青年非轻型缺血性卒中的影响因素及预后分析

doi:10.3969/j.issn.1673-5765.2025.02.009

摘要/Abstract

摘要： 目的探讨青年非轻型缺血性卒中的影响因素及预后，以期降低重症率。
方法分析2016年1月—2022年1月于海军军医大学第二附属医院神经内科住院的青年缺血性卒中患者，依据首诊2 h内NIHSS评分分为轻型组（NIHSS评分≤3分）与非轻型组（NIHSS评分>3分），详细记录两组临床基本特征、危险因素、TOAST分型及90 d结局，比较两组差异。采用logistic回归分析探讨青年非轻型缺血性卒中的危险因素和预后影响因素。
结果共185例患者纳入研究，平均年龄为（38.72±5.24）岁，男性137例（74.05%）；非轻型组92例，轻型组93例。危险因素中比例较高的是高血压（47.03%）、吸烟（41.08%）、糖尿病（20.54%）、高脂血症（20.00%）。两组在有无糖尿病、心脏病、TOAST分型方面差异有统计学意义（P<0.05）。多因素logistic回归分析显示，糖尿病（OR 2.483，95%CI 1.076～5.726，P=0.033）与心脏病（OR 7.948，95%CI 1.691～37.367，P=0.009）是青年非轻型缺血性卒中的独立危险因素。回归分析显示90 d神经功能及焦虑情绪与发病时神经功能严重程度呈正相关（P<0.05）。
结论青年罹患糖尿病、心脏病者卒中后重症风险大，90 d预后相对较差，应早期识别、积极干预，减少发病的同时降低重症率。

文章导读： 青年罹患糖尿病、心脏病者卒中后重症风险大，90 d预后相对较差，应早期识别、积极干预，减少发病的同时降低重症率。

关键词: 青年; 缺血性卒中; 非轻型缺血性卒中; 轻型缺血性卒中; 影响因素

Abstract: Objective To explore the influencing factors and prognosis of non-minor ischemic stroke in young adults, with the aim of reducing the rate of severe cases.
Methods Young patients with ischemic stroke hospitalized in the Department of Neurology, the Second Affiliated Hospital of Naval Medical University from January 2016 to January 2022 were analyzed. According to the NIHSS score within 2 hours of the first visit, they were divided into the minor group (NIHSS score≤3 points) and the non-minor group (NIHSS score>3 points). The basic clinical characteristics, risk factors, TOAST classification, and 90-day outcomes of the two groups were recorded in detail, and the differences between the two groups were compared. Logistic regression analysis was used to explore the risk factors and prognostic factors of non-minor ischemic stroke in young adults.
Results A total of 185 patients were included in the study, with an average age of (38.72±5.24) years and 137 males (74.05%). Among them, 92 cases were in the non-minor group and 93 cases in the minor group. The proportions of risk factors were relatively high for hypertension (47.03%), smoking (41.08%), diabetes mellitus (20.54%), and hyperlipidemia (20.00%). There were statistically significant differences in the presence or absence of diabetes mellitus, heart disease, and TOAST classification between the two groups (P<0.05). Multivariate logistic regression analysis showed that diabetes mellitus (OR 2.483, 95%CI 1.076-5.726, P=0.033) and heart disease (OR 7.948, 95%CI 1.691-37.367, P=0.009) were independent risk factors for non-minor ischemic stroke in young adults. Regression analysis showed that the neurological function and anxiety levels at 90 days were positively correlated with the severity of neurological function at the onset of the disease (P<0.05).
Conclusions Young people with diabetes mellitus and heart disease have a high risk of severe disease after stroke, and the prognosis is relatively poor at 90 days. Early identification and active intervention should be carried out to reduce the incidence of the disease and decrease the rate of severe cases.

Key words: Young adult; Ischemic stroke; Non-minor ischemic stroke; Minor ischemic stroke; Influencing factor

中图分类号:

金鑫, 郭笑, 陈坤, 龚宝峰, 徐瑾. 青年非轻型缺血性卒中的影响因素及预后分析[J]. 中国卒中杂志, 2025, 20(2): 190-198.

JIN Xin, GUO Xiao, CHEN Kun, GONG Baofeng, XU Jin. Analysis of Influencing Factors and Prognosis of Non-Minor Ischemic Stroke in Young Adults[J]. Chinese Journal of Stroke, 2025, 20(2): 190-198.

