青年卒中患者可能无需长期二级预防治疗

与老年患者相比，青年缺血性卒中患者（〈50岁）的病因异质性更明显，而且长期随访研究表明青年缺血性卒中患者的预后通常较好。由于目前的卒中预防指南主要是基于老年患者的研究制定的，因此是否适用于青年卒中患者还有疑问。据最近出版的Neurology报道，如果没有传统危险因素，青年卒中患者的复发性卒中或心肌梗死的风险极低，长期二级预防药物对这些患者可能不是必需的。     

男女青年缺血性卒中发病危险因素及病因分型

目的 分析男女青年缺血性卒中发病危险因素及病因分型,为预防青年缺血性卒中提供参考.方法 青年(18～45岁)急性缺血性卒中住院患者215例,其中男176例(81.86％)、女39例(18.14％).回顾性分析男女青年缺血性卒中患者临床资料,包括吸烟史、饮酒史、卒中家族史,高血压、高脂血症、糖尿病、心脏病(卵圆孔未闭、房颤等可致心源性卒中的心脏疾病)、睡眠呼吸暂停、高尿酸血症病史,血液指标(血糖及糖化血红蛋白、血脂、肝功能、肾功能、同型半胱氨酸、尿酸等).比较男女青年缺血性卒中患者上述各指标,采用Logistic回归分析男女青年缺血性卒中的独立影响因素.据临床特点及影像学[颈部血管超声、经颅多普勒、头颅血管CTA和(或)MRA或DSA、心电图、心脏彩超]检查、实验室检查进行病因分型(TOAST分型),比较男女青年缺血性卒中的TOAST分型比例.结果 男女性青年缺血性卒中危险因素如吸烟、饮酒、高同型半胱氨酸血症、高血压、高尿酸血症、睡眠呼吸暂停、高脂血症所占百分比比较,P均<0.05;糖尿病、心脏病、家族史所占百分比比较,P均>0.05.多因素Logistic回归分析提示,高同型半胱氨酸血症和高尿酸血症为男女青年患缺血性卒中的独立影响因素.TOAST病因分型中,男性、女性青年缺血性卒中均以SAA、LAA多见,两组比较,P>0.05.两组SOE比较,P<0.05,均以烟雾病多见.结论 青年缺血性卒中的主要危险因素有明显的性别差异.青年缺血性卒中男性患者吸烟、饮酒、高同型半胱氨酸血症、高血压、高尿酸血症、睡眠呼吸暂停、高脂血症方面的暴露高于女性.高同型半胱氨酸血症和高尿酸血症为青年缺血性卒中的影响因素.男、女青年缺血性卒中均以SAA、LAA多见,女性SOE型患者多于男性.     

青年与老年缺血性卒中危险因素的比较

近年来，脑血管病的发病有年轻化的趋势。青年卒中是指45岁以下成人发生的卒中。王文化等报道，我国这一年龄段的发病率，男性为18～142／10万，女性为23～95／10万。本研究拟通过对青年缺血性卒中患者与老年卒中患者及健康青年组人员危险因素及血浆同型半胱氨酸（homocysteine，Hey）水平的对比分析，探讨青年缺血性卒中危险因素的特点，以期为预防及治疗提供依据。     

青年缺血性卒中的病因之一:血液异常

近年来，对青年缺血性卒中的病因研究取得了许多进展。血液异常占青年缺血性卒中的１％～２５％，有关这方面的研究结果显示，蛋白Ｃ、蛋白Ｓ缺乏、抗凝血酶Ⅲ缺乏、抗磷脂抗体阳性及脂蛋白（ａ）增高等，有可能参与缺血性卒中的发病机制。对此进行积极探讨，对预防和治疗青年缺血性卒中是很有意义的。     

缺血性卒中与血液系统疾病的关系

多种血液病包括血细胞疾病、原发或继发的凝血和纤溶系统功能障碍等，可导致缺血性卒中，在病因暂不明的青年卒中病人中更为常见。文章对一些血液病伴发的缺血性卒中的发病机制和治疗进展的综述在一定程度上为卒中诊断、治疗和预防提供了新思路     

青年缺血性卒中的病因之一：血液异常

近年来，对青年缺血性卒中的病因研究取得了许多进展。血液异常占青年缺血性卒中的１％￣２５％，有关这方法的研究结果显示，蛋白Ｃ、蛋白Ｓ缺乏、抗凝血酶Ⅲ缺乏、抗磷脂抗体阳性及脂蛋白（ａ）增高等，有可能参与缺血性卒中的发病机制。对此进行积极探讨，对预防和治疗青年缺血性卒中是很有意义的。     

缺血性卒中与血液系统疾病的关系

多种血液病包括血细胞疾病、原发或继发的凝血和纤溶系统功能障碍等，可导致缺血性卒中，在病因暂不明的青年卒中病人中更为常见。文章对一些血液病伴发的缺血性卒中的发病机制和治疗进展的综述在一定程度上为卒中诊断、治疗和预防提供了新思路。     

急性缺血性卒中右向左分流定量测定的必要性

缺血性卒中是西方国家的第三大死因，尽管做了大量的调查，但仍有４０％的缺血性卒中患者病因不清。已有报道青年不明原因卒中患者右向左分流的发生率较高，但在非选择性急性卒中人群中的情况还不清楚。该研究的目的是确定在非选择性人群中右向左分流的大小与卒中危险度的...     

