青年缺血性卒中患者脑动脉狭窄的分布特点及病因分析

目的探讨青年缺血性卒中患者脑动脉狭窄的发生率、分布特点及可能的病因。方法回顾性纳入217例发病≤2周的缺血性卒中患者,分为青年组(18~45岁,106例)及中年组(46~55岁,111例)。比较青年组与中年组脑动脉狭窄的发生率及分布情况,并对伴有脑动脉狭窄患者的危险因素及病因进行分析。结果 (1)青年组脑动脉狭窄的发生率为69.8%(74/106),中年组为78.4%(87/111),差异无统计学意义(P0.05)。(2)青年组与中年组脑动脉狭窄在颅、内外分布差异无统计学意义,均以颅内动脉狭窄为主分别为75.7%(56/74)和62.1%(54/87)]。青年组前循环狭窄发生率为71.6%(53/74),高于中年组的41.4%(36/87);中年组前、后循环均有狭窄的发生率为20.7%(18/87),高于青年组的8.1%(6/74),P均0.05。青年组单纯大脑中动脉狭窄发生率为58.9%(33/56),高于中年组的27.8%(15/54),P0.05;中年组椎动脉及基底动脉狭窄发生率为27.8%(15/54),高于青年组的12.5%(7/56),P0.05。(3)中年组脑动脉狭窄患者中,高血压、糖尿病、冠心病及饮酒者所占的比例高于青年组,P0.01或P0.05。中年组动脉粥样硬化性狭窄发生率高于青年组93.1%(81/87)对比64.9%(48/74),P0.01],青年组不明原因的血管狭窄比例高于中年组23.0%(17/74)对比2.3%(2/87),P0.01]。非动脉粥样硬化病因中,青年组动脉夹层、烟雾病及血管炎发病率更高,但差异无统计学意义。结论青、中年卒中患者脑动脉狭窄发生率相近;青年卒中脑动脉狭窄以前循环为主,单纯大脑中动脉狭窄发生率高;动脉粥样硬化性狭窄的相关危险因素较少,而不明原因比例较高。

Distribution characteristics and etiological analysis of cerebral artery stenosis in young patients with ischemic stroke

Objective To investigate the incidence,distribution characteristics and possible causes of cerebral artery stenosis in young patients with ischemic stroke. Methods A total 217 patient with ischemic stroke （onset ≤2 weeks） were enrolled retrospectively.They were divided into either a youth group （18 - 45 years,n=106） or a middle age group （45 - 55 years,n=111）.The incidence of cerebral artery stenosis and distribution in both groups were compared,and the risk factors and etiology in patients with cerebral artery stenosis were analyzed. Results （1）The incidence of cerebral artery stenosis was 69.8% （74/106） in the youth group,while it was 78.4% （87/111） in the middle age group （P〉0.05）.（2）There was no significant difference in cerebral artery stenosis in intracranial and extracranial distribution between the two groups.They were predominantly intracranial artery stenosis （75.7%（56/74）vs.62.1%（54/87）].The incidence of anterior circulation stenosis was 71.6% （53/74） in the youth group,and it was higher than 41.4% （36/87） in the middle age group.The incidences of stenosis in both anterior and posterior circulation of the middle age group were higher than those in the youth group 20.7%（18/87）vs.8.1%（6/74）],all P〈0.05].The incidence of middle cerebral artery stenosis in the youth group was 58.9% （33/56）,and it was higher than 27.8% （15/54） in the middle age group （P〈0.05）.The proportion of vertebral and basilar artery stenoses in the middle age group （27.8%,15/54） was higher than that in the youth group （12.5%,7/56,P〈0.05）.（3）Among the patents with cerebral artery stenosis in the middle age group,the proportions of hypertension,diabetes,coronary heart disease,and drinking were higher than those in the youth group （P〈0.01 or P〈0.05）.The incidence of atherosclerotic stenosis in the middle age group was higher than that in the youth group 93.1%（81/87）vs.64.9%（48/74）].The proportion of cryptogenic vascular stenosis in the youth group was higher than that in the middle age group 23.0%（17/74）vs.2.3%（2/87）].In the non-atherosclerotic etiology,artery dissection,Moyamoya disease and vasculitis were more common in the youth group,however,there were no significant differences. Conclusion The incidences of cerebral artery stenosis in the young and middle-aged stroke patients are similar.Cerebral artery stenosis in young stroke patients is mainly in anterior circulation,and the incidence of middle cerebral artery stenosis is high.The related risk factors for atherosclerotic stenosis are fewer,and the cryptogenic proportion is higher.