安阳地区青年脑梗死的临床特征、危险因素及病因学分析

摘要/Abstract

摘要：

目的探讨安阳地区青年脑梗死（cerebral infarction，CI）的临床特征、危险因素及病因。方法收集长期居住于安阳地区的148例首发急性青年CI患者为研究对象，依据年龄分为18～25岁组、26～35岁组和36～45岁组，各组患者按照急性卒中治疗低分子肝素试验（Trial of Org 10172 in Acute Stroke Treatment，TOAST）方法进行病因分型，同时记录每例患者的基本资料以及合并的危险因素。结果 148例青年C I患者中男性（81.8%）多于女性（18.2%），农村患者（56.8%）多于城市患者（43.2%）。常见可干预危险因素暴露率以高同型半胱氨酸血症最高（58.1%），其次为高血压病（54.7%）、高脂血症（45.9%）、大量吸烟（30.4%）、大量饮酒（17.6%）、糖尿病（10.8%）。各年龄组间合并高血压病（P =0.008）、大量吸烟（P =0.031）发生率差异有显著性，且均以36～45岁组最高。 TOAST分型中大动脉粥样硬化型（large artery atherosclerosis，LAA）62例（41.9%）、不明原因型（stroke of undetermined etiology，SUE）48例（32.4%）、小动脉闭塞型（small artery occlusion，SAO）20例（13.5%）、其他明确病因型（stroke of other determined etiology，SDE）14例（9.5%）、心源性栓塞型（cardioembolism， CE）4例（2.7%）。各病因组间合并糖尿病（P =0.014）、高脂血症（P =0.030）发生率差异有显著性，且均以SAO组最高。不同年龄组患者TOAST分型构成不同：18～25岁组以SDE构成比最高（60.0%），其次为SUE（40.0%）；26～35岁组以LAA、SUE构成比最高（均为31.8%）；36～45岁组以LAA构成比最高（45.5%），SUE次之（32.2%）。结论安阳地区青年CI患者的性别和城乡构成差异明显。危险因素以高同型半胱氨酸血症最为常见，其次为高血压病、高脂血症和大量吸烟。36～45岁患者合并高血压病、大量吸烟明显增多。TOAST病因分型以LAA和SUE为主，并且合并不同危险因素患者发病病因不尽相同。

文章导读： 本研究显示河南安阳地区青年脑梗死的分布显示出性别差异和城乡差异，其最常见的危险因素为高同型
半胱氨酸血症，大动脉粥样硬化型最常见，其次为不明原因型。

关键词: 安阳; 青年; 脑梗死; 危险因素; 病因

Abstract:

Objective To explore the clinical characteristics, risk factors and etiology of youth cerebral infarction in Anyang region. Methods One hundred and forty-eight cases of inpatients (aged from 18 to 45 years) with first-ever cerebral infarction were selected in the study. Patients were separated into three groups:youth group I (aged from 18 to 25 years), youth group II (aged from 26 to 35 years), and youth group III (aged from 36 to 45 years). Their basic information and risk factors were recorded, the etiologic patterns were classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Results The result showed significantly more men (81.8%) than women (18.2%), more villagers (56.8%) than urbanites (43.2%) suffered from cerebral infarction. The highest exposure ratios of risk factors were hyperhomocysteinemia (58.1%), hypertension (54.7%), hyperlipidemia (45.9%), heavy smoking (30.4%), heavy drinking (17.6%), and diabetes (10.8%). Regarding stroke subtype, largeartery atherosclerosis (LAA) was diagnosed in 41.9% of cases, stroke of undetermined etiology (SUE) in 32.4%, small artery occlusion (SAO) in 13.5%, stroke of other determined etiology (SDE) in 9.5%, and cardioembolism (CE) in 2.7%. Diabetes and hyperlipidemia were found to be common in the group of SAO. SDE was found to be the most frequent etiologic subtype in youth group I, followed by SUE. LAA and SUE were observed to be the most frequent etiologic subgroup in youth group II. LAA was also seen to be the most common etiologic subtype in youth group II, followed by SUE. Conclusion The sex and rural-urban differences are obvious in the distribution of youth cerebral infarction in Anyang region. The most common risk factor is hyperhomocysteinemia, followed by hypertension; hyperlipidemia and heavy smoking, drinking and diabetes are relatively rare. Hypertension and heavy smoking may be related with the increased number of disease after age of 35 years. The LAA and SUE are the most common etiologic subtypes in young adults with cerebral infarction, and etiologies in patients with different risk factors are not the same.

Key words: Anyang; Youth; Ischemic infarction; Risk factors; Etiology

李振华1，杨清成2，张向东2. 安阳地区青年脑梗死的临床特征、危险因素及病因学分析[J]. 中国卒中杂志, 2014, 9(05): 383-388.

LI Zhen-Hua*, YANG Qing-Cheng, ZHANG Xiang-Dong.. Analysis of Clinical Features, Risk Factors and Etiology of Youth Ischemic Infarction in Anyang Region[J]. Chinese Journal of Stroke, 2014, 9(05): 383-388.

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