有症状脑动脉粥样硬化患者的危险因素和致卒中机制：青年与中年患者的比较

Risk factors and stroke meclmaisms in patients with symptomatic cerebral mtevy athemsclerosis： compadson of young and niddle-aged patients

目的探讨青年和中年有症状脑动脉粥样硬化（symptomatic cerdralartery atherosclerosis，sCAA）患者危险因素和致卒中机制的差异。方法连续纳入因sCAA所致缺血性卒中或短暂性缺血发作住院的青年（18～44岁）和中年（45～55岁）患者。根据弥散加权成像所示急性脑梗死灶的分布模式判定sCAA的致卒中机制，包括动脉一动脉栓塞（axtery—artery embolism,AAE）、闭塞旁支动脉（local branch occlusion，LBO）和血流动力学障碍（hemody namic imp airment，HI）。单发卒中机制定义为只存在上述1种机制，多发卒中机制定义为存在上述≥2种机制。结果共纳入186例患者，男性138例；青年组82例，平均年龄（40．11±4．94）岁；中年组104例，平均年龄（51．26±2．97）岁。青年组男性患者比例显著高于中年组（81．71％对68．27％；P=0．043）；而中年组高血压（70．19％对47．56％；P=0．002）和糖尿病（38．46％对20．73％；P=0．011）的患者比例显著高于青年组。青年组sCAA累及大脑中动脉更多见（64．63％对48．08％；P=0．002）；而中年组累及基底动脉更常见（12．50％xey3．66％；P=o．037）。单4＂／2个卒中机制在2组患者中均较常见（青年组49／30，中年组57／42；P=O．645）。在多个卒中机制中，青年组AAE＋LBO＋HI更多见（16．46％对6．06％；P=0．030），而中年组AAE＋HI更为多见（21．21％对3．80％；P=0．001）。结论青年sCAA患者的危险因素和致卒中机制与中年患者存在明显差异，提示青年sCAA具有其独特的病理生理学机制，其防治策略可能有别于中年患者。

Objective To investigate the differences of risk factors and stroke menchanisms between young and middle-aged patients with symptomatic cerebral artery atherosclerosis （sCAA）. Metheds The young （18-44 years） and middle-aged （45-55 years） patients with sCAA caused ischemic stroke or transient ischemic attack admitted to hospital were enrolled consecutively. According the distribution patterns of acute infarcts on the diffitsion-weighted imaging the stroke mechanisms of sCAA were identified, including artery-artery embolism （AAE）, local branch occlusion （LBO）, and hemodynamic impairment （HI）. Single stroke mechanism was defined as only having I mechanism, and multiple stroke mechanisms were defined as having ≥2 mechanisms. Results A total of 186 patients were enrolled, and 138 patients were males. There were 82 patients in the youth group （mean 40. 11 ±4. 94 years）; there were 104 patients in the middle-aged group （mean 51.27 ±2. 97 years）. The proportion of male in the youth group was sigfificently higher than that in the middle-age group （81.71% vs. 68.27% ; P =0. 043）, and hypertension （70. 19% vs. 47. 56% ; P=0.002） and diabetes （38.46% vs. 20.73%; P=0.011） in the middle-aged group were significantly higher than those in the youth group, sCAA involved the middle cerebral artery was more common in the youth group （64. 63% vs. 48. 08%; P=0. 002）, and sCAA involved the basilar artery was more common in the middle-aged group （12. 50% vs. 3.66% ; P =0. 037）. The single or multiple stroke mechanisms were more common in both groups （the youth group, 49/30; the middle-aged group 57/42; P =0. 645）. In multiple stroke mechanisms, AAE ＋LBO ＋HI in the youth group was more common （16.46% vs. 6. 06%; P= 0. 030）, and AAE ＋ HI was more common in the middle-aged group （21.21% vs. 3.80%; P = 0. 001）. Conclusions There are significant differences in the risk factors and stroke mechanisms between the young and the middle-aged patients with CAA stroke, suggesting that the young patients with sCAA had its unique pathophysiological mechanism. Its control strategy may be different from the middle-aged patients.