【作者】 殷卓琳；

【导师】 尹琳；

【作者基本信息】 大连医科大学 ， 神经病学， 2008， 硕士

【摘要】 目的:探讨在青年脑卒中患者中可能存在的病因及危险因素。方法:本研究病例选自1999年10月至2008年1月期间在大连医科大学附属二院神经内科住院的青年脑卒中患者,共268例,均符合1995年全国第四次脑血管疾病学术会议会议通过的《各类脑血管疾病诊断要点》标准,全部经头部CT或MRI证实为脑卒中,外伤性脑出血及严重的肝、肾疾病则排除在外。对所有病例一般资料(包括性别、年龄、血压、既往病史、家族史、吸烟及饮酒史)、实验室指标(包括血常规、空腹血糖、血脂、血流变学指标、纤维蛋白)指标进行检查,部分病例行心脏彩色超声多普勒,脑脊液及脑血管造影等检查。观察各类病因及危险因素在患者中的分布。结果:1.青年脑卒中占全部脑卒中的9.92% ( 268/2701 ),其中男性占66.79%,女性占33.20%;发病年龄18～45岁,平均36.05±7.81岁;有明确病因者200例(74.62%)。2.在青年脑卒中患者中,缺血性脑卒中129例(48.13%)。其中,有明确病因者101例(78.29%),包括动脉粥样硬化65例(50.38%),心源性脑栓塞18例(13.95%),凝血功能异常4例(3.10%),其它原因(如血管炎)等14例(10.85%)。3.在青年脑卒中患者中,出血性脑卒中139例( 51.86%),其中有明确病因者99例(71.22%),包括高血压病53例(38.12%),颅内血管发育异常(动脉瘤、动静脉畸形、烟雾病、海绵状血管瘤、脑膜动静脉瘘)37例(26.62%),其它(如颅内肿瘤等)9例(6.48%)。4.在青年脑卒中患者中,既往有TIA或脑卒中病史44例(16.41%),脑卒中家族史19例(7.08%),口服避孕药史2例(0.74%),吸烟史75例(27.98%),饮酒史63例(23.50%),入院后辅助检查结果提示高血压120例(44.77%),高脂血症85例(31.71%),心脏病34例(12.68%),糖尿病14例(5.23%)。结论:1.青年卒中的发病率有逐年增高的趋势,且随年龄增长而增高,男性比例明显高于女性,发病类型以出血性脑卒中居多。2.青年出血性脑卒中最主要的病因仍然是高血压病,其次是颅内血管发育异常。缺血性脑卒中最主要的病因仍是动脉粥样硬化,其次是心源性脑栓塞,其他病因如血管炎、烟雾病等较少见,而约1/4的患者病因不清。3.青年脑卒中主要的危险因素是高血压、高脂血症、吸烟、饮酒、TIA或既往脑卒中史等。4.对青年脑卒中的可干预危险因素进行干预和控制,对于减少或延迟脑卒中发病有重大意义。更多还原

【Abstract】 Objective:To investigate the possible etiology factors and risk factors in young adult stroke.Methods:268 young patients with stroke were studied in department of neurology of the Second Affiliated Hospital of Dalian Medical University from October 1999 to January 2008. All patients were matched with diagnosis by clinical standards referred to the fourth national cerebrovascular diseases meeting in 1995 and they were confirmed diagnoses by computerized tomography (CT) or magnetic resonance imaging (MRI), excluding the traumatic cerebral hemorrhage and serious liver or renal disease.General parameters were studied, including sex, age, blood pressure, history of past illness, family medical history, smoking,drinking, clinical feature and neuroimaging feature. Laboratory parameters were studied, including blood routine,fasting blood glucose, blood-lidpoids, hemorheolegy and fibrinogen .According to the clinical demand,the part of the patients were examined cordis color hypersound Doppler,cerebrospinal fluid or angiography. To observe the distribution of etiology factors and risk factors in these adults’stroke.Results:1.The young adult group comprised 9.92%(268/2701)of patients of all ages admitted for stroke.179 of 268(66.79%) acute young adults stroke patients were male.89 of 268(38.89%) acute young adults stroke patients were female. The age of onset was 18~45 years old and the mean age was36.05±7.81 years old. 200(75.37%)young patients had definite etiological factor.2.129 of 268(48.13%)were due to ischemic stroke,101(78.29%)young patients had definite etiological factors,including atherosclerosis 65 cases(50.38%),cardiogenic cerebral embolism 18 cases(13.95%) ,hemopathic disease or abnormality of clotting mechanism 4 cases(3.10%),other etiological factors (such as vasculitis etc)14cases(10.85%).3.139 of 268 were due to hemorrhagic stroke,99(71.22%)young patients had definite etiological factors,including hypertension53 cases(38.12%),intracranial blood vessel dysplasia(aneurysms、arteriovenous malformations、Moyamoya disease、cavernous angioma、dural arteriovenous fistulae)37 cases(26.62%),other etiological factors (such as intracranial tumors etc)9 cases (6.48%).4.In young adults with stroke,44 of 268(16.41%) had history of TIA or cerebral stroke;19 of 268(7.08%) had family history of cerebral stroke, 2 of 268 (0.74%) had history of oral contraceptive medication,50 of 268(27.28%) had history of smoking,45 of 268 (25%) had history of drinking, after the patients were admitted to hospital, according to the auxiliary examination, this article finded that 120 of 268 (44.77%) suffered from hypertension, 85 of 268 (31.71%) suffered from hyperlipemia,34 of 268 (12.68%)suffered from cardiac disease,14 of 268 (5.23%) suffered from diabetes mellitus.Conclusions:1.The incidence of stroke of the young adults has the increasing trend year by year, and increase with growth of the age. hemorrhagic stroke in young adults is higher and male predominance existed the percentage of stroke in young adults is higher.2.The main etiological factor of ischemic cerebral stroke in young adults is still atherosclerosis, cardiogenic cerebral embolism is followed, other etiological factors(such as vasculitis、Moyamoya disease) are few, about one fourth patients have no definite etiological factor.3.The main risk factors of cerebral stroke in young adults are hypertension、hyperlipemia、smoking、drinking、history of TIA or stroke、family history of stroke and so on.4.It will has great significance to control or delay incident onset if we can prevent and treat these risk factors of young stroke efficiently.更多还原