【摘要】：目的探討青年多發(fā)性腦梗死患者的危險(xiǎn)因素、病因及近期預(yù)后。 方法收集2011年9月至2013年7月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科住院的青年腦梗死患者71例,將患者分為單發(fā)性腦梗死(single cerebral infarction,SCI)組(29例)和多發(fā)性腦梗死(multiple cerebral infarction, MCI)組(42例),詳細(xì)評(píng)估患者的血管病危險(xiǎn)因素和病因,進(jìn)行TOAST分型,采用NIHSS評(píng)分量表和改良Rankin量表對(duì)患者入院時(shí)的神經(jīng)功能缺損程度及發(fā)病后3個(gè)月時(shí)的預(yù)后進(jìn)行評(píng)定,根據(jù)資料類(lèi)型選擇χ2檢驗(yàn)、t檢驗(yàn)、秩和檢驗(yàn)及Logistic回歸分析比較兩組患者在危險(xiǎn)因素、病因和預(yù)后方面存在的差異。 結(jié)果研究的結(jié)果顯示,青年腦梗死最常見(jiàn)的危險(xiǎn)因素依次為男性性別[74.65%(53/71)]、高血壓病[64.79%(46/71)]、吸煙[54.93%(39/71)]和高脂血癥[49.30%(35/71)]。Logistic回歸分析提示青年多發(fā)腦梗死的獨(dú)立危險(xiǎn)因素為高血壓病(OR=3.48,95%CI1.52～7.97,P=0.01)和心臟疾病(OR=2.30,95%CI1.10-4.84,P=0.03)。從TOAST分型各亞型所占的比例來(lái)看,單發(fā)性腦梗死患者以大動(dòng)脈病變卒中[44.83%(13/29)]、小動(dòng)脈病變卒中[24.14%(7/29)]和心源性栓塞[13.79%(4/29)]為主,多發(fā)性腦梗死患者以大動(dòng)脈病變卒中[30.95%(13/42)]、不明原因的卒中[26.19%(11/42)]和小動(dòng)脈病變卒中[23.81%(10/42)]為主,兩者差異明顯(χ2=8.99,P0.05)。Logistic回歸分析顯示青年腦梗死患者預(yù)后不良的獨(dú)立危險(xiǎn)因素為病灶的數(shù)目(OR=23.4,95%CI1.44-379.47,P=0.03)和入院時(shí)的NIHSS評(píng)分(OR=5.44,95%CI2.19-13.51,P=0.01)。結(jié)論青年單發(fā)腦梗死與多發(fā)腦梗死在危險(xiǎn)因素和病因方面存在差異,青年多發(fā)腦梗死的獨(dú)立危險(xiǎn)因素為高血壓病和心臟疾病,病因以大動(dòng)脈病變、不明原因和小動(dòng)脈病變?yōu)橹�。影響青年腦梗死患者預(yù)后的獨(dú)立危險(xiǎn)因素為病灶的數(shù)目和入院時(shí)的NIHSS評(píng)分。
[Abstract]:Objective to investigate the risk factors, etiology and short-term prognosis of young patients with multiple cerebral infarction. Methods from September 2011 to July 2013, 71 young patients with cerebral infarction in Department of Neurology, first affiliated Hospital of Kunming Medical University were collected and divided into single cerebral infarction (single cerebral infarction,). SCI group (29 cases) and multiple cerebral infarction (multiple cerebral infarction, MCI) group (42 cases). The risk factors and etiology of vascular disease were evaluated in detail, and TOAST classification was performed. NIHSS score scale and modified Rankin scale were used to evaluate the degree of neurological deficit and prognosis at 3 months after onset. 蠂 2 test and t test were selected according to the data types. Rank sum test and Logistic regression analysis were used to compare the risk factors, etiology and prognosis between the two groups. Results the most common risk factors for cerebral infarction in young adults were male sex (74.65%) and hypertension (64.79% (46 / 71). Smoking [54.93% (39 / 71)] and hyperlipidemia [49.30% (35 / 71)]. Logistic regression analysis showed that the independent risk factor for multiple cerebral infarction was hypertension (OR=3.48,95%CI1.52~7.97,). P0.01) and heart disease (OR=2.30,95%CI1.10-4.84,P=0.03). According to the proportion of subtypes in TOAST classification, stroke in patients with single cerebral infarction was caused by arteriopathy [44.83% (13 / 29)]. Arteriopathy stroke [24.14% (7 / 29)] and cardiogenic embolism [13.79% (4 / 29)]. Patients with multiple cerebral infarction suffered from large artery disease stroke [30.95% (13 / 42)]. The incidence of stroke of unknown cause [26.19% (11 / 42)] and arteriopathy stroke [23.81% (10 / 42)] were significantly different (蠂 2: 8.99, P < 0.05). P0.05). Logistic regression analysis showed that the independent risk factors for poor prognosis in young patients with cerebral infarction were the number of lesions (OR=23.4,95%CI1.44-379.47,P=0.03) and the NIHSS score on admission (OR=5.44,95%CI2.19-13.51,). P0.01). Conclusion there are differences in risk factors and etiology between single cerebral infarction and multiple cerebral infarction in young people. The independent risk factors of multiple cerebral infarction in young people are hypertension and heart disease. The main causes are arteriopathy, unknown cause and arteriopathy. The independent risk factors influencing the prognosis of young patients with cerebral infarction were the number of lesions and the NIHSS score on admission.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3

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