大动脉粥样硬化型与小动脉闭塞型青年缺血性卒中高危因素相关分析

目的探讨青年缺血性卒中两种不同病因分类亚型的高危因素的差别。方法收集北京大学第一医院神经内科(2006-2011年,18～45岁)缺血性卒中病人。入选66例,分为大动脉粥样硬化组(46例)及小动脉闭塞组(20例)。以性别、年龄、既往病史(包括高血压、糖尿病、长期大量吸烟、饮酒史)以及周围血检测(甘油三脂、低密度脂蛋白、高密度脂蛋白、同型半胱氨酸)研究变量。结果单变量分析发现大动脉粥样硬化组低密度脂蛋白升高率及甘油三酯升高率与小动脉闭塞组比较有显著性差异(P<0.05)。小动脉闭塞组血压升高率与大动脉粥样硬化组比较有显著性差异(P<0.05),其他高危因素比较差异无显著性意义(P>0.05)。logistic回归分析发现甘油三酯升高率(wald=4.372,95%CI 0.089-0.925,p=0.037)与大动脉粥样硬化性青年缺血性卒中有关。高血压(wald=4.764,95%CI 1.196-21.986,p=0.029)与小动脉闭塞性青年缺血性卒中有关。结论两种不同病因的青年缺血性卒中主要致病高危因素不同,大动脉粥样硬化型需要更好的调控血脂,尤其是甘油三酯,而小动脉闭塞型需要更好的控制血压。

The high risk factors related analysis between large artery atherosclerosis type and small artery occlusion type ischemic stroke in youth

Objective To identify and compare the high risk factors in youth patients with ischemic stroke subtypes.Methods A total of 66 patients with ischemic stroke(18-45 years) from Peking university first hospital were consecutively enrolled into large artery atherosclerosis group(n = 46) and small artery occlusion group(n = 20) during 2006-2011.The study variables included the demographic characteristics such as age and sex;previous medical history such as hypertension,diabetes,long-term smoking and long-term alcohol intake;and laboratory parameters such as serum levels of triglyceride,high-density lipoprotein,low-density lipoprotein,homocysteine.Results In univariate analysis,there were significant differences in increased low density lipoprotein rate and increased triglyceride rate between large artery atherosclerosis group and small artery occlusion group(P < 0.05).Elevated blood pressure rate in small artery occlusion group was markedly higher than elevated blood pressure rate in large artery atherosclerosis group(P < 0.05).No significant differences between two groups in other risk factors(P >0.05).Logistic regression analysis found that increased triglyceride rate(wald = 4.372,95% CI 0.0890.925,P = 0.037) was the only significant risk factor for Large Artery Atherosclerosis subtype in youth patients.High blood pressure(wald = 4.764,95% CI 1.196-21.986,P = 0.029) was associated with an increased risk of ischemic stroke with small artery occlusion subtype in youth patients.Conclusion The high risk factors in youth patients with ischemic stroke subtypes could be different.The study suggested that the regulation of blood lipids will be needed in patients with ischemic stroke in large artery atherosclerosis subtype,especially triglycerides,but the control of blood pressure in patients with ischemic stroke in Small Artery Atherosclerosis subtype.