2019 年第 8 期 第 14 卷

青年脑梗死患者危险因素及病因学分型分析

Risk factors and etiological classification of cerebral infarction in young adults

作者：王力何晓芬王力锋刘广志张茁

英文作者：

单位：100029首都医科大学附属北京安贞医院神经内科（王力、刘广志、张茁），神经介入科（何晓芬、王力锋）

英文单位：

关键词：脑梗死；危险因素；病因学分型

英文关键词：

• 摘要：

• 【摘要】目的    分析青年脑梗死患者的危险因素及病因学分型。方法    2010年1月至2018年12月在首都医科大学附属北京安贞医院神经内科病房登记住院的急性脑梗死患者共5 120例，抽取其中青年脑梗死患者337例，作为青年组。随机按1∶1比例从剩余的4 783例中老年脑梗死患者中抽取337例作为中老年组。我们收集患者年龄、性别等一般情况，记录是否存在糖尿病、血脂异常、高血压病、心脏疾病史、卒中病史/家族史、吸烟史、饮酒史、高同型半胱氨酸（Hcy）血症及睡眠呼吸暂停综合征等病史资料进行回顾性分析。2组间进行比较，探究青年脑梗死患者的危险因素及病因学分型。结果    青年组卒中危险因素暴露率由高到低依次为男性、高血压、吸烟史、高脂血症、饮酒史、高Hcy血症、糖尿病、心脏疾病史、卒中病史/家族史、高尿酸血症、睡眠呼吸暂停综合征、偏头痛。中老年卒中组危险因素暴露率由高到低依次为高脂血症、高血压、男性、吸烟史、糖尿病、心脏疾病史、卒中病史/家族史、饮酒史、高Hcy血症、高尿酸血症、睡眠呼吸暂停综合征、偏头痛。青年组中男性、吸烟史、饮酒史、高Hcy血症比例高于中老年组患者，而高血压病、糖尿病、高脂血症、心脏疾病史、卒中病史/家族史比例低于中老年组患者［81.9%（276/337）比70.3%（237/337）、64.4%（217/337）比49.3%（166/337）、38.3%（129/337）比23.7%（80/337）、37.4%（126/337）比18.4%（62/337），66.2%（223/337）比78.9%（266/337）、25.2%（85/337）比40.4%（136/337）、49.3%（166/337）比81.0%（273/337）、16.3%（55/337）比37.7%（127/337）、12.5%（42/337）比32.6%（110/337）］，差异均有统计学意义（均P＜0.05）。青年组患者中大动脉粥样硬化型比例最高［47.5%（160/337）］，其次为小动脉闭塞型［32.0%（108/337）］，不明原因型占比12.8%（43/337），心源性栓塞型占比10.1%（34/337）。不明原因型中男性占比较高。中老年组患者中大动脉粥样硬化型比例最高，其次为小动脉闭塞型。结论    青年男性较女性更容易发生脑梗死；青年脑梗死危险因素较多；大动脉粥样硬化型是第1位病因；加强戒烟戒酒健康宣教，提倡健康饮食，提高青年人群对卒中危险因素的认知，对于青年卒中的防治意义重大。

• 【Abstract】Objective    To analyze the risk factors and etiological classification in young patients with cerebral infarction. Methods    From January 2010 to December 2018, 5 120 patients with acute cerebral infarction were admitted to neurology ward of Beijing Anzhen Hospital, Capital Medical University. Among them, 337 young patients and 337 matched(1∶1) middle-aged and old patients were selected. Age, sex, smoking, alcohol consumption, comorbidities of diabetes, dyslipidemia, hypertension, heart disease, stroke, hyper-homocysteine(Hcy) and sleep apnea syndrome were recorded. Risk factors and etiological types of cerebral infarction were analyzed. Results    Prevalence rates of cerebral infarction risk factors in young patients from high to low were male, hypertension, smoking history, hyperlipidemia, history of alcohol consumption, hyper-Hcy, diabetes, heart disease history, stroke/family history, hyperuricemia, sleep apnea syndrome and migraine. Prevalence rates of cerebral infarction risk factors in middle-aged and old patients from high to low were hyperlipidemia, hypertension, male, smoking history, diabetes, heart disease history, stroke/family history, history of alcohol consumption, hyper-Hcy, hyperuricemia, sleep apnea syndrome and migraine. Proportions of male, smoking history, history of alcohol consumption and hyper-Hcy in young patients were higher while the proportions of hypertension, diabetes, hyperlipidemia, heart disease history, stroke/family history were lower than those in middle-aged and old patients［81.9%（276/337） vs 70.3%（237/337）, 64.4%（217/337） vs 49.3%（166/337）, 38.3%（129/337） vs 23.7%（80/337）, 37.4%（126/337） vs 18.4%（62/337）; 66.2%（223/337） vs 78.9%（266/337）, 25.2%（85/337） vs 40.4%（136/337）, 49.3%（166/337） vs 81.0%（273/337）, 16.3%（55/337） vs 37.7%（127/337）, 12.5%（42/337） vs 32.6%（110/337）］(all P<0.05). Atherosclerosis type of cerebral infarction took the highest ratio among young patients; small artery occlusion type accounted for 32.0%（108/337）; unexplained type accounted for 12.8%(43/337); cardiogenic type accounted for 10.1%(34/337). Males took a large ratio in young patients with unexplained type of cerebral infarction. Among middle-aged and old patients, atherosclerosis type and small artery occlusion type of cerebral infarction accounted for high ratios. Conclusions    Young men are more likely to suffer from cerebral infarction than women. Cerebral infarction in young adults are associated with various risk factors. Atherosclerosis type of cerebral infarction is the most common etiological type. It is of great significance for the prevention and treatment of young stroke to strengthen health education on smoking and alcohol cessation, promote healthy diet and raise the awareness of stroke risk factors among young people.