple cerebral infarctions was 82% versus 54% (P<0.01).Subcortical cerebral infarction was sorted according position of the brain: comparing the cases of the C group with the B group, the rate of cortical is 33% versus 38% (P>0.05), subcortical is 88% versus 68% (P<0.05), stem-cer is 20% versus 28%, other position is 16% versus 13% (P>0.05).Conclusions:1. Course of T2DM patients who suffered from cerebral infarction were long, proportion of female in C group was more thanA group.2. Age, smoking, hypertension and TG are the independence risk factor of daibetes with cerebral infarction.3. Hyperglycemia is the main feature, especially postprandial blood sugar.4. Symptom of diabetes with cerebral infarction was not obvious and. TC and MRI can diagnosis.5. The manifestations of type 2 diabetes combined with stroke were lacunose and multiple cerebral infarctions which usually occurred in basal ganglia and corona radiata where the boold supplied by the middle cerebral artery.6. Stroke patients of type 2 diabetes usuallily suffered infection fate and coronary artery disease.
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