青年缺血性卒中的中国缺血性卒中亚型及危险因素分析

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。 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。 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）。 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。

Chinese Ischemic Stroke Subclassification and Risk Factors in Ischemic Stroke in Young Adults

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 classification and risk factors were analyzed retrospectively.Results ①88.46% patients in young patient group are male, the percentage is significantly 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 significant 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 numberis significantly 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 significantly 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