摘要
目的探讨青年和中年有症状脑动脉粥样硬化（symptomatic cerdralartery atherosclerosis，sCAA）患者危险因素和致卒中机制的差异。方法连续纳入因sCAA所致缺血性卒中或短暂性缺血发作住院的青年（18～44岁）和中年（45～55岁）患者。根据弥散加权成像所示急性脑梗死灶的分布模式判定sCAA的致卒中机制，包括动脉一动脉栓塞（axtery—artery embolism,AAE）、闭塞旁支动脉（local branch occlusion，LBO）和血流动力学障碍（hemody namic imp airment，HI）。单发卒中机制定义为只存在上述1种机制，多发卒中机制定义为存在上述≥2种机制。结果共纳入186例患者，男性138例；青年组82例，平均年龄（40．11±4．94）岁；中年组104例，平均年龄（51．26±2．97）岁。青年组男性患者比例显著高于中年组（81．71％对68．27％；P=0．043）；而中年组高血压（70．19％对47．56％；P=0．002）和糖尿病（38．46％对20．73％；P=0．011）的患者比例显著高于青年组。青年组sCAA累及大脑中动脉更多见（64．63％对48．08％；P=0．002）；而中年组累及基底动脉更常见（12．50％xey3．66％；P=o．037）。单4＂／2个卒中机制在2组患者中均较常见（青年组49／30，中年组57／42；P=O．645）。在多个卒中机制中，青年组AAE＋LBO＋HI更多见（16．46％对6．06％；P=0．030），而中年组AAE＋HI更为多见（21．21％对3．80％；P=0．001）。结论青年sCAA患者的危险因素和致卒中机制与中年患者存在明显差异，提示青年sCAA具有其独特的病理生理学机制，其防治策略可能有别于中年患者。
Objective To investigate the differences of risk factors and stroke menchanisms between young and middle-aged patients with symptomatic cerebral artery atherosclerosis （sCAA）. Metheds The young （18-44 years） and middle-aged （45-55 years） patients with sCAA caused ischemic stroke or transient ischemic attack admitted to hospital were enrolled consecutively. According the distribution patterns of acute infarcts on the diffitsion-weighted imaging the stroke mechanisms of sCAA were identified, including artery-artery embolism （AAE）, local branch occlusion （LBO）, and hemodynamic impairment （HI）. Single stroke mechanism was defined as only having I mechanism, and multiple stroke mechanisms were defined as having ≥2 mechanisms. Results A total of 186 patients were enrolled, and 138 patients were males. There were 82 patients in the youth group （mean 40. 11 ±4. 94 years）; there were 104 patients in the middle-aged group （mean 51.27 ±2. 97 years）. The proportion of male in the youth group was sigfificently higher than that in the middle-age group （81.71% vs. 68.27% ; P =0. 043）, and hypertension （70. 19% vs. 47. 56% ; P=0.002） and diabetes （38.46% vs. 20.73%; P=0.011） in the middle-aged group were significantly higher than those in the youth group, sCAA involved the middle cerebral artery was more common in the youth group （64. 63% vs. 48. 08%; P=0. 002）, and sCAA involved the basilar artery was more common in the middle-aged group （12. 50% vs. 3.66% ; P =0. 037）. The single or multiple stroke mechanisms were more common in both groups （the youth group, 49/30; the middle-aged group 57/42; P =0. 645）. In multiple stroke mechanisms, AAE ＋LBO ＋HI in the youth group was more common （16.46% vs. 6. 06%; P= 0. 030）, and AAE ＋ HI was more common in the middle-aged group （21.21% vs. 3.80%; P = 0. 001）. Conclusions There are significant differences in the risk factors and stroke mechanisms between the young and the middle-aged patients with CAA stroke, suggesting that the young patients with sCAA had its unique pathophysiological mechanism. Its control strategy may be different from the middle-aged patients.
出处
《国际脑血管病杂志》
2016年第9期819-826,共8页
International Journal of Cerebrovascular Diseases
基金
国家自然科学基金（81571107）
广东省医学科研基金（A2016107）
关键词
卒中
脑缺血
颅内动脉硬化
颅内栓塞
磁共振成像
脑血管造影术
危险因素
年轻人
中年人
Stroke
Brain Ischemia
Intracranial Arteriosclerosis
Intracranial Embolism
Magnetic Resonance Imaging
Cerebral Angiography
Risk Factors
Young Adult
Middle Aged