青年卒中患者可能无需长期二级预防治疗

与老年患者相比,青年缺血性卒中患者(<50岁)的病因异质性更明显,而且长期随访研究表明青年缺血性卒中患者的预后通常较好。由于目前的卒中预防指南主要是基于老年患者的研究制定的,因此是否适用于青年卒中患者还有疑问。据最近出版的Neurology报道,如果没有传统危险因素,青年卒中患者的复发性卒中或心肌梗死的风险极低,长期二级预防药物对这些患者可能不是必需的。挪威卑尔根大学Haukeland大学医院神经内科的Naess等对1988年—1997年的232例首发卒中的青年患者进行了平均6年的随访。血管性事件的传统危险因素是指糖尿病、高血压、高胆固醇…     

缺血性卒中与凝血病的实验诊断

高凝状态是缺血性卒中的少见病因之一。文章总结了缺血性卒中患者出现凝血病的概率，分析了凝血试验结果的影响因素及相关因素，对现有的凝血病诊断性试验作出了评价，指出应结合缺血性卒中患者的病史和临床特征，有针对性地选择试验时机与特异性凝血试验方法。     

青年隐源性卒中的可能病因

脑血管病是目前导致人类死亡的主要疾病之一,其发病率逐年上升,而且有年轻化的趋势.青年卒中占全部卒中病例的25％～ 33％.青年人一旦发生卒中,其生活质量会急剧下降,亦给家庭和社会带来沉重的负担.因此,对青年卒中的病因进行总结以实现早期诊断和早期治疗,对改善其预后尤为重要.隐源性卒中约占所有卒中的30％左右,青年人隐源性卒中的可能病因包括心脏疾病、动脉炎、动脉夹层分离、阻塞性睡眠呼吸暂停综合征以及药物滥用等.     

The Growing Problem of Stroke among Young Adults

Although overall stroke incidence has been declining in developed countries, there is evidence that stroke in the young is increasing. Increasing incidence may be particularly pronounced among minorities in whom historically a higher burden of stroke has been reported. Compared with older adults, time spent with disability is longer for those affected at younger ages, and new data suggests that among 30-day young adult stroke survivors, increased mortality persists for as long as 20 years. Stroke in young adults is often missed by less experienced clinicians due to its unexpectedness, leading to lost opportunities for intervention. The causes and risk factors for stroke in the young are often rare or undetermined, but young adults with stroke also have a high burden of traditional cardiovascular risk factors, including hypertension, diabetes, obesity, and substance abuse. Disseminating awareness and promoting research on young adult stroke are steps towards reducing the burden of stroke.     

青年缺血性脑卒中病因及相关危险因素的分析研究

目的探讨青年缺血性脑卒中的常见病因及危险因素。方法回顾性分析51例18～45岁青年脑卒中患者病例资料,并与74例45岁以上老年脑卒中患者进行对照研究,探讨青年患者发病的病因及危险因素。结果青年组非动脉粥样硬化性血管病变及无明显血管病变的比例高于老年组,常见危险因素包括血脂异常(尤其总胆固醇、三酰甘油及脂蛋白-A)、高血压及吸烟。空腹血糖、低密度脂蛋白和纤维蛋白原等指标与老年脑卒中有关。结论青年脑卒中病因及危险因素多样,且有特殊性,不明原因的病例占较大比例,明确病因有赖于完善各项检查。     

Stroke in young adults with celiac disease

INTRODUCTION: Celiac disease is a common condition with a prevalence of about 1%. Clinical extradigestive presentations are various and stroke can be one of the neurological manifestations. EXEGESIS: Two cases of stroke occurring in young adults are described, leading to the diagnosis of celiac disease. Hyperhomocysteinemia or cerebral arterial vasculopathy in one case and antiphospholipid syndrome in the other case are thought to be involved in the pathogenesis of stroke during celiac disease. CONCLUSION: The possible presence of celiac disease should be discussed in unexplained young adult stroke.     

