青年脑出血病因和危险因素分析

目的：探讨青年脑出血病因和危险因素。方法：收集2010年5月—2016年8月收治的20~45岁青年脑出血患 者401例，按年龄将其分为20~29岁组，30~39岁组和40~45岁组，比较3组患者病因和危险因素差异。结果：在401例 青年脑出血患者中，男273例，女128例。有明确病因者294例(73.32%)，病因不明者107例(26.68%)。在294例中高血 压性脑出血226例(56.36%)，脑血管畸形41例(10.22%)(包括颅内动静脉畸形25例、颅内海绵状血管瘤8例、颅内动脉 瘤8例)，其他原因27例(6.73%)(包括烟雾病9例，颅内静脉窦血栓形成6例，吸毒4例，瘤卒中3例，颅内感染2例，系 统性红斑狼疮1例，药源性1例和子痫1例)。危险因素包括高血压病史237例(59.10%)，吸烟123例(30.67%)，饮酒74例 (18.45%)，其他高危因素19例(4.74%)(包括妊娠/产褥期8例，脑出血家族史8例和抗凝/抗血小板药物3例)。3组脑出血 患者病因比较，高血压脑出血所占比例随着年龄增长明显增加(P<0.01)；20~29岁组脑血管畸形比例较其他两组明显 增加(P<0.01)，40~45岁组原因不明者比例明显减少(P<0.01)，其他原因在3组中差异无统计学意义(P>0.05)。3组脑出 血患者高危因素比较，高血压所占比例随着年龄增长明显增加(P<0.01)，而吸烟、饮酒及其他高危因素不同年龄组相 比差异无统计学意义(P>0.05)。 结论：青年脑出血患者随着年龄增长发病率逐渐增高，男性多于女性；高血压病是主 要病因，且随着年龄增长其比例明显增加，其次是脑血管畸形，且年龄越小该病因可能越常见；在青年脑出血患者 中年龄越小原因不明者越常见；高血压病史、吸烟及饮酒可能为青年脑出血三大常见可控高危因素。

Etiologies and risk factors for young people with intracerebral hemorrhage

Objective: To determine the etiologies and risk factors of intracerebral hemorrhage in young people. Methods: A total of 401 young patients with intracerebral hemorrhage were enrolled, and they were assigned into a 20–29 , a 30–39, and a 40–45 age group. The differences of various etiologies and risk factors among the three groups were analyzed. Results: There were 273 men and 128 women in the 401 young patients. The etiologies of 294 patients (73.32%) were identified while 107 patients (26.68%) were unknown. Among those with identified etiology, 226 patients (56.36%) suffered from hypertension, 41 patients (10.22%) congenital cerebrovascular malformation (including 25 patients with cerebral arteriovenous malformation, 8 intracranial cavernous hemangioma, and 8 intracranial aneurysm), and 27 other etiologies (including 9 patients with moyamoya disease, 6 cerebral venous sinus thrombosis, 4 drug abuse, 3 hemorrhagic brain tumor, 2 intracranial infection, 1 systemic lupus erythematosus, 1 druginduced, and 1 eclampsia). Risk factors included hypertension (237 cases, 59.10%), smoking (123 cases, 30.67%), alcohol consumption (74 cases, 18.45%), and others (19 cases, 4.74%; including 8 cases of pregnancy or in the puerperium, 8 family history of intracerebral hemorrhage, and 3 taking anti-platelet aggregation/anticoagulation agents). The rate of hypertension induced hemorrhage significantly increased with age (P<0.01); the rate of vascular malformations in 20–29 age group was obviously higher than other groups (P<0.01); the rate of unknown cause in the 40–45 age group was significantly lower than other groups (P<0.01) and the rate of other etiologies showed no significant difference in the 3 groups. The rate of hypertension was significantly elevated with the age (P<0.01), while smoking, alcohol consumption, and other risk factors showed no significant difference in the 3 groups. Conclusion: The rate of intracerebral hemorrhage in young people increases with the increasing of age and hemorrhage affects men more than women; hypertension may be the main cause and congenital cerebrovascular malformation is the second cause, which may be more common in younger patients. Hypertension, smoking, and alcohol consumption may be the major controllable risk factors in intracerebral hemorrhage in young people.