耿春生;杨伟民;张丽;张卓;

• 1:郑州大学第一附属医院神经内科

摘要(Abstract)：

目的探讨青年急性脑梗死患者的危险因素及病因分型。方法回顾性收集180例青年急性脑梗死患者为病例组,同期收集的150例门诊健康体检者为对照组,采用单因素χ²检验及多因素Logistic回归模型对危险因素进行分析。病因分析采用TOAST分型及国际儿童卒中研究(International Pediatric Stroke Study,IPSS)方法进行探讨。结果单因素χ2检验及多因素Logistic回归模型对危险因素进行分析。病因分析采用TOAST分型及国际儿童卒中研究(International Pediatric Stroke Study,IPSS)方法进行探讨。结果单因素χ²检验示高血压、高脂血症、吸烟、饮酒、高同型半胱氨酸的组间分布差异有统计学意义(P<0.05)。多因素Logistic回归分析示高同型半胱氨酸、高脂血症、吸烟和高血压的组间分布差异有统计学意义(P<0.05)。采用TOAST分型而被认定为不明原因脑梗死的24例患者,利用IPSS方法发现83%的患者有其他危险因素。结论高同型半胱氨酸血症可能是青年缺血性脑卒中的独立危险因素。采用IPSS方法可能为青年缺血性脑卒中特定病因分型的发展提供参考。

关键词(KeyWords)： 青年缺血性脑卒中;危险因素;病因;高同型半胱氨酸;国际儿童卒中研究

Abstract:

Keywords:

基金项目(Foundation): 2015年度河南省医学科技攻关计划项目(编号:201503059)

作者(Authors): 耿春生;杨伟民;张丽;张卓;

参考文献(References)：

• [1] BéJOT Y,BAILLY H,DURIER J,et al.Epidemiology of stroke in Europe and trends for the 21st century[J].Presse Med,2016,45(12 Pt 2):e391.
• [2] KISSELA B M,KHOURY J C,ALWELL K,et al.Age at stroke:temporal trends in stroke incidence in a large,biracial population[J].Neurol,2012,79(17):1781-1787.
• [3] YESILOT B N,PUTAALA J,WAJEANDREASSEN U,et al.Etiology of first-ever ischaemic stroke in European young adults:the 15 cities young stroke study[J].Eur J Neurol,2013,20(11):1431-1439.
• [4] ARNTZ R M,VAN ALEBEEK M E,SYNHAEVE N E,et al.The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age:The FUTURE study[J].Eur Stroke J,2016,1:337-345.
• [5] MAAIJWEE N A,RUTTEN-JACOBS L C,ARNTZ R M,et al.Long-term increased risk of unemployment after young stroke:a long-term follow-up study[J].Neurol,2014,83(13):1132-1138.
• [6] FEIGIN V L,ROTH G A,NAGHAVI M,et al.Global burden of stroke and risk factors in 188 countries,during 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet Neurol,15(9):913-924.
• [7] ADAMS H P,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial.TOAST.Trial of Org 10172 in Acute Stroke Treatment[J].Stroke,1993,24:35-41.
• [8] AMLIE-LEFOND C,BERNARD T,SEBIRE G,et al.Predictors of cerebral arteriopathy in children with arterial ischaemic stroke:results of the international pediatric stroke study[J].Circ,2009,119:1417-1423.
• [9] AYATA C,SHIN H K,DILEK?Z E,et al.Hyperlipidemia disrupts cerebrovascular reflexes and worsens ischemic perfusion defect[J].Cereb Blood Flow Metab,2013,6:954-962.
• [10] TIAN X U,TAO Z J,MEI Y,et al.Dyslipidemia and outcome in patients with acute ischemic stroke[J].Biomed,2014,27(2):106-110.
• [11] LAKSHMIKUMAR K,GOMTI K D,SHUGETA N D,et al.Effect of age on serum homocysteine level among adult urban population of Manipur[J].J Med Soc,2013,27:46-48.
• [12] DZEVDET S,DENISA S,IBRAHIMAGI O C,et al.Characteristics of stroke in young adults in Tuzla Canton,Bosnia and Herzegovina[J].Coll Antropol,2013,7(2):515-519.
• [13] PUTAALA J,METSO A J,METSO T M,et al.Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke:the Helsinki Young Stroke Registry[J].Stroke,2009,40:1195-1203.
• [14] JUKKA P,NILUFER Y,ULRIKE W A,et al.Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke:the 15 Cities Young Stroke Study[J].Stroke,2012,43(10):2624-2630.
• [15] ZHANG Y N,HE L.Risk factors study of ischemic stroke in young adults in Southwest China[J].JSichuan Da Xue Xue Bao Yi Xue Ban.,2012,43(4):553-557.
• [16] WU T Y,KUMAR A,WONG E H.Young ischaemic stroke in South Auckland:a hospital-based study[J].N Z Med J,125(1364):47.
• [17] ALBERTO M,ROSENDAAL F R,ALE A,et al.Hypercoagulability is a stronger risk factor for ischaemic stroke than for myocardial infarction:a systematic review[J].PloS One,2015,10(8):e133523.
• [18] WILCKEN D E.Homocysteine and vascular disease[J].Nat Med,1996,2(4):386.
• [19] 李贯清,杨瑞,靳瑜,等.高同型半胱氨酸血症与脑梗死后早期神经功能恶化的相关性研究[J].中国实用神经疾病杂志,2018,21(3):283-286.
• [20] AUSTIN R C,LENTZ S R,WERSTUCK G H.Role of hyperhomocysteinemia in endothelial dysfunction and atherothrombotic disease[J].Cell Death Differ,2004,11(suppl 1):S56-S64.
• [21] PETRAS M,TATARKOVA Z,KOVALSKA M,et al.Hyperhomocysteinemia as a risk factor for the neuronal system disorders[J].Physiol.Pharmacol,2014,65(1):15-23.
• [22] LESNIAK W,KOLASINSKA-KLOCH W,KIEC B.Vascular endothelium-Function,disorders and clinical modification probes[J].Folia Med Cracov,2001,42(1/2):5.
• [23] YESILOT B N,PUTAALA J,WAJEANDREASSEN U,et al.Etiology of first-ever ischaemic stroke in European young adults:the 15 cities young stroke study[J].Eur J Neurol,2013,20(11):1431-1439.
• [24] SAVER J L.Clinical practice.Cryptogenic Stroke[J].New Engl J Med,2016,374(21):2065-2074.
• [25] RUTTEN-JACOBS L C,MAAIJWEE N A,ARNTZ R M,et al.Risk factors and prognosis of young stroke.The FUTURE study:a prospective cohort study.Study rationale and protocol[J].BMC Neurol,2011,11(1):109.
• [26] MAAIJWEE N A M M,RUTTEN-JACOBS L C A,PAULINE S,et al.Ischaemic stroke in young adults:risk factors and long-term consequences[J].Nat Rev Neurol,2014,10(6):315-325.
• [27] SEBIRE G,FULLERTON H,RIOU E,et al.Toward the definition of cerebral arteriopathies of childhood[J].Curr Opin Pediatr,2004,16(6):617-622.
• [28] VAN ALEBEEK M E,ARNTZ R M,EKKER M S,et al.Risk factors and mechanisms of stroke in young adults:The FUTURE study[J].J Cerel Blood Flow Metab,2018,38(9):1631-1641.