| Background and ObjectivesThe number of young stroke patients increases by approximately two million yearly on the global scale,and according to the current date,the number of young stroke patients account for 15%-18%of all stroke cases.Compared with the older stoke patients,the risk factors and the etiologies of ischemic stroke in young adults are more complex,furthermore,a higher recurrence occurs in this portion of patients after stroke,in addition,high rate of disability and psychologic problems after stroke significantly affects the work and daily life of patients,which can exaggerate the financial burden to his/her family and the whole society.The epidemiologic evidence suggests that the incidence of ischemic in young adults has increased substantially year by year,therefore it is crucial to elucidate the risk factors and etiologies of stroke in young adults.Based on these,we explored the risk factors and etiologies in the young patients with acute cerebral infarction,which providing information for clinically diagnostic and prognosis.Materials and Methods1 Research objectsYoung patients with acute ischemic stroke who were registered during December 2017 to June 2019 at the Department of Neurology of the first affiliated hospital of Zhengzhou University were collected consecutively as the case group,the diagnoses of all patients met the diagnostic criteria in guidelines of diagnosis and management of acute ischemic cerebral stroke in 2014 and were confirmed as acute cerebral infarctions by brain CT or MRI,and the responsible cerebral lesions detected by neuroimaging tests were in concordance with clinical symptoms,patients with TIA,iatrogenic stroke and hemorrhagic stroke were excluded.Meanwhile,persons who had practiced health examination at Outpatient Department were collected as the control group.2 Investigation contentsThe medical records of all enrolled objects were obtained,including:(1)General conditions:sex,age,weight,with or without sleep disorders;(2)History:hypertension,diabetes mellitus,atrial fibrillation,hyperlipidemia,coronary heart disease,family history of stroke;(3)Personal history:smoking,alcohol drinking,use of oral contraceptives,contact history of exposure to some special drugs,venereal history;(4)Laboratory testing:blood routine,liver and kidney function,blood glucose,blood lipid,blood coagulation,plasma homocysteine,antibodies against the connective tissue,tumor markers,antibodies against parasite;(5)Neuroimaging test:electrocardiogram,echocardiography and carotid ultrasonography,cardiac foaming test,head CT and head-neck CTA,brain MRI and MRA;(6)Neurologically functional state evaluation:NIHSS score within 6 hours after admission.3 Statistical methodsThe data were analyzed by using SPSS 23.0 software.Mean number±Sd((?)±s)was used to represent the measurement data.The t test was conducted for comparison between groups with normally distributed data,and Mann Whitney U test was applied for comparison between groups with non-normally distributed data;the x2 test and Logistic regression analysis were conducted for comparison with enumeration data which were represented by the constituent ratio.There would be a statistical significance when the P<0.05 was shown.Results1 General informationTotally 180 young patients with acute ischemic stroke who were registered during December 2017 to June 2019 at the Department of Neurology of the first affiliated hospital of Zhengzhou University were collected consecutively,including 143 males and 37 females with a male-to-female ratio of 4.61:1,and the age of the patients ranged from 18 to 45(36.8±6.4)years old.Another 150 healthy control cases in the same period were collected,including 114 males and 36 females with a male-to-female ratio of 3.17:1,and the age range in this group was from 18 to 45(35.4±7.1)years old.Compared with the control group,the plasma levels of red blood cell count,glucose,TC(total cholesterol),LDL-C(LDL-cholesterol),TG(triglyceride)and Hcy(homocysteine)in the case group patients were much higher with a significant difference(P<0.05).2 Prevalence of traditional vascular risk factors between case and control groupsThe univariate x2 test was conducted to analyze the difference of traditional vascular risk factors prevalence between case and control groups,the results showed that the risk factors of hypertension,hyperlipidemia,smoking,alcohol drinking,overweight and HHcy(hyperhomocysteinemia)were higher in the case group than those in the control group(P<0.05),yet there was no distribution difference for the diabetes mellitus and atrial fibrillation between the two groups(P>0.05).3 Logistic regression analysis of traditional vascular risk factors.According to the results of univariate x2 test analysis,the following covariates including hypertension,hyperlipidemia,smoking,alcohol drinking,overweight and HHcy were employed in the model of Logistic regression,the sex variate was added to avoid confounding effects,the Enter Method was chosen for the selection of independent variables,the results showed that the risk factors presented with statistical significance were hyperlipidemia(OR=6.93,P<0.01),HHcy(OR=5.55,P<0.01),smoking(OR=4.46,P<0.01),overweight(OR=4.26,P<0.05),and hypertension(OR=3.39,P<0.01).4 IPSS categorization of the associated risk factors in the case group patients.The associated risk factors of 180 young patients with acute ischemic infarction in the case group were categorized by the IPSS method,the result showed that 122(67.8%)young stroke patients had one or more risk factors for early atherosclerosis;75(41.7%)patients had one risk factor in IPSS category,of which chronic systemic conditions(13.9%)and arteriopathy(12.2%)were the common associated risk factors categories.5 TOAST etiologic classification of patients in the case group The etiologic analysis of 180 young patients with acute ischemic infarction in the case group were classified by the TOAST system,the results were as follows:103(57.2%)large-artery atherosclerotic cases,2(1.1%)cardioembolic cases,23(12.7%)small-artery occlusion cases,24(13.3%)cases of unknown etiology,and 28(15.6%)cases of other causes which were comprised of 16 cases of Moyamoya disease,5 cases of arteritis,5 cases of connective tissue disease,1 case of cervical artery dissection and 1 case of amyloidosis.6 Comparison of IPSS category and TOAST etiologic classification in the case group The main associated risk factor categories analyzed by the IPSS method were》1 risk factors for early atherosclerosis,chromic systemic conditions,arteriopathy and cardiac disorders.The main results classified by TOAST system were large artery atherosclerosis,other etiology,undetermined etiology and small artery occlusion.7 Correlation analysis between IPSS category and neuroimaging features of cerebral infarcts,the severity of neurologic deficits.7.1 Correlation analysis between IPSS category and neuroimaging features of cerebral infarcts.According to the results of analysis,there was a correlation between cardiac disorders and multiple infarcts(P<0.05).7.2 Correlation analysis between IPSS category and the severity of neurologic deficits.Based upon the results of the present study,there was yet no correlation between IPSS category and non-mild stroke(P>0.05).Conclusions1.Hyperlipidemia,hyperhomocysteinemia,smoking,overweight and hypertension are the important traditional vascular risk factors of ischemic stroke in the young adults.2.The IPSS(international Pediatric Stroke Study)category can be applied to the etiologic study of ischemic stroke in the young adults. |
