青中年脑梗死病因及危险因素分析

Analysis of etiologic subtypes and risk factors in young-middle aged adults with cerebral infarction

目的探讨青中年脑梗死的病因、危险因素、影像学特点。方法采用logistic回归分析,回归模型以脑梗死为因变量,年龄、性别、高血压、糖尿病、血脂、纤维蛋白原、尿酸、同型半胱氨酸(Hcy)、颅内动脉狭窄及吸烟为自变量,分析内蒙古地区青中年脑梗死的危险因素;回顾性分析100例18～45岁青中年脑梗死患者病例资料,并分为两组,青年Ⅰ组年龄18～35岁(26例),青年Ⅱ组年龄>35～45岁(74例),及100例48～62岁中年脑梗死患者资料,按TOAST分类探讨其病因、危险因素及影像学特点。结果年龄、糖尿病、低密度脂蛋白胆固醇(LDL-C)、Hcy、颅内动脉狭窄和吸烟是内蒙古地区青中年脑梗死的独立危险因素;青年组脑梗死男性多于女性,中年组血脂、血Hcy水平与青年组比较差异无统计学意义(P>0.05)。病因分析显示:18～35岁青中年脑梗死,大动脉粥样硬化和心源性脑栓塞(即先天性心脏病)各3例(11.5%),小动脉闭塞4例(15.4%),其他病因8例(30.8%),包括甲状腺功能亢进3例、外伤后动脉夹层2例、烟雾病2例、大动脉炎1例,病因不明8例(30.8%);>35～45岁青年,大动脉粥样硬化40例(54.1%),小动脉闭塞26例(35.1%),心源性脑栓塞3例(4.0%),包括心脏瓣膜置换术后2例、卵圆孔未闭1例,其他病因4例(5.4%),包括甲状腺功能亢进、烟雾病、抗磷脂综合征、系统性红斑狼疮各1例,病因不明1例(1.4%)。青中年脑梗死患者,颈动脉内中膜增厚(>1.0mm)比例高于中年组,颈动脉斑块、狭窄或闭塞的比例低于中年组(P<0.05);颅内外动脉狭窄及闭塞的比例低于中年组(77.0%vs91.0%),青年组颅内动脉狭窄/颅外动脉狭窄约为2.0:1,中年组约为1.7:1,差异有统计学意义(P<0.05)。结论青中年脑梗死病因复杂、多样,早发性动脉粥样硬化为35岁以上青年脑梗最常见病因,青中年脑梗死病变侧侧支循环代偿丰富,致残率低,预后良好。

Objective To analyze the etiology, risk factors and neuroimaging features of cerebral infarction in young-middle aged adults. Methods Logistic regression analysis was used, cerebral infarction was regarded as dependent variable in regression model. Gender, age, hypertension, diabetes, blood lipid, fibrinogen, uric acid, homocysteine（ Hcy）, intracranial artery stenosis and smoking were regarded as independent variables, the risk factors of cerebral infarction in young-middle aged adults of Inner Mongolia area were analyzed. We analyzed 200 cases of cerebral infarction retrospectively, 100 cases aged 18 to 45 with first-ever cerebral infarction, who were divided into two groups, youth I group aged 18-35 （26 cases）,youth ]l group aged ;~35-45 （74 cases）,and 1100 cases middle-aged cerebral infarction patients aged 48-62, the etiology was explored according to the TOAST classification criteria, the risk factors and imaging features were analyzed. Results Age, diabetes, low density lipoprotein cholesterol （LDL-C）, Hcy, intracranial artery stenosis and smoking were independent risk {actors of youth cerebral infarction in the Inner Mongolia area. In the young adults with cerebral infarction, male was more common than female; there were no statistical difference in the blood lipid and Hcy levels between the youth cerebral infarction and the middle-age group（ P 〉0.05）. The cause analysis showed for young adults aged 18-35 with cerebral infarction, large artery atherosclerosis and cardiogenic cerebral embolism（congenital heart disease） each 3 cases（ 11.5 % ） ;small artery occlusion 4 cases（ 15.4 % ） other causes 8 cases （30.8%）, which included hyperthyroidism 3 cases, cerebral infarction following head and neck injury 2 cases, moyamoya disease 2 cases, aorta inflammation 1 case; undetermined etiology 8 cases（30.8 % ）. For young adults aged ;〉35-45 with cerebral infarction, large artery atherosclerosis 40 cases（54.1 % ） ; small artery occlusion 26 cases（35.1% ） ; cardiogenic cerebral embolism 3 cases（4.0 % ）, which included post-cardiac valve replacement surgery 2 cases,patent foramen ovale 1 case; and other specific etiologies 4 cases（5.4%）, which included hyperthyroidism, moyamoya disease,antiphospholipid syndrome,systemic lupus erythematosus respectively 1 case; unknown etiology 1 case（1.4 % ）. The ratio of carotid intimal medial thickness （〉 1.0 mm） in the young adults with cerebral infarction was higher than that of the middle-age group, but the ratios of carotid plaques, stenosis or occlusion in the young adults with cerebral infarction were significantly lower than those of the middle-age group （ P 〈 0.05） ; The proportion of the intracranial arterial stenosis and occlusion in the young adults with cerebral infarction was significantly lower than that of the middle-aged group （77.0% vs 91.0% ） ,intracranial artery stenosis/extracranial artery stenosis was about 2.0/1 in the young adults with cerebral infarction,while it was 1.7/1 in the middle-age group（ P 〈0.05）. Conclusion The etiology was complex and diverse in young adults with cerebral infarction, premature atherosclerosis was the most common cause of cerebral infarction in young adults over 35 years, and in young adults with cerebral infarction, the compensation of the collateral circulation for the ischemic regions of lesions was rich,and it had lower morbidity, better prognosis.