CAJ | 학술논문

目的：调查青年缺血性卒中患者的危险因素、诊断评估、病因和治疗情况。方法前瞻性登记2008年8月至2013年7月期间在中山大学附属第一医院卒中中心住院的青年(18~45岁)缺血性卒中(发病2周内)患者资料。结果共纳入300例患者,年龄(37．8±6．8)岁,男性227例(75．7%),84例(28．0%)年龄≤35岁。吸烟(43．3%)、高血压(38．7%)和高胆固醇血症(38．0%)是最常见的危险因素。抗核抗体(8/278)、抗心磷脂抗体(34/250)、24 h动态心电图(2/60)和经胸心脏超声(38/232)检查的阳性结果检出率较低。根据 MRI 结果,脑白质改变、陈旧性梗死灶、单发急性梗死灶和多发急性梗死灶的检出率分别为40/282、77/282、145/282和137/282。 TOAST 卒中亚型：大动脉粥样硬化,26．7%；小动脉闭塞,18．0%；心源性栓塞,10%；其他明确的病因,23．0%；病因不明,22．3%。大动脉粥样硬化主要累及前循环(69/80)和颅内动脉(75/80)。心源性栓塞主要由心脏瓣膜病所致(18/30)。在其他明确的病因中,以脑动脉夹层分离最常见(36/69),其他病因包括烟雾病(7/69)和感染性血管炎(7/69)等。平均住院时间为15．4 d,平均入院美国国立卫生研究院卒中量表评分为7．0分,平均出院改良 Rankin 量表评分为2．5分,住院期间并发症发生率为9．7%。分别有80．3%和48．3%的患者在住院期间接受抗血小板药和他汀类药物治疗。结论本研究采用前瞻性单中心登记的方法,对当前中国人青年缺血性卒中患者的危险因素、诊断评估、治疗和病因进行了全面分析,其研究数据将为中国人青年卒中患者建立高效-费比的诊断策略、深入理解其病理生理学机制和改进治疗策略提供有用的信息。
목적：조사청년결혈성졸중환자적위험인소、진단평고、병인화치료정황。방법전첨성등기2008년8월지2013년7월기간재중산대학부속제일의원졸중중심주원적청년(18~45세)결혈성졸중(발병2주내)환자자료。결과공납입300례환자,년령(37．8±6．8)세,남성227례(75．7%),84례(28．0%)년령≤35세。흡연(43．3%)、고혈압(38．7%)화고담고순혈증(38．0%)시최상견적위험인소。항핵항체(8/278)、항심린지항체(34/250)、24 h동태심전도(2/60)화경흉심장초성(38/232)검사적양성결과검출솔교저。근거 MRI 결과,뇌백질개변、진구성경사조、단발급성경사조화다발급성경사조적검출솔분별위40/282、77/282、145/282화137/282。 TOAST 졸중아형：대동맥죽양경화,26．7%；소동맥폐새,18．0%；심원성전새,10%；기타명학적병인,23．0%；병인불명,22．3%。대동맥죽양경화주요루급전순배(69/80)화로내동맥(75/80)。심원성전새주요유심장판막병소치(18/30)。재기타명학적병인중,이뇌동맥협층분리최상견(36/69),기타병인포괄연무병(7/69)화감염성혈관염(7/69)등。평균주원시간위15．4 d,평균입원미국국립위생연구원졸중량표평분위7．0분,평균출원개량 Rankin 량표평분위2．5분,주원기간병발증발생솔위9．7%。분별유80．3%화48．3%적환자재주원기간접수항혈소판약화타정류약물치료。결론본연구채용전첨성단중심등기적방법,대당전중국인청년결혈성졸중환자적위험인소、진단평고、치료화병인진행료전면분석,기연구수거장위중국인청년졸중환자건립고효-비비적진단책략、심입리해기병리생이학궤제화개진치료책략제공유용적신식。
Objective To investigate the risk factors, diagnostic evaluation, etiology, and treatment in young patients with ischemic stroke. Methods The clinical data of young patients (age range 18 - 45 years) with ischemic stroke (within 2 weeks of stroke onset) admitted to the Stroke Center, the First Affiliated Hospital of Sun Yat-sen University from August 2008 to July 2013 were registered prospectively. Results A total of 300 patients were enroled, their age was 37. 8 ± 6. 8 years. There were 227 males (75. 7% ). The age of 84 patients (28. 0% ) was ≤35 years. The most common risk factors were smoking (43. 3% ), hypertension (38. 7% ), and hypercholesterolemia (38. 0% ). The positive result detection rates were lower in the antinuclear antibody (8/278), anticardiolipin antibody (34/250), 24-h Holter monitoring (2/60 ), and transthoracic echocardiography (38/232). According to the MRI findings, the detection rate of the white matter changes, old infarcts, single acute infarcts, and multiple acute cerebral infarcts were 40/282, 77/282, 145/282, and 137/282, respectively. The stroke subtypes of TOAST: large artery atherosclerosis (26. 7% ), smal artery occlusion (18. 0% ), cardioembolism (10. 0% ), other determined etiology (23. 0% ), and undetermined etiology (22. 3% ). Large artery atherosclerosis was mainly involved in anterior circulation (69/80) and intracranial arteries (75/80). In other definite causes, cerebral artery dissection was most common (36/69), and other causes included moyamoya disease (7/69) and infectious vasculitis (7/69), etc. The average length of hospital stay was 15. 4 d. The mean National Institutes of Health Stroke Scale score on admission was 7. 0, and the mean modified Rankin scale score at discharge was 2. 5. The complication rate during hospitalization was 9. 7% . 80. 3% and 48. 3% of patients received anti-platelet drugs and statins therapy during hospitalization.Conclusions This study used a prospective single-center method. It conducted a comprehensive analysis of risk factors, diagnostic evaluation, treatment, and etiology in current Chinese young patients with ischemic stroke. Its research data wil provide useful information for establishing a diagnostic strategy of high performance cost ratio, in-depth understanding of its pathophysiological mechanisms, and improving treatment strategies in Chinese young patients with ischemic stroke.