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近年来,脑卒中发病率逐年升高,已经成为全球人类首位致残和第二位死亡的主要疾病[1]。以往认为45岁以下人群发生脑卒中相对较少,较多发生在老年人;然而这一事实正在发生改变,青年卒中的发病率逐渐上升,并且以缺血性卒中为主[2]。而青年人作为社会的中坚力量,一旦患病致残,给家庭带来沉重的精神压力和经济负担,因此受到国内外学者的广泛关注,加强对青年患病人群特点的认识十分关键。本研究选择本地区青年缺血性卒中病人作为研究对象,分析其危险因素、病因分型以及预后等临床特征,指导疾病的预防和治疗。现作报道。
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2组性别分布差异无统计学意义(P>0.05)。中老年卒中组高血压、糖尿病、高脂血症、既往TIA病史率高于青年组,而吸烟、酗酒、高Hcy血症率均低于青年组(P<0.05~P<0.01)(见表 1)。
分组 男 女 高血压 糖尿病 高脂血症 吸烟 酗酒 高Hcy血症 房颤 卒中家族史 偏头痛 心瓣膜病 既往TIA史 PFO 动脉夹层 青年卒中组 40 35 25(33.33) 10(13.33) 14(18.67) 23(30.7) 21(28.00) 11(14.67) 8(10.67) 3(4.00) 5(6.67) 11(14.67) 2(2.67) 3(4) 5(6.67) 中老年卒中组 42 38 56(70.00) 30(37.50) 27(33.75) 10(12.50) 5(6.25) 3(3.75) 10(12.50) 1(1.30) 2(2.50) 6(7.50) 16(20.00) 0(0) 1(1.30) χ2 0.01 20.86 11.81 4.53 7.62 13.12 5.16 0.13 — — 2.04 11.33 — — P >0.05 <0.01 <0.01 <0.05 <0.01 <0.01 <0.05 >0.05 >0.05* >0.05* >0.05 <0.01 >0.05* >0.05* *示Fisher′s确切概率法 表 1 2组常见危险因素比较[n; 百分率(%)]
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2组CISS亚型分布差异有统计学意义(P<0.05)(见表 2)。
分组 n LAA CS PAD UE OE χ2 P 青年卒中组 75 40(53.33) 11(14.67) 8(10.67) 6(8.00) 10(13.33) 中老年卒中组 80 55(68.75) 10(12.50) 11(13.75) 2(2.50) 2 (2.50) 10.07 <0.05 合计 155 95(61.29) 21(13.55) 19(12.26) 8(5.16) 12(7.74) 表 2 2组病人CISS病因学亚型的分布[n; 百分率(%)]
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青年卒中组前循环狭窄率高于中老年组,而后循环狭窄低于中老年组(P<0.05),2组前后循环均有狭窄差异无统计学意义(P>0.05)(见表 3)。
分组 n 前循环狭窄 后循环狭窄 前后循环均有狭窄 青年卒中组 75 49(65.33) 17(22.67) 9(12.00) 中老年卒中组 80 36(45.00) 30(37.50) 14(17.50) χ2 — 6.46 4.03 0.93 P — <0.05 <0.05 >0.05 表 3 2组卒中在狭窄部位比较[n; 百分率(%)]
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青年卒中组预后效果明显优于中老年卒中组(P<0.01)(见表 4)。
分组 n 良好 一般 不良 uc P 青年卒中组 75 42(56.00) 23(30.67) 10(13.33) 中老年卒中组 80 19 (23.75) 33(41.25) 28(35.00) 4.28 <0.01 合计 155 61(39.35) 56(36.13) 38(24.52) 表 4 2组预后情况比较[n; 百分率(%)]
青年缺血性卒中75例临床特点分析
Clinical characteristics analysis of ischemic stroke in 75 young patients
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摘要:
目的分析青年缺血性卒中病人的临床特点,指导青年缺血性卒中的防治。 方法选取2014-2017年神经内科住院的75例青年缺血性卒中病人作为青年卒中组,选取同期住院的80例中老年缺血性卒中病人作为中老年卒中组,进行危险因素、中国缺血性卒中(CISS)分型、脑动脉狭窄分布和预后评价的分析。 结果2组性别分布差异无统计学意义(P>0.05)。中老年卒中组高血压、糖尿病、高脂血症、既往短暂性脑缺血发作病史率高于青年组,而吸烟、酗酒、高同型半胱氨酸血症率低于青年组(P<0.05~P<0.01);青年卒中组在CISS分型上以大动脉粥样硬化型为主(53.33%),2组CISS亚型分布差异具有统计学意义(P<0.05)。青年卒中组前循环狭窄率高于中老年组,而后循环狭窄低于中老年组(P<0.05)。青年卒中组预后效果明显优于中老年卒中组,2组预后评分差异具有统计学意义(P<0.01)。 结论吸烟、酗酒、高同型半胱氨酸血症已经成为青年缺血性卒中的常见危险因素;在CISS分型中,大动脉粥样硬化型常见分型;狭窄部位以前循环狭窄为主;同时短期预后优于中老年卒中病人。 