青年脑梗死的病因及预后分析

目的分析青年脑梗死的病因、危险因素以及预后。方法回顾性分析首发急性青年脑梗死患者（年龄≤45岁）65例的临床资料，经影像学及其他病因学检查确定诊断。依据新版治疗急性卒中试验（NEW—TOAST）分型标准，确定患者的脑梗死病因分型。经统计学分析其分型构成比及其主要危险因素的暴露情况。结果①65例青年脑梗死病因呈多样化，根据NEW—TOAST分型构成，大动脉粥样硬化型卒中占33．8％（22／65），其中颅内动脉狭窄占72．7％（16／22）、颅外动脉狭窄占27．3％（6／22）；小动脉闭塞型卒中占30．8％（20／65），心源性脑栓塞型占1．5％（1／65），其他原因型卒中占12．3％（8／65），原因不明缺血性卒中占21．5％（14／65）。②危险因素的暴露率最高的为血脂异常，占58．5％（38／65）；其次为吸烟，占56．9％（37／65）；以下依次为高血压（52．3％，34／65）、糖尿病（35．4％，23／65）及饮酒（30．8％，20／65）。卒中分型的组问危险因素单因素分析显示，血脂异常（90．9％，χ^2=37．276，P〈0．01）在大动脉粥样硬化型卒中患者中增高最显著。③NEW—TOAST分型各组预后较差的是其他原因引发的缺血性卒中组（37．5％疗效差）以及小动脉闭塞型组（35％疗效差）。结论青年脑梗死的病因分型以大动脉粥样硬化型和小动脉闭塞型卒中所占比例较高，颅内动脉狭窄较颅外动脉狭窄更为常见，以血脂异常和吸烟的暴露率为高。

Analysis of the etiology and prognosis in young and middle-aged patients with cerebral infarction

Objective To analyze the etiology, risk factors and prognosis in young and middle-aged patients with cerebral infarction. Methods Sixty-five young and middle-aged patients （ ≤45 years old） with first attack of cerebral infarction were analyzed retrospectively. The clinical diagnosis were established by imaging and other causative examinations. The types of patients were determined according to the NEWTOAST classification criterion. The constituent ratios of each type and the main risk factors to exposure were analyzed statistically. Results ①The etiologies of the 65 young and middle-aged patients with cerebral infarction were varied. According to the constituent ratios of the NEW-TOAST criterion, the large artery atherosclerotie stroke accounted for 33.8% （22/65） , of those, intracranial arterial stenosis accounted for 72. 7% （ 16/22）, and extracranial arterial stenosis accounted for 27.3% （6/22） ; the small artery occlusion stroke accounted for 30. 8% （20/65）, eardiogenic cerebral embolism accounted for 1.5% （1/65） , cryptogenie embolism accounted for 21.5% （14/65） , and other reasons accounted for 12. 3% （8/65）. ②The highest exposure rate of the risk factors was dyslipidemia （58. 5%, 38/65 ）, then smoking （56. 9%, 37/65 ）, and the following was hypertension （ 52. 3%, 34/65 ）, diabetes mellitus （ 35.4%, 23/65 ） , and alcohol consumption （30. 8% , 20/65 ）. Univariate analysis of the risk factors for stroke classi- fication between the groups showed that dyslipidaemia （90. 96%, χ^2 = 32. 276, P 〈 0. 01 ） increased significantly in patients with large artery cerebral infarction. ③In all the NEW-TOAST classification groups, the other reasons caused cerebral infarction group （37.5% with poor efficacy） and small artery occlusion-type cerebral infarction group （35% with poor efficacy）had more poor prognosis. Conclusion The proportions of large artery atherosclerotic cerebral infarction and small artery occlusion-type cerebral infarction are higher in the young and middle-aged patients with cerebral infarction. Intracranial arterial stenosis is more common than extracranial arterial stenosis. The exposure rate of risk factors are higher in dyslipidaemia and smoking.