中国卒中杂志
中國卒中雜誌
중국졸중잡지
CHINESE JOURNAL OF STROKE
2014年
5期
376-382
,共7页
王韵%郝咏刚%董谦%李淑娟%胡文立
王韻%郝詠剛%董謙%李淑娟%鬍文立
왕운%학영강%동겸%리숙연%호문립
青年%缺血性卒中%中国缺血性卒中亚型%危险因素%同型半胱氨酸
青年%缺血性卒中%中國缺血性卒中亞型%危險因素%同型半胱氨痠
청년%결혈성졸중%중국결혈성졸중아형%위험인소%동형반광안산
Young adults%Ischemic stroke%Chinese ischemic stroke subclassification%Risk factors%Homocysteine
目的分析青年缺血性卒中的病因分型以及危险因素，以期对青年缺血性卒中的防治有所帮助。
<br> 方法回顾性分析2011年1～12月于我院脑病中心住院的共52例青年缺血性卒中患者（青年卒中组）的临床资料，随机抽取同期住院的中老年缺血性卒中患者50例作为中老年卒中组，进行中国缺血性卒中亚型（Chinese ischemic stroke subclassification，CISS）病因分型以及危险因素分析。
<br> 结果①青年卒中组男性46例（88.46%），女性6例（11.54%），与中老年卒中组差异存在显著性（χ2=5.573，P=0.018）。②青年卒中组CISS分型分布依次为大动脉粥样硬化型（large artery atherosclerosis，LAA）46.15%，穿支动脉疾病型（penetrating artery disease，PAD）36.54%，病因不确定型（undetermined etiology，UE）11.54%，心源性卒中型（cardiogenic stroke，CS）5.77%，无一例其他病因型（other etiology，OE）。其分布与中老年卒中组差异无显著性。③青年卒中组患者危险因素暴露率依次为吸烟、高血压、血脂异常、饮酒、糖尿病、卒中家族史；具有3个以上的危险因素者超过半数，该数量与中老年卒中组相比差异存在显著性（χ2=7.186，P=0.007），同型半胱氨酸（homocysteine，Hcy）水平较中老年卒中组增高（t=1.250，P=0.038），叶酸水平较中老年卒中组下降（t=2.106，P=0.007）；吸烟（χ2=7.993，P=0.005）、饮酒（χ2=17.005，P=0.000）的暴露率较中老年卒中组升高；LAA亚组Hcy水平高于PAD亚组（t=2.046，P=0.004）。
<br> 结论青年缺血性卒中患者在性别分布、危险因素、卒中病因分型方面具有一定特点，Hcy水平可能与缺血性卒中的发生年龄以及病因分型有关。青年缺血性卒中患者危险因素较中老年患者多，控制并减少危险因素，尤其是纠正高Hcy，对青年缺血性卒中的预防十分重要。
目的分析青年缺血性卒中的病因分型以及危險因素，以期對青年缺血性卒中的防治有所幫助。
<br> 方法迴顧性分析2011年1～12月于我院腦病中心住院的共52例青年缺血性卒中患者（青年卒中組）的臨床資料，隨機抽取同期住院的中老年缺血性卒中患者50例作為中老年卒中組，進行中國缺血性卒中亞型（Chinese ischemic stroke subclassification，CISS）病因分型以及危險因素分析。
<br> 結果①青年卒中組男性46例（88.46%），女性6例（11.54%），與中老年卒中組差異存在顯著性（χ2=5.573，P=0.018）。②青年卒中組CISS分型分佈依次為大動脈粥樣硬化型（large artery atherosclerosis，LAA）46.15%，穿支動脈疾病型（penetrating artery disease，PAD）36.54%，病因不確定型（undetermined etiology，UE）11.54%，心源性卒中型（cardiogenic stroke，CS）5.77%，無一例其他病因型（other etiology，OE）。其分佈與中老年卒中組差異無顯著性。③青年卒中組患者危險因素暴露率依次為吸煙、高血壓、血脂異常、飲酒、糖尿病、卒中傢族史；具有3箇以上的危險因素者超過半數，該數量與中老年卒中組相比差異存在顯著性（χ2=7.186，P=0.007），同型半胱氨痠（homocysteine，Hcy）水平較中老年卒中組增高（t=1.250，P=0.038），葉痠水平較中老年卒中組下降（t=2.106，P=0.007）；吸煙（χ2=7.993，P=0.005）、飲酒（χ2=17.005，P=0.000）的暴露率較中老年卒中組升高；LAA亞組Hcy水平高于PAD亞組（t=2.046，P=0.004）。
<br> 結論青年缺血性卒中患者在性彆分佈、危險因素、卒中病因分型方麵具有一定特點，Hcy水平可能與缺血性卒中的髮生年齡以及病因分型有關。青年缺血性卒中患者危險因素較中老年患者多，控製併減少危險因素，尤其是糾正高Hcy，對青年缺血性卒中的預防十分重要。
목적분석청년결혈성졸중적병인분형이급위험인소，이기대청년결혈성졸중적방치유소방조。
<br> 방법회고성분석2011년1～12월우아원뇌병중심주원적공52례청년결혈성졸중환자（청년졸중조）적림상자료，수궤추취동기주원적중노년결혈성졸중환자50례작위중노년졸중조，진행중국결혈성졸중아형（Chinese ischemic stroke subclassification，CISS）병인분형이급위험인소분석。
<br> 결과①청년졸중조남성46례（88.46%），녀성6례（11.54%），여중노년졸중조차이존재현저성（χ2=5.573，P=0.018）。②청년졸중조CISS분형분포의차위대동맥죽양경화형（large artery atherosclerosis，LAA）46.15%，천지동맥질병형（penetrating artery disease，PAD）36.54%，병인불학정형（undetermined etiology，UE）11.54%，심원성졸중형（cardiogenic stroke，CS）5.77%，무일례기타병인형（other etiology，OE）。기분포여중노년졸중조차이무현저성。③청년졸중조환자위험인소폭로솔의차위흡연、고혈압、혈지이상、음주、당뇨병、졸중가족사；구유3개이상적위험인소자초과반수，해수량여중노년졸중조상비차이존재현저성（χ2=7.186，P=0.007），동형반광안산（homocysteine，Hcy）수평교중노년졸중조증고（t=1.250，P=0.038），협산수평교중노년졸중조하강（t=2.106，P=0.007）；흡연（χ2=7.993，P=0.005）、음주（χ2=17.005，P=0.000）적폭로솔교중노년졸중조승고；LAA아조Hcy수평고우PAD아조（t=2.046，P=0.004）。