Abstract:ObjectiveTo analyze the clinical characristics of ischemic stroke in young patients, and provide the guidance in prevention and treatment of disease. MethodsSeventy-five young patients with ischemic stroke and 80 middle-aged and old patients with ischemic stroke were divided into the young group and middle-aged and old group, respectively.The risk factors, Chinese ischemic stroke subclassification(CISS) typing, cerebral artery stenosis and prognosis in two groups were evaluated. ResultsThe difference of gender distribution between two groups was not statistically significant(P>0.05).The incidence rates of hypertension, diabetes mellitus, hyperlipidaemia, TIA disease history in middle-aged and old group were higher than those in young group, and the incidence rates of smoking, alcoholism and hyperhomocysteinemia in middle-aged old group were lower than those in young group(P < 0.05 to P < 0.01).The large-artery atherosclerosis in young group was the main type of CISS classification(53.3%), and the difference of CISS subtype between two groups was statistically significant(P < 0.05).The anterior circulation stenosis rate in young group was higher than that in middle-aged and old group, but the posterior circulation stenosis rate in young group was lower than that in middle-aged and old group(P < 0.05).The prognosis in young group was significantly better than that in middle-aged and old group(P < 0.05).The difference of the prognosis score between two groups was statiscally siginificant(P < 0.01). ConclusionsSmoking, alcoholism and hyperhomocysteinemia are the most common risk factors in young patients with ischemic stroke.LAA is the most common subtype of CISS.The anterior circulation stenosis is more.The short-term prognosis in young patients with ischemic stroke is better than that in middle-aged and old patients with ischemic stroke. -
Key words:
- ischemic stroke /
- young people /
- risk factor
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表 1 2组常见危险因素比较[n; 百分率(%)]
分组 男 女 高血压 糖尿病 高脂血症 吸烟 酗酒 高Hcy血症 房颤 卒中家族史 偏头痛 心瓣膜病 既往TIA史 PFO 动脉夹层 青年卒中组 40 35 25(33.33) 10(13.33) 14(18.67) 23(30.7) 21(28.00) 11(14.67) 8(10.67) 3(4.00) 5(6.67) 11(14.67) 2(2.67) 3(4) 5(6.67) 中老年卒中组 42 38 56(70.00) 30(37.50) 27(33.75) 10(12.50) 5(6.25) 3(3.75) 10(12.50) 1(1.30) 2(2.50) 6(7.50) 16(20.00) 0(0) 1(1.30) χ2 0.01 20.86 11.81 4.53 7.62 13.12 5.16 0.13 — — 2.04 11.33 — — P >0.05 <0.01 <0.01 <0.05 <0.01 <0.01 <0.05 >0.05 >0.05* >0.05* >0.05 <0.01 >0.05* >0.05* *示Fisher′s确切概率法 表 2 2组病人CISS病因学亚型的分布[n; 百分率(%)]
分组 n LAA CS PAD UE OE χ2 P 青年卒中组 75 40(53.33) 11(14.67) 8(10.67) 6(8.00) 10(13.33) 中老年卒中组 80 55(68.75) 10(12.50) 11(13.75) 2(2.50) 2 (2.50) 10.07 <0.05 合计 155 95(61.29) 21(13.55) 19(12.26) 8(5.16) 12(7.74) 表 3 2组卒中在狭窄部位比较[n; 百分率(%)]
分组 n 前循环狭窄 后循环狭窄 前后循环均有狭窄 青年卒中组 75 49(65.33) 17(22.67) 9(12.00) 中老年卒中组 80 36(45.00) 30(37.50) 14(17.50) χ2 — 6.46 4.03 0.93 P — <0.05 <0.05 >0.05 表 4 2组预后情况比较[n; 百分率(%)]
分组 n 良好 一般 不良 uc P 青年卒中组 75 42(56.00) 23(30.67) 10(13.33) 中老年卒中组 80 19 (23.75) 33(41.25) 28(35.00) 4.28 <0.01 合计 155 61(39.35) 56(36.13) 38(24.52) -
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