参考文献

[1] BOOT E，EKKER M S，PUTAALA J，et al. Ischaemic stroke in young adults：a global perspective[J]. J Neurol Neurosurg Psychiatry，2020，91（4）：411-417.
[2] POWERS W J，DERDEYN C P，BILLER J，et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke，2015，46（10）：3020-3035.
[3] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. 2018 guidelines for the early management of patients with acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2018，49（3）：e46-e110[2023-08-24]. https://doi.org/10.1161/STR.0000000000000158.
[4] FISCHER U，BAUMGARTNER A，ARNOLD M，et al. What is a minor stroke？[J]. Stroke，2010，41（4）：661-666.
[5] ADAMS H P，Jr，BENDIXEN B H，KAPPELLE L J，et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial[J]. Stroke，1993，24（1）：35-41.
[6] SULTER G，STEEN C，DE KEYSER J. Use of the Barthel index and modified Rankin scale in acute stroke trials[J]. Stroke，1999，30（8）：1538-1541.
[7] WU X K，ZOU Y T，YOU S J，et al. Distribution of risk factors of ischemic stroke in Chinese young adults and its correlation with prognosis[J/OL]. BMC Neurol，2022，22（1）：26[2023-08-24]. https://doi.org/10.1186/s12883-022-02552-1.
[8] HAMILTON M. The assessment of anxiety states by rating[J]. Br J Med Psychol，1959，32（1）：50-55.
[9] HAMILTON M. A rating scale for depression[J]. J Neurol Neurosurg Psychiatry，1960，23（1）：56-62.
[10] LI F，YANG L，YANG R，et al. Ischemic stroke in young adults of Northern China：characteristics and risk factors for recurrence[J]. Eur Neurol，2017，77（3/4）：115-122.
[11] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志，2019，52（9）：684-709.
Chinese Society of Neurology，Chinese Stroke Society. Guidelines for the primary prevention of cerebrovascular diseases in China 2019[J]. Chin J Neurol，2019，52（9）：684-709.
[12] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：666-682.
[13] 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志，2018，98（24）：1902-1914.
Chinese Medical Doctor Association Sleep Medicine Committee. Multidisciplinary diagnosis and treatment guidelines for adult obstructive sleep apnea[J]. Natl Med J China，2018，98（24）：1902-1914.
[14] BERRY R B，BUDHIRAJA R，GOTTLIEB D J，et al. Rules for scoring respiratory events in sleep：update of the 2007 AASM manual for the scoring of sleep and associated events[J]. J Clin Sleep Med，2012，8（5）：597-619.
[15] 中国高血压防治指南修订委员会，高血压联盟（中国），中华医学会心血管病学分会，等. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019，24（1）：24-56.
Writing Group of 2018 Chinese Guidelines for the Management of Hypertension，Chinese Hypertension League，Chinese Society of Cardiology，et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med，2019，24（1）：24-56.
[16] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）[J]. 中华糖尿病杂志，2021，13（4）：315-409.
Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China（2020 edition）[J]. Chin J Diabetes Mellitus，2021，13（4）：315-409.
[17] 中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南（2016年修订版）[J]. 中华全科医师杂志，2017，16（1）：15-35.
Joint Committee for the Revision of Chinese Guideline for the Management of Dyslipidemia in Adults. 2016 Chinese guideline for the management of dyslipidemia in adults[J]. Chin J Gen Pract，2017，16（1）：15-35.
[18] 中国营养学会骨健康与营养专业委员会，中华医学会肠外肠内营养学分会，中国老年医学学会北方慢性病防治分会. 高同型半胱氨酸血症诊疗专家共识[J]. 肿瘤代谢与营养电子杂志，2020，7（3）：283-288.
Bone Health and Nutrition Branch of Chinese Nutrition Society，Chinese Society of Parenteral and Enteral Nutrition，North Chronic Disease Prevention and Treatment Branch of Chinese Geriatric Society. Expert consensus on hyperhomocysteinemia[J]. Electronic Journal of Metabolism and Nutrition of Cancer，2020，7（3）：283-288.
[19] 中华医学会妇产科学分会绝经学组. 中国绝经管理与绝经激素治疗指南（2018）[J]. 协和医学杂志，2018，9（6）：512-525.
Menopause Group，Obstertrics and Gynecology Branch，Chinese Medical Association. 2018 Chinese guideline on menopause management and menopause hormone therapy[J]. Medical Journal of Peking Union Medical College Hospital，2018，9（6）：512-525.
[20] 中华医学会整形外科分会血管瘤和脉管畸形学组. 血管瘤和脉管畸形的诊断及治疗指南（2019版）[J]. 组织工程与重建外科杂志，2019，15（5）：277-317.
Chinese Society for the Study of Vascular Anomalies. Guidelines for diagnosis and treatment of hemangioma and vascular malformation（2019 edition）[J]. Journal of Tissue Engineering and Reconstructive Surgery，2019，15（5）：277-317.
[21] 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志，2017，33（11）：641-654.