<br> 결론청년결혈성졸중환자재성별분포、위험인소、졸중병인분형방면구유일정특점，Hcy수평가능여결혈성졸중적발생년령이급병인분형유관。청년결혈성졸중환자위험인소교중노년환자다，공제병감소위험인소，우기시규정고Hcy，대청년결혈성졸중적예방십분중요。
Objective To explore the characteristics of Chinese ischemic stroke subclassification (CISS) classification and risk factors in ischemic stroke in young adults and to provide the basis for prevention and treatment. Methods There were 52 young adults with ischemic stroke who were hospitalized in our department in 2011. These patients were enrolled in young patient group while 50 middle-aged and old patients with ischemic stroke enrolled in middle-aged and old patient group. Their CISS classiifcation and risk factors were analyzed retrospectively. Results ①88.46%patients in young patient group are male, the percentage is signiifcantly higher than in middle-aged and old patient group (χ2=5.573, P=0.018). ②The CISS classification in young patient group was as follows:large artery atherosclerosis (LAA) 46.15%, penetrating artery disease (PAD) 36.54%, undetermined etiology (UE) 11.54%, cardiogenic stroke (CS) 5.77%, and no other etiology (OE). Compared with middle-aged and old patient group, there is no signiifcant difference. ③The common risk factors for young patient group are listed in order as follows:smoking, hypertension, hyperlipidaemia, alcoholism, diabetes mellitus and family history. More than half of the patients in young patient group had more than three risk factors, and this number is signiifcantly larger than that of middle-aged and old patient group (χ2=7.186, P=0.007). The concentration of homocysteine (Hcy) (t=1.250, P=0.038) and the occurrence rate of smoking (χ2=7.993, P=0.005) and alcoholism (χ2=17.005, P=0.000) in young patient group are signiifcantly higher than those in middle-aged and old patient group; the concentration of folic acid is significantly lower (t=2.106, P=0.007); and the concentration of Hcy in LAA is significantly higher than that in PAD in young patient group (t=2.046, P=0.004). Conclusion We should pay more attention to the concentration of Hcy in patients with ischemic stroke as it may be related to the age of onset and the CISS classiifcation. The young adults with ischemic stroke have more risk factors than middle-aged and old patients. Improving and reducing the risk factors, especially improving hyperhomocysteinemia, are important to prevent against ischemic stroke in young adults.
