【作者】 张浩；

【导师】 王晓平；

【作者基本信息】 上海交通大学 ， 神经病学（专业学位）， 2016， 硕士

【摘要】 目的近年来,缺血性卒中病人有逐渐年轻化的趋势,青年是社会及家庭的支柱,卒中造成的功能缺失会给社会和家庭造成更加沉重的负担,故而研究其病因和危险因素,进而指导预防青年缺血性卒中的发生具有非常大的意义。本文将探讨上海地区45岁以下青年缺血性卒中的危险因素、病因及卒中亚型等特征。方法回顾性连续纳入自2011年1月至2015年12月在上海市第一人民医院住院的来自上海地区的18岁至45岁的137例首发缺血性卒中患者的临床资料,全部行头部磁共振平扫(MRI)、超声心动图、血糖、血脂、血流变、抗心磷脂抗体及血管方面的检查,包括经颅多普勒,颈部血管超声,磁共振血管造影(MRA),颈部CT血管造影(CTA)。应用统计学工具进行青年卒中危险因素及卒中亚型的分析讨论。结论本研究通过分析上海地区首发的青年缺血性脑卒中的病因及危险因素,发现:(1)性别构成特点:首发的青年缺血性脑卒中男性患者所占比例明显较女性患者高。二者之比为3.5:1。(2)危险因素特点:青年脑卒中病因及危险因素较传统老年性卒中更纷繁多样,除传统意义上的危险因素等以外,口服避孕药,抗心磷脂抗体增高、凝血功能障碍、遗传代谢性疾病等皆应考虑在内。(3)本研究显示吸烟、高血压、饮酒仍是上海地区青年缺血性卒中最主要的危险因素,提示我们的预防工作需进一步加强在年轻人中的限酒戒烟教育,提高青年对高血压危害的认识、对高血压药物治疗的理解,对青年人(尤为男性)预防缺血性脑卒中十分有必要。(4)卒中亚型特点:在137例样本中,大动脉粥样硬化型脑卒中所占比例最高,占63.5%(5)危险因素与卒中亚型的关系:大动脉粥样硬化性脑卒中的男性患者比例较女性患者高,这一点可能与男性患者中吸烟和酗酒比例较高有关,而女性患者中则有抗心磷脂抗体升高及口服避孕药的特殊病因,故应在筛查病因时关注性别的特殊性。(6)青年脑卒中患者脑动脉狭窄的分布有其特殊性,单纯颅内动脉狭窄比例高,前循环狭窄多于后循环狭窄,早发动脉粥样硬化应是青年患者颅内动脉狭窄的最主要因素。更多还原

【Abstract】 Objective:Recent years,the ischemic stroke patients are becoming younger and younger.The young adults are the hard core of society and family.Stroke causes the loss of body function which leaves a heavy burden on society and family.So it is significant for us to research on the etiology and risk factor in young ischemic stroke to guide the prevention of young ischemic stroke.This paper analyzes 45 years old the following youth ischemic stroke in shanghai etiology,risk factors and stroke subtype features.Methods:From January 2011 to December 2015,a total of 137 young ischemic stroke patient from 18 to 45 years old were admitted to the Department of Neurology in Shanghai General Hospital.All of the patients were performed echocardiography,,routine blood,blood sugar,blood fat and blood clotting and include all cerebral imaging,transcranial Doppler sonography,blood vessels ultrasonography,MRI,MRA and CTA.A11 the clinial datas were put into the statistics tools to analyze the etiology,risk factors and stroke subtype features.Conclusions:Our research found out thar among the young ischemic stroke patients,male is much more than female.The rish factors of young patients is more complex than that of elder patients.Oral contraceptive,the high level of anticardiolipin antibody,coagulation disorder,inherited metabolic disorder should be taken into account.This study shows that smoking,hypertension and alcohol abuse still are the main rick factors.So it is very important for us to enhance the health education among the youth adult about the harm of these main risk factors.We also found that the large artery atherosclerosis are the main subtype in the young ischemic stroke.Among them,male patients is more than female patients,which may have something to do with the smoking and alcohol abuse.while female patients have some special risk factors such as oral contraceptive and anticardiolipin antibody.Stenosis of the carotid is much more than that of vertebral arteries while significant intracranial stenosis is much more than extracranial stenosis.更多还原