Etiology, Risk Factors And Related Research Of Ischemic Stroke Of The Youth

ObjectiveTo explore the etiology and risk factors of young patients with ischemic stroke, study the relationship of cerebral vascular abnormalities and ischemic stroke among young people and research the differences of the causes and risk factors between young and old patients so as to provide strong evidence of primary and secondary prevention for ischemic stroke in youth.Methods285 cases were selected with acute ischemic stroke at the in-patient, out-patient Department of Neurology, and in the emergency room, the First Affiliated Hospital of Soochow University, from September 2008 to December 2009. All of them were in three days from onset. Among them 120 young cases (aged 15 to 45 years) for the observed objects, were divided into two groups: the youth groupⅠ(15 to 35 years) with 35 cases, the youth groupⅡ(36-45 years) with 85 cases; patients (older than 45 years) as control objects, owning165 cases, were divided into middle-aged group (between 46 to 65 years) of 64 cases and the older group (older than 65 years) of 101 cases. Clinical data in detail was collected among all cases, including the history of smoking, drinking, hypertension, diabetes, dyslipidemia, heart disease, migraine, and episode of TIA, cerebral infarction. All patients underwent ECG, fasting blood glucose, random blood glucose and glycated hemoglobin, triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL -C), lipoprotein (a) (Lp (a)), hyper- sensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate, anti-streptolysin O(anti-O), homocysteine (Hcy), fibrinogen (Fbg), carotid artery ultrasound and echocardiography examination. All patients took cranial CT, nuclear magnetic resonance imaging (MRI) and angiography (including magnetic resonance angiography (MRA), CT angiography (CTA), digital subtraction angiography (DSA)), in some cases underwent protein C and protein S, anti-neutrophil cytoplasmic antibodies(ANCA), transcranial doppler (TCD). Patients with ischemic stroke were assessed with National Institutes of Health Stroke Scale (NIHSS), at the first day of admission and on the date of 21st day after onset. SPSS13.0 software was used for statistical analysis.Results1. Common risk factors: the smoking rate in youth groupⅠ(17.1%) was significantly lower than that in the other groups(p <0.05, respectively), there was not significant statistical difference in the smoking rate of youth groupⅡ(51.7%) and middle-aged group(46.8%)(p>0.05),but the rate of youth groupⅡ(51.7%) was higher than that of the older group (35.6%)(p<0.05); the drinking rate in youth groupⅠ(14.2 %) was significantly lower than that of other groups(p<0.05); hypertension incidence of youth groupⅠ(20.0%) and youth groupⅡ(34.1%) was significantly lower than that of the middle-aged (87.5%) and elderly patients (85.1%) (p<0.05, respectively). Diabetes incidence of youth groupⅠ(8.5%) was significantly lower than that of the middle-aged (29.6%) and elderly patients (30.6%) (p <0.05 respectively). The rate of dyslipidemia was high in all the groups (all is over 50%) , but there was no marked difference among them (p >0.05, respectively). There wasn't significant difference in the rate of heart disease, episode of TIA and history of migraine (p >0.05, respectively ).2. Comparison of biochemical indexes: the levels of Lp (a) (mg/L) and Hcy (μmol/L) in the youth groupⅠ( 202.55±173.16, 17.61±4.41) andⅡ(204.24±175.38, 17.50±3.97) were significantly higher than those in the middle-aged (112.77±96.08, 15.35±2.76) and old group (112.77±96.08, 15.35±2.76) (p <0.05, respectively); the level of Fbg (g/L) in the youth groupⅠ(2.47±1.00) andⅡ(2.52±1.26) was lower than that in middle-aged (3.20±0.92) and old group (3.01±0.84) (p <0.05 respectively); the level of TC (mmol/L) in the youth groupⅠ(4.02±1.30) was obviously lower than that of the middle-aged (4.74±1.15) or old group (4.55±1.00) (p <0.05 respectively); the level of LDL-C in the youth groupⅠwas lower than that of any other groups (p<0.05 respectively); the level of TG(mmol/L) in the youth groupⅡwas significantly lower than that of the old group (1.40±0.69) (p<0.05); the level of hsCRP (mg/L) in youth groupⅡ(2.83±2.20) was obviously lower than that of the middle-aged group (3.80±3.030) and old group (5.65±4.93) (p<0.05, respectively). The level of uric acid (μmol/L) in the youth groupⅠ(318.99±141.99) orⅡ(301.06±99.85) was lower than that in the old group (268.09±84.62) (p <0.05 respectively). In the level of TC, TG, LDL-C, Lp (a), hsCRP, Fbg, Hcy and uric acid, there was no significant difference between the youth groupⅠandⅡ(p >0.05 respectively). There were no statistical differences in the HDL-C levels among all the groups (p >0.05 respectively)3. The results of carotid artery ultrasound examination: the detection rate of plaque was statistically different in four groups (p <0.05 respectively), the rate was 0 in the youth groupⅠ, while it was 14.1% in the youth groupⅡ. It was 53.1% and 84.2% in the middle-aged and in the older group respectively. The carotid artery intima-media thickness thickness (IMT)(mm) in the youth groupⅠ(0.50±0.08) andⅡ(0.70±0.56) was also significantly less than that in middle-aged (0.82±0.72) and old group (1.09±0.94) (p <0.05 respectively).4. In youth groupⅠ, the rate of cerebral vascular stenosis was 45.7%, while it was 52.9% in youth groupⅡ. The rate was 51.5% in the middle-aged group and 43.5% in the elderly group. Obviously the rate of stenosis was high in all the groups, though there was no significant difference among them (p >0.05 respectively)5. China ischemic stroke Subclassification (CISS) showed that the causes of four groups were different. In youth groupⅠa nd youth groupⅡ, ischemic stroke was dominatedly caused by other demonstratedetiology (SOE), while the cause of the middle age group was large artery atherosclerosis (LAA) and the eldly group was perforating small arterial occlusive stroke (PSAO). There was no difference in the rate of cardioembolism (CE) among the groups (p >0.05 respectively).6. NIHSS score of four groups at the first day of admission was not significantly different (p >0.05 respectively), but on the date of 21 days after onset the NIHSS score in the youth groups (4.76±4.44) and youth groupⅡ(4.79±5.64) was lower than that of middle-aged (7.16±8.10) or elderly (7.16±6.92) patients (p<0.05 respectively), the male patients in youth groupⅠa nd youth groupⅡwere more than the famale patients when compared to middle-aged group and elderly group (p <0.05 respectively).Conclusion1. The data showed stroke risk factors of young people were smoking, drinking, dyslipidemia and high level Hcy.2. Carotid artery ultrasound showed there was no plaque in the carotid arteries in the youth groupⅠ, but the number of plaques was significantly increased with age. The angiostegnosis rates of young and old patients were both high.3. Young people were mostly caused by other demonstratedetiology (SOE).