不同年龄急性脑梗死患者危险因素及出院结局研究

Study on risk factors and discharge outcome of patients with acute cerebral infarction at different ages

目的探讨青年及中老年人群急性脑梗死TOAST病因分型、危险因素及出院结局的异同。方法选取2014年1月至2018年11月任丘康济新图医院神经内科住院的急性脑梗死患者3996例,按年龄分为青年组(162例,年龄≤45岁)和中老年组(3834例,年龄≥46岁)。对比两组TOAST病因分型、相关危险因素以及不同TOAST病因分型的出院结局。结果TOAST病因分型中,两组大动脉粥样硬化型(large artery atherosclerosis,LAA)比例最高,且中老年组高于青年组(84.5%比59.9%),而青年组小动脉闭塞型(small artery occlusion,SAO)、其他原因型(other determined etiologles,OE)和不明原因型(undetermined etiology,UE)比例均高于中老年组(26.5%比11.6%、4.4%比0.4%和4.9%比0.4%),差异有统计学意义(P<0.01)。青年组和中老年组的男性比例[122例(75.3%)比2359例(61.5%)]、年龄[42(37,44)岁比66(59,73)岁]、不良出院结局[23例(14.2%)比810例(21.1%)]、高血压[92例(56.8%)比2699例(70.4%)]、卒中[24例(14.8%)比1325例(34.6%)]、冠心病[9例(5.6%)比535例(14.0%)]、过量饮酒[17例(10.5%)比161例(4.2%)]、抗血小板药物使用[14例(8.6%)比615例(16.0%)]、SBP[152.5(136.8,167.2)mmHg比162.0(147.0,179.0)mmHg,1 mmHg=0.133 kPa]、DBP[95.0(84.0,104.0)mmHg比87.0(79.0,96.0)mmHg]、FIB[2.8(2.3,3.2)g/L比2.9(2.5,3.4)g/L]、TG[1.5(1.1,2.2)mmol/L比1.2(0.9,1.7)mmol/L]、HDL-C[1.0(0.9,1.2)μmol/L比1.1(0.9,1.3)μmol/L]、UA[344.4(286.8,474.2)μmol/L比322.8(266.4,389.6)μmol/L]、BUN[4.6(3.9,5.9)mmol/L比5.4(4.4,6.6)mmol/L]、胱抑素C[0.7(0.6,0.9)mg/L比0.9(0.7,1.1)mg/L]和出院结局不良[23例(14.2%)比810例(21.1%)]比较,差异均有统计学意义(P<0.05);两组间最重要的危险因素为高血压及吸烟。青年组TOAST不同亚型出院结局比较,差异无统计学意义(P>0.05),中老年组LAA、CE和SAO出院结局组间比较,差异均有统计学意义(P<0.01)。结论急性脑梗死TOAST病因分型以LAA最常见,其次为SAO。青年脑梗死最常见的危险因素为高血压、吸烟和糖尿病,中老年为高血压、吸烟和卒中。中老年脑梗死TOAST病因分型中的LAA、CE和SAO出院结局存在差异。针对不同年龄、不同病因分型寻找脑梗死的常见危险因素,并进行全面控制,对预防和减少急性脑梗死的发生更为重要。

Objective To explore the differences of TOAST etiology classification,risk factors and discharge outcomes of acute cerebral infarction between the young and middle-aged and elderly population.Methods A total of 3996 patients with acute cerebral infarction who were hospitalized in the Department of Neurology,Renqiu Kangjixintu Hospital from January 2014 to November 2018 were selected and divided into the young group(162 cases,age≤45 years)and the middle-aged and elderly group(3834 cases,age≥46 years)according to age.The two groups were compared for TOAST etiological types,related risk factors and discharge outcomes of different TOAST etiological types.Results In TOAST etiology classification,the proportion of large artery atherosclerosis(LAA)was the highest in the two groups,and the proportion of LAA in the middle-aged and elderly group was higher than that in the young group(84.5%vs.59.9%).The proportions of small artery occlusion(SAO),other determined etiologles(OE)and undetermined etiology(UE)in the young group were higher than those in the middle-aged and elderly group(26.5%vs.11.6%,4.4%vs.0.4%,4.9%vs.0.4%),the differences were statistically significant(P<0.01).There were statistically significant differences in gender[122 male cases(75.3%)vs.2359 male cases(61.5%)],age[42(37,44)years vs.66(59,73)years],adverse discharge outcome[23 cases(14.2%)vs.810 cases(21.1%)],hypertension[92 cases(56.8%)vs.2699 cases(70.4%)],stroke[24 cases(14.8%)vs.1325 cases(34.6%)],coronary heart disease[9 cases(5.6%)vs.535 cases(14.0%)],excessive alcohol consumption[17 cases(10.5%)vs.161(4.2%)],antiplatelet drug use[14 cases(8.6%)vs.615(16.0%)],SBP[152.5(136.8,167.2)mmHg vs.162.0(147.0,179.0)mmHg,1 mmHg=0.133 kPa],DBP[95.0(84.0,104.0)mmHg vs.87.0(79.0,96.0)mmHg],FIB[2.8(2.3,3.2)g/L vs.2.9(2.5,3.4)g/L],TG[1.5(1.1,2.2)mmol/L vs.1.2(0.9,1.7)mmol/L],HDL-C[1.0(0.9,1.2)μmol/L vs.1.1(0.9,1.3)μmol/L],UA[344.4(286.8,474.2)μmol/L vs.322.8(266.4,389.6)μmol/L],BUN[4.6(3.9,5.9)mmol/L vs.5.4(4.4,6.6)mmol/L],cystatin C[0.7(0.6,0.9)mg/L vs.0.9(0.7,1.1)mg/L]and discharge adverse outcome[23 cases(14.2%)vs.810 cases(21.1%)]between the young group and the middle-aged and elderly group(P<0.05).The most important risk factors between the two groups were hypertension and smoking.There was no statistically significant difference in the discharge outcomes of different TOAST subtypes in the young group(P>0.05),while there was statistically significant difference in the discharge outcomes of LAA,CE and SAO in the middle-aged and elderly group(P<0.01).Conclusions LAA is the most common etiological type of TOAST in acute cerebral infarction,followed by SAO.The most common risk factors for cerebral infarction are hypertension,smoking and diabetes mellitus in young people,and hypertension,smoking and stroke in middle-aged and elderly people.There are differences in discharge outcomes of LAA,CE and SAO among TOAST etiology types of cerebral infarction in middle-aged and elderly.In order to prevent and reduce the occurrence of acute cerebral infarction,it is more important to search for common risk factors of cerebral infarction according to different age and different etiology types and to carry out comprehensive control.