青年缺血性卒中的危险因素和病因学

Risk factors and etiology in young adults with ischemic stroke

目的 探讨青年缺血性卒中患者的危险因素和病因学.方法 回顾性连续收集2014年6月至2017年6月在成都市第三人民医院神经内科住院且年龄18 ～ 45岁的首次缺血性卒中患者.记录人口统计学资料、血管危险因素、美国国立卫生院卒中量表评分、梗死部位和病因学分型.按照性别分为男性组和女性组,按照年龄段分为18 ～35岁组和36 ～ 45岁组.结果 研究期间共纳入103例青年缺血性卒中患者,其中男性比例高于女性（73.8％对26.2％）,前5位最常见的危险因素分别为吸烟、脂代谢异常、饮酒、高血压和大动脉粥样硬化.36 ～ 45岁组合并糖代谢异常（37.2％对11.8％）、高血压（46.5％对11.8％）和大动脉粥样硬化（37.2％对11.8％）的比例显著高于18～35岁组（P均＜0.05）.男性组吸烟（67.1％对14.8％）和饮酒（51.3％对18.5％）的比例显著高于女性组（P均＜0.05）.在病因学分型方面,18 ～35岁组不明原因型卒中的比例显著高于36 ～ 45岁组（47.1％对15.1％;P=0.006）,而大动脉粥样硬化型比例显著低于36 ～45岁组（11.8％对41.9％;P=0.019）;不同性别组病因学亚型差异无统计学意义.结论 青年缺血性卒中患者的危险因素分布和病因学分型在不同性别和年龄段有所差异.一些共同的可干预危险因素（如吸烟、饮酒、脂代谢异常等）青年缺血性卒中患者中所占比例仍较高.

Objective To investigate the risk factors and etiology in young adults with ischemic stroke.Methods From June 2014 to June 2017,consecutive patients with first-ever ischemic stroke aged from 18 to 45 years and admitted to the Department of Neurology,the Third People＇s Hospital of Chengdu were collected retrospectively.The demographic data,vascular risk factors,National Institutes of Health Stroke Scale score,location of infarction,and etiological subtypes were documented.They were divided into either a male group or a female group according to the gender,and they were divided into 2 age groups of 18-35 years and 36-45 years.Results A total of 103 young adults with ischemic stroke were enrolled during the study.Among them,the proportion of men was higher than that of women （73.8% vs.26.2%）.The most common 5 risk factors were smoking,abnormal lipid metabolism,drinking alcohol,hypertension,and large atherosclerosis,respectively.The proportions of abnormal glucose metabolism （37.2% vs.11.8%）,hypertension （46.5% vs.11.8%）,and large artery atherosclerosis （37.2% vs.11.8%） in the age group of 36-45 years were significantly higher than those in the age group of 18-35 years （all P〈0.05）.The proportions of smoking （67.1% vs.14.8%） and drinking alcohol （51.3% vs.18.5%） in the male group were significantly higher than those in the female group （all P〈 0.05）.In the etiological aspect,the proportion of cryptogenic stroke in the age group of 18-35 years was significantly higher than that in the age group of 36-45 years （47.1% vs.15.1%;P=0.006）,while the proportion of the large artery atherosclerotic stroke was significantly lower than that in the age group of 36-45 years （11.8%vs.41.9%;P =0.019）.There were no significant differences in the etiological subtypes between different sex groups.Conclusion The distribution of risk factors and etiological subtypes in young patients with ischemic stroke have some differences in different gender and age groups.Some common modifiable risk factors （such as smoking,drinking,abnormal lipid metabolism,etc.） still account for a higher proportion in young adults with ischemic stroke.