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目的探讨青年缺血性卒中两种不同病因分类亚型的高危因素的差别。方法收集北京大学第一医院神经内科(2006-2011年,18～45岁)缺血性卒中病人。入选66例,分为大动脉粥样硬化组(46例)及小动脉闭塞组(20例)。以性别、年龄、既往病史(包括高血压、糖尿病、长期大量吸烟、饮酒史)以及周围血检测(甘油三脂、低密度脂蛋白、高密度脂蛋白、同型半胱氨酸)研究变量。结果单变量分析发现大动脉粥样硬化组低密度脂蛋白升高率及甘油三酯升高率与小动脉闭塞组比较有显著性差异(P<0.05)。小动脉闭塞组血压升高率与大动脉粥样硬化组比较有显著性差异(P<0.05),其他高危因素比较差异无显著性意义(P>0.05)。logistic回归分析发现甘油三酯升高率(wald=4.372,95%CI 0.089-0.925,p=0.037)与大动脉粥样硬化性青年缺血性卒中有关。高血压(wald=4.764,95%CI 1.196-21.986,p=0.029)与小动脉闭塞性青年缺血性卒中有关。结论两种不同病因的青年缺血性卒中主要致病高危因素不同,大动脉粥样硬化型需要更好的调控血脂,尤其是甘油三酯,而小动脉闭塞型需要更好的控制血压。
Objective To investigate the differences of risk factors among two subtypes of different causes of ischemic stroke in young people. Methods Patients with ischemic stroke were collected from Department of Neurology, Peking University First Hospital (2006 - 2011, 18-45 years old). A total of 66 patients were enrolled and divided into two groups: the atherosclerosis group (n = 46) and the arteriole occlusion group (n = 20). Variables were studied by gender, age, prior medical history (including hypertension, diabetes, prolonged heavy smoking, alcohol consumption), and peripheral blood tests (triglycerides, LDL, HDL, and homocysteine). Results Univariate analysis showed that the rate of increase of low density lipoprotein and the rate of increase of triglyceride in atherosclerotic group were significantly different from those in arteriolar occlusion group (P <0.05). There was a significant difference between the rate of increase of arterial pressure in arteriolar occlusion group and that of atherosclerosis group (P <0.05). There was no significant difference in other risk factors (P> 0.05). Logistic regression analysis found that triglyceride rise rate (wald = 4.372, 95% CI 0.089-0.925, p = 0.037) was associated with atherosclerotic youth ischemic stroke. Hypertension (wald = 4.764, 95% CI 1.196-21.986, p = 0.029) was associated with arterial occlusive youth ischemic stroke. Conclusions There are different risk factors for the pathogenesis of ischemic stroke in two different etiologies. Atherosclerosis requires better regulation of blood lipids, especially triglycerides, whereas arteriolar occlusion requires better control of blood pressure.