青年脑卒中268例病因分析

Etiologic analysis of 268 stroke in youth

目的探讨青年脑卒中的病因,提高预防意识。方法回顾性分析268例青年脑卒中患者的病因,其中67例患者接受了数字减影血管造影(DSA)检查。结果本组268例青年脑卒中占我院同期全部住院脑卒中病例的9.92%(268/2701),青年脑卒中的发病率男性比例明显高于女性。268例中有明确病因者200例(74.63%),病因不明者68例(25.37%)。在268例青年脑卒中患者中,缺血性脑卒中129例,占48.13%。其中有明确病因者101例,占77.51%,包括动脉粥样硬化65例,占50.38%;栓塞性脑血管病18例,占13.95%;非动脉硬化性血管病10例,占7.75%;凝血机制异常4例,占3.1%;疑似遗传性脑动脉病1例,占1.55%;偏头痛性脑梗死3例,占2.32%;出血性脑卒中139例,占51.86%。其中有明确病因者99例,占71.22%,包括高血压病53例,占38.12%;颅内血管发育异常(动脉瘤、动静脉畸形、烟雾病、海绵状血管瘤、脑膜动静脉瘘)37例,占26.62%;其他病因(如颅内肿瘤等)9例,占6.48%,病因不明40例,占28.78%。结论青年缺血性脑卒中最主要的病因是动脉粥样硬化,其次是栓塞性脑血管病,其他病因如血管炎、烟雾病等较少见。青年出血性脑卒中最主要的病因是高血压病,其次是颅内血管发育异常。

Objective To investigate the etiology in young stroke. Method We analyzed 268 cases of young stroke retrospeceively in order to find the reason of the disease. Digital subtraction angiography （DSA） was performed in 67 cases. Results The group of 268 cases with young stroke comprised 9.92% （268/2701） in our hospital over the same period. The percentage of male cases was higher than that of female cases. Among the 268 cases, 200 cases were found to have etiologic factors （74.63%） and 68 cases were not found（25.73% ）. In 129 cases with ischemic stroke, 101 （77.51%） cases had a clear cause, including atherosclerosis in 65 （50.38 % ）, embolic cerebral artery disease in 18 （ 13.95 % ）, non-atherosclerosis artery disease in 10 （7.75%） , hemopathic disease or abnormality of clotting mechasim in 4 （3.1%） , suspected hereditary cerebral artery disease in 1 （ 1.55% ）, migraine cerebral infarction in 3 （2.32%）. In 139 cases with hemorrhagic stroke, 97 （71. 22% ） cases had a clear, including hypertension in 53 （38.12%） , intracranial blood vessel dysplasia （aneurysms, arteriovenous malformations, Moyamoya disease, cavernous angioma, dural arterivenous fistula） in 37 （26.62%）, other etiological factors （such as intracranial tumors, etc. ） in 9 （6.48%） ; 40 （28.78%） cases had unknown etiology. Conclusions The most important etiological factor in young ischemic stroke was atherosclerosis, followed by embolic cerebral artery disease; other factors （such as vasculitis, Moyamoya disease） are few. The main factor of young hem- orrhagic stroke was hypertension, followed by intracranial blood vessel dysplasia.