中青年缺血性卒中的病因及危险因素分析

Analysis of the Etiology and Risk Factors of Ischemic Stroke in Young and Middle Adults

目的:分析中青年缺血性卒中的病因及危险因素。方法:中青年缺血性卒中318例,分为16～44岁组和45～54岁组,对患者临床资料进行回顾性分析,比较2组TOAST分型、人口学特征、危险因素及生化指标差异。结果:16～44岁组131例,45～54岁组187例;明确病因175例(55%),依次为:大动脉粥样硬化(38.3%),心源性栓塞(24.6%),小血管疾病(21.1)%,其他病因(16.0%);45～54岁组中,大动脉粥样硬化、心源性栓塞及小血管疾病比较常见(P<0.01);16～44岁组中,其他原因所致的和不明原因的缺血性卒中所占比例明显较高(P<0.01);45～54岁组中,男性、高血压、糖尿病、卒中史及饮酒的比例明显高于16～44岁组(P<0.01);超敏C反应蛋白、同型半胱氨酸及心脏病史低于16～44岁组(P<0.05)。结论:中青年缺血性卒中具有该年龄段的特定病因分型和危险因素。

Objective： To analyze the etiology and risk factors of ischemic stroke in youth and middle-aged patients.Methods： Three hundred and eighteen patients with ischemic stroke were enrolled in this study and divided into 16～44 years group and 45～54 years group.The clinic data were retrospectively analyzed.The TOAST classification,demographic characteristics,risk factors and biochemical parameters of two groups were evaluated.Results： One hundred and thirty one patients were assigned to 16～44 years group and 187 to 45～54 years group.Defined causes of strokes were identified in 175 patients（55%）,including large-vessel atherosclerosis（38.3%）,cardioembolism（24.6%）,small-vessel disease（21.1%） and other causes（16.0%）.Large-vessel atherosclerosis,cardioembolism and small-vessel disease were the major causes of strokes in the patients aged 45～54 years（P0.01）.Other causes and unknown etiology constituted the major causes of strokes in the patients aged 16～44 years（P0.01）.The proportion of male,hypertension and diabetes,alcohol consume and strokes in the past in the patients aged 45～54 years were significantly higher（P0.01）,while the levels of high sensitivity C-reactive protein,homocysteinemia and the heart diseases in the past were much lower than those in the cases aged 16～44 years（P0.05）.Conclusion： The causes and risk factors of ischemic strokes in youth and the middle-aged patients show different pattern.