青年与中老年脑梗死的对比研究

目的 探讨青年与中老年脑梗死危险因素及病因的不同。 方法 将148例青年脑梗死患者分为18～35岁组和36～45岁组，同期232例中老年脑梗死患者作为对 照组，比较3组患者危险因素暴露率和病因的不同。 结果 （1）18～35岁组前3位危险因素是高同型半胱氨酸血症（hyperhomocysteinemia，HHcy）（66.7%）、 高脂血症（40.7%）和高血压病（33.3%）；36～45岁组前3位危险因素是高血压病（59.5%）、HHcy （56.2%）和高脂血症（47.1%）；中老年组前3位危险因素是高血压病（72.4%）、HHcy（54.7%）和高脂 血症（48.7%）。（2）3组患者间高血压病、糖尿病、大量吸烟暴露率有显著差异，其中，18～35岁组（P ＜0.001，P =0.014）和36～45岁组（P＜0.001，P＜0.001）的高血压病、糖尿病暴露率均显著低于中老 年组，18～35岁组高血压病、糖尿病暴露率显著低于36～45岁组（P =0.009，P＜0.001）；18～35岁组大 量吸烟暴露率低于36～45岁组和中老年组（P =0.006，P＜0.001）。（3）18～35岁组急性卒中治疗低分 子肝素试验（Trial of Org 10 172 In Acute Stroke Treatment，TOAST）分型以不明原因型构成比最高， 显著高于中老年组（37.0% vs 27.6%，P =0.013）。36～45岁组和中老年组均以大动脉粥样硬化型构成 比（50.4%和58.2%）最高，均显著高于18～35岁组的25.9%（P =0.021，P =0.014）。 结论 36～45岁青年组与中老年组相似，前3位危险因素依次是高血压病、HHcy和高脂血症，病因以 大动脉硬化为主；18～35岁青年组则不同，前3位危险因素依次是HHcy、高脂血症和高血压病，病因 不明者居多。

A Comparative Study of Cerebral Infarction between Young Adults and the Elderly

Objective To investigate the differences of risk factors and etiology among different age groups of youth and middle aged & elderly people. Methods A total of 148 cases of youth cerebral infarction inpatients were separated into two groups: 18 to 35 years old group and 36 to 45 years old group. And 232 cases of middle aged & elderly inpatients (older than 45 years) in the same period were collected as control group, the distribution of risk factors and stroke subtypes were compared statistically among groups. Results (1) In 18 to 35 years old group, the top three risk factors were hyperhomocysteinemia (HHcy) (66.7%), hyperlipemia (40.7%) and hypertension (33.3%). In 36 to 45 years old group, the three most frequent risk factors were hypertension (59.5%), HHcy (56.2%) and hyperlipemia (47.1%). In the elderly group, the three most common risk factors were hypertension (72.4%), HHcy (54.7%) and hyperlipemia (48.7%). (2) The frequencies of hypertension and diabetes in elderly group were observed to be higher than that in 18 to 35 years old group (P<0.001,P=0.014) and 36 to 45 years old group (P<0.001,P<0.001), which was lower in 18 to 35 years old group than in 36 to 45 years old group (P=0.009,P<0.001). The exposure of heavy smoking was signiifcantly lower in 18 to 35 years old group than that in 36 to 45 years old group (P=0.006) and elderly group (P<0.001). (3) The proportion of undetermined etiology was highest in 18 to 35 years old group, significantly higher than in elderly group (37.0%vs 27.6%,P=0.013). The proportion of large artery atherosclerosis was highest in 36 to 45 years old group and elderly group (50.4% and 58.2%), were signiifcantly higher than that (25.9%) in 18 to 35 years old group (P=0.021,P=0.014). Conclusion Similar to the elderly group, the top three risk factors are hypertension, HHcy and hyperlipemia in 36 to 45 years old group, and large artery atherosclerosis is the leading cause of stroke. The difference is that HHcy, hyperlipemia and hypertension are the former three risk factors in 18 to 35 years old group, and most of patients are of unknown etiology.