Sex differences in risk factors, etiology, and short-term outcome of cerebral infarction in young patients

Investigations to date have demonstrated that the underlying etiology, causes and burden of stroke may be different for women and men. However, data regarding sex differences among young cerebral ischemic stroke patients remains scarce. We conducted this study in 669 young Chinese adults with acute ischemic stroke as determined by the modified Rankin Scale at discharge. Stepwise multiple logistic regression analysis confirmed that NIHSS score (OR 1.277; 95% CI 1.179-1.383, p=0.000), diabetes mellitus (OR 0.121; 95% CI 0.0209-0.718, p=0.020) and serum glucose levels on admission (OR 1.135; 95% CI 0.997-1.293, p=0.046) independently predict short-term outcomes at discharge in young female patients with acute stroke, but the significant variables related to male patients appeared to be Apo A1 (OR 0.165; 95% CI 0.035-0.776, p=0.023) and NIHSS score on admission (OR 1.458; 95% CI 1.325-1.605, p=0.000). In our series, our data suggest that there are several sex differences for risk of cerebral infarction in young patients, which have important implications for the diagnosis, management and prognosis of stroke in young adults.     

Association between hypertension and stroke among young Thai adults in Bangkok, Thailand

A hospital based case-control study was conducted to assess the association between hypertension and stroke among young Thai adults at a private hospital in Bangkok, Thailand. The study population was comprised of 98 inpatients with a first diagnosis of stroke and 98 inpatients without stroke admitted from 2006 to 2008, aged 18-45 years. Cases were matched with controls by sex and five year age group intervals. Risk factors for stroke, including hypertension were collected using a questionnaire. Significant finding on physical examination and blood testing were obtained from the patients' charts. Multivariate analysis revealed significant risk factors for stroke were: diagnosis of hypertension (adjusted OR 8.94; 95% CI 1.47-54.34), family history of stroke (adjusted OR 16.15; 95% CI 1.71-151.82), history of no or irregular exercise (adjusted OR 8.06; 95% CI 1.12-57.60) and having a low high density lipoprotein level (adjusted OR 5.93; 95% CI 1.11-31.52). Hypertension was the greatest risk factor for stroke among young Thai adults. Modification of lifestyle to reduce risk for stroke should focus on exercise, regular health check-ups and adequate treatment of hypertension.     

高同型半胱氨酸血症与青年卒中

卒中的发病有年轻化的趋势。目前 ,国内外学者都加强了对青年卒中的研究。文章从同型半胱氨酸的代谢、生化特性及其与青年卒中的关系方面阐述了高同型半胱氨酸血症是青年卒中重要的独立危险因素 ,并探讨了可能的机制。     

青年缺血性卒中患者的基因突变

缺血性卒中是一种多基因遗传性疾病 ,并由多种危险因素叠加而致发病 ,其发病率和致残率均较高。遗传因素对于青年人缺血性卒中的影响作用较大。文章对与青年人缺血性卒中有关的血小板相关基因、凝血 /纤溶基因、脂代谢基因、同型半胱氨酸代谢基因等作了综述。     

Epidemiology of Stroke in Young Adults: Race/Ethnic Differences

Stroke is the third leading cause of death and the leading cause of disability in the United States. Stroke incidence is clearly associated with advancing age. Although younger adults are at lower risk, stroke in this population has a particularly high public health impact because of associated indirect costs, such as longer years of lost productivity. There have been many epidemiological studies addressing race ethnic differences in overall stroke incidence and mortality, but few specifically examining these differences in the young adult population. There is evidence that race ethnic differences may have a greater effect on stroke incidence and mortality in young adults. An understanding of these differences may help better identify high risk populations and focus preventative strategies. Furthermore, analysis of race/ethnic differences in stroke subtypes may help clarify mechanisms of stroke in young adults and potential race-ethnic differences in early stroke risk factors.     

Antiphospholipid Antibodies in Young Adults with Stroke

Background. Antiphospholipid antibodies have been associated with a clinical syndrome consisting thrombosis and recurrent, unexplained fetal loss. Methods. The literature pertaining to stroke associated with antiphospholipid antibodies, with emphasis on stroke in young adults, was reviewed. Results. Antiphospholipid antibodies are an independent risk factor for stroke in young adults in five of six studies. Multiple antiphospholipid specificities or the Lupus Anticoagulant were tested in addition to anticardiolipin antibody in these studies. In the single study that found no increased risk for stroke, only anticardiolipin antibody was tested. Only one of these studies evaluated for risk of recurrent stroke in young adults with antiphospholipid antibodies and found it to be increased. No treatment trials have been conducted in young adults with antiphospholipid antibodies and stroke. In the single treatment trial comparing aspirin and low-INR producing doses of warfarin to prevent recurrent stroke, both were found to be equally effective. Conclusions. Antiphospholipid antibodies, particularly Lupus Anticoagulant, is an independent risk factor for first and possibly recurrent ischemic stroke in young adults. The best therapeutic strategy for preventing antiphospholipid antibody-associated recurrent stroke is not clear.