The Committee of Great Vessels of Chinese Assonciation of Cardiovascular Surgeons. Chinese experts’ consensus of standardized diagnosis and treatment for aortic dissection[J]. Chin J Thorac Cardiovasc Surg，2017，33（11）：641-654.
[22] JENNETTE J C，FALK R J，BACON P A，et al. 2012 revised international chapel hill consensus conference nomenclature of vasculitides[J]. Arthritis Rheum，2013，65（1）：1-11.
[23] 中华医学会风湿病学分会，国家皮肤与免疫疾病临床医学研究中心，中国系统性红斑狼疮研究协作组. 2020中国系统性红斑狼疮诊疗指南[J]. 中华内科杂志，2020，59（3）：172-185.
Chinese Rheumatology Association，National Clinical Research Center for Dermatologic and Immunologic Diseases，Chinese Systemic Lupus Erythematosus Treatment and Research Group. 2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus[J]. Chin J Intern Med，2020，59（3）：172-185.
[24] PUTAALA J. Ischemic stroke in the young：current perspectives on incidence，risk factors，and cardiovascular prognosis[J]. Eur Stroke J，2016，1（1）：28-40.
[25] SINGHAL A B，BILLER J，ELKIND M S，et al. Recognition and management of stroke in young adults and adolescents[J]. Neurology，2013，81（12）：1089-1097.
[26] ROSMAN L，SICO J J，LAMPERT R，et al. Posttraumatic stress disorder and risk for stroke in young and middle-aged adults：a 13-year cohort study[J]. Stroke，2019，50（11）：2996-3003.
[27] MARINI C，RUSSO T，FELZANI G. Incidence of stroke in young adults：a review[J/OL]. Stroke Res Treat，2010，2011：535672[2023-08-24]. https://doi.org/10.4061/2011/535672.
[28] AIGNER A，GRITTNER U，ROLFS A，et al. Contribution of established stroke risk factors to the burden of stroke in young adults[J]. Stroke，2017，48（7）：1744-1751.
[29] BÉJOT Y，BAILLY H，DURIER J，et al. Epidemiology of stroke in Europe and trends for the 21st century[J/OL]. Presse Med，2016，45（12 Pt 2）：e391-e398[2023-08-24]. https://doi.org/10.1016/j.lpm.2016.10.003.
[30] EKKER M S，VERHOEVEN J I，VAARTJES I，et al. Stroke incidence in young adults according to age，subtype，sex，and time trends[J/OL]. Neurology，2019，92（21）：e2444-e2454[2023-08-24]. https://doi.org/10.1212/WNL.0000000000007533.
[31] TANG M Y，HAN G S，YAO M，et al. Risk factors of ischemic stroke in young adults：a Chinese single-center study[J/OL]. Front Neurol，2022，13：874770[2023-08-24]. https://doi.org/10.3389/fneur.2022.874770.
[32] AK C，GUPTA R，WARKADE V. Study of clinical profile and risk factors for ischemic stroke in young adults[J]. J Assoc Physicians India，2022，70（4）：11-12.
[33] JIN P，MATOS DIAZ I，STEIN L，et al. Intermediate risk of cardiac events and recurrent stroke after stroke admission in young adults[J]. Int J Stroke，2018，13（6）：576-584.
[34] GOEGGEL SIMONETTI B，MONO M L，HUYNH-DO U，et al. Risk factors，aetiology and outcome of ischaemic stroke in young adults：the Swiss young stroke study（SYSS）[J]. J Neurol，2016，262（9）：2025-2032.
[35] PAN Y S，WANG Y J，LI H，et al. Association of diabetes and prognosis of minor stroke and its subtypes：a prospective observational study[J/OL]. PLoS One，2016，11（4）：e0153178[2023-08-24]. https://doi.org/10.1371/journal.pone.0153178.
[36] PERERA K S，DE SA BOASQUEVISQUE D，RAO-MELACINI P，et al. Evaluating rates of recurrent ischemic stroke among young adults with embolic stroke of undetermined source：the young ESUS longitudinal cohort study[J]. JAMA Neurol，2022，79（5）：450-458.
[37] GONZALEZ-AQUINES A，MARTINEZ-ROQUE D，BALTAZAR TREVINO-HERRERA A，et al. Obstructive sleep apnea syndrome and its relationship with ischaemic stroke[J]. Rev Neurol，2019，69（6）：255-260.
[38] SULTAN S，ELKIND M S V. The growing problem of stroke among young adults[J/OL]. Curr Cardiol Rep，2013，15（12）：421[2023-08-24]. https://doi.org/10.1007/s11886-013-0421-z.
[39] SYNHAEVE N E，ARNTZ R M，MAAIJWEE N A M，et al. Poor long-term functional outcome after stroke among adults aged 18 to 50 years：follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation（FUTURE）study[J]. Stroke，2014，45（4）：1157-1160.
[40] EKKER M S，VERHOEVEN J I，VAARTJES I，et al. Association of stroke among adults aged 18 to 49 years with long-term mortality[J]. JAMA，2019，321（21）：2113-2123.
[41] PUTAALA J. Ischemic stroke in young adults[J]. Continuum（Minneap Minn），2020，26（2）：386-414.
[42] KONO Y，TERASAWA Y，SAKAI K，et al. Risk factors，etiology，and outcome of ischemic stroke in young adults：a Japanese multicenter prospective study[J/OL]. J Neurol Sci，2020，417：117068[2023-08-24]. https://doi.org/10.1016/j.jns.2020.117068.