| Objective: The main factor of death and mutilation is ischemia stroke in our country, it brings heavy burden to the family and the country. Ischemia stroke is one of the common diseases of the old people, but its age of onset is diminishing year by year. Therefore, the morbidity of the ischemia stroke of young people is unceasing upgrade. The criticality of stroke prevention is studying the risk factors of young stroke; it's also a global studying hot spot. The abroad studying covered that the main etiological factors of young ischemia stroke are smoking (50.5%), hyperpiesia (31.2%), hypertension (22.6%), drinking (16.1%). It's obviously different from the senile patients. The internal correlated reports are less. On account of that, in order to understand the etiological characteristics and pathogenesis of young ischemia stroke patents, we determine the etiopathogenisis of different age section of stroke patients on the basis of Trial of Org 10 172 in acute stroke treatment (TOAST) criteria.Methods: Between January 2002 and June 2007, all ischemic stroke patients in inpatients were enrolled in this study. Their clinical and laboratory information, including the age, sex, blood pressure, fasting plasma glucose, fasting serum lipids, smoking, drinking, previous history and family history were recorded. According to age region, the patients were divided into two groups. The patients whose age was between 18 and 45 years old (including 18 and 45 years old) are the young group. The patients whose age was above 45 years old are the middle-aged and old-aged group.Cerebral infarction was classified into 5 categories according to the TOAST criteria:1.Large-artery atherosclerosis, LAA: the patients of this type were all examined by TCD, MRA or/and carotis Doppler ultrasound and diagnosed atherosclerotic stenosis or occlusion. And the degree of stenosis of the responsibility blood vessel was more than 50%.2.Small - artery occlusion lacunars, SAA: To be provided with one of the three standardization was final diagnosis. (1) To have the typical appearance of lacouna infarction syndrome, and the imageology examination was matched to the clinical appearance; the biggest diameter of the responsibility focus of infection was smaller than 1.5cm. (2) Having the appearance of lacouna infarction syndrome, but there wasn't the responsibility focus of infection with the imageology examination. (3) There wasn't typical appearance of lacouna infarction syndrome, but the imageology examination was matched to the clinical appearance, the biggest diameter of the responsibility focus of infection was smaller than 1.5cm.3.Cardioembolism, CE: this type included that all kinds diseases which have cardiogenical embolus initiated cerebral embolism.4.Stroke of other demonstrated etiology, SOE: this type is the cerebral infarction was initiated by other demonstrated etiology. The other demonstrated etiologies include hypercoagulabale state, hematological system disease, importation dope, et al.5.Stroke of other undemonstrated etiology, SUE: this type includes the cerebral infarction which wasn't belong to the other four types.The stenosis or occlusions of cervical and intracranial vascular lesion were diagnosed by TCD/MRA.The association between the risk factors of stroke and the TOAST subtyping was determined by Logistic regression. Results: There were 102 young ischemic stroke patients, and there were 78 men (76.47%) and 24 women (23.53%). Their average age was 40±5.10 years. According to the TOAST criteria, stroke of LAA was 45(44.12%), stroke of SAA was 31 (30.39%), stroke of CE was 7 (6.86%), stroke of SOE was 6(5.88%), and stroke of SUE was 13 (12.75%). The constituent ratios of the risk factors were hypertension (69.61%), smoking (58.82%), hyperlipemia (43.14%), drinking (39.22%), and family history of stroke (24.51%), diabetes (20.59%).There were 1062 middle-aged and old-aged ischemic stroke patients, and there were 645 men (60.73%) and 417 women (39.27%). Their average age was 64.64±10.28 years. According to the TOAST criteria, stroke of LAA was 787 (74.11%), stroke of SAA was 218 (20.53%), stroke of CE was 29 (2.73%), stroke of SOE was 4 (0.38%), and stroke of SUE was 24 (2.26%). The constituent ratios of the risk factors were hypertension (78.51%), smoking (50.66%), hyperlipemia (35.40%), diabetes (31.07%), drinking (21.75%), and family history of stroke (16.57%).The result of logistic regression analysis was that diabetes and smoking were the independent risk factors of the LAA of young patients (OR values are 4.182, 3.004; P values are=0.020, =0.014); hypertension was the independent risk factors of the SAA of young patients (OR values is 6.444, P=0.004). Diabetes, drinking, smoking, and hypertension were the independent risk factors of the LAA of middle-aged and old-aged patients (OR values are 17.872, 7.738, 2.739, 2.191; P values are all<0.0001); hypertension and hyperlipemia were the independent risk factors of the SAA of middle-aged and old-aged patients (OR values and are 2.541, 1.582; P values are =0.0002, = 0.014).Conclusion:1.The turns of the TOAST criteria subtyping of young ischemic patients were large-artery atherosclerosis (LAA), small -artery occlusion lacunars (SAA), stroke of other undemonstrated etiology (SUE), cardioembolism (CE), and stroke of other undemonstrated etiology (SOE). The common risk factors were hypertension, smoking, hyperlipemia, and drinking. 2.The turns of the TOAST criteria subtyping of middle-aged and old-aged ischemic patients were large-artery atherosclerosis (LAA), small - artery occlusion lacunars (SAA), cardioembolism (CE), stroke of other undemonstrated etiology (SUE), and stroke of other undemonstrated etiology (SOE). The common risk factors were hypertension, smoking, hyperlipemia, and diabetes.3.The TOAST criteria subtyping were obviously different between young ischemic patients and middle-aged/old-aged ischemic patients. Logistic regression showed that diabetes and smoking were significantly more common in large-artery atherosclerosis (LAA), and hypertension was significantly more common in small - artery occlusion lacunars (SAA). When we diagnose young ischemic patients, we must think highly of the risk factors of earlier arteriosclerotic and should consider the special etiological factors of young ischemic patients. |
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