Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study.
Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study.
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DOI：
10.1371/journal.pone.0268481
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
很少有比较研究关注年轻人和非年轻人缺血性卒中病因的差异。本研究是在日本福冈进行的一项大型多中心医院卒中登记，以确定缺血性卒中在年轻人中比在非年轻人中更重要的原因。我们调查了2007年至2019年期间住院的15860例年龄≥18岁的急性缺血性卒中患者（平均年龄：73.5±12.4岁，58.2%为男性）的数据。共有779例患者被归类为青壮年（≤50岁）。尽管血管危险因素，包括高血压、糖尿病和血脂异常，在年轻人中比在非年轻人中更少见，但在40岁至40岁的年轻人中，糖尿病和血脂异常的患病率与非年轻人相当。与生活方式相关的危险因素，如吸烟、饮酒和肥胖，在年轻人中比在非年轻人中更常见。随着年轻人年龄的增长，心脏栓塞和其他确定病因的中风的比例下降，但大动脉粥样硬化和小血管闭塞的比例增加。一些栓塞源（高危源：动脉黏液瘤、扩张型心肌病、心内血栓；中等危险源：房间隔缺损、非细菌性血栓性心内膜炎、卵圆孔未闭、左室运动不足）和不常见原因(血管疾病：可逆性脑血管收缩综合征、烟雾病、其他血管原因、动脉夹层、脑静脉血栓形成；血液系统疾病（抗磷脂综合征和蛋白S缺乏症）在年轻人中比在非年轻人中更普遍，这些趋势随着年龄的增长而下降。某些栓塞来源和不常见的原因可能是年轻人缺血性中风的病因学上重要的原因。然而，随着年龄的增长，传统的血管危险因素和生活方式相关的危险因素的贡献是不可忽视的，即使在年轻人中也是如此。
Very few comparative studies have focused on the differences in the causes of ischemic stroke between young adults and non-young adults. This study was performed to determine what causes of ischemic stroke are more important in young adults than in non-young adults using a large-scale multicenter hospital-based stroke registry in Fukuoka, Japan. We investigated data on 15,860 consecutive patients aged ≥18 years with acute ischemic stroke (mean age: 73.5 ± 12.4 years, 58.2% men) who were hospitalized between 2007 and 2019. In total, 779 patients were categorized as young adults (≤50 years of age). Although vascular risk factors, including hypertension, diabetes mellitus, and dyslipidemia, were less frequent in young adults than in non-young adults, the prevalence of diabetes mellitus and dyslipidemia in young adults aged >40 years were comparable to those of non-young adults. Lifestyle-related risk factors such as smoking, drinking, and obesity were more frequent in young adults than in non-young adults. As young adults became older, the proportions of cardioembolism and stroke of other determined etiologies decreased, but those of large-artery atherosclerosis and small-vessel occlusion increased. Some embolic sources (high-risk sources: arterial myxoma, dilated cardiomyopathy, and intracardiac thrombus; medium-risk sources: atrial septal defect, nonbacterial thrombotic endocarditis, patent foramen ovale, and left ventricular hypokinesis) and uncommon causes (vascular diseases: reversible cerebral vasoconstriction syndrome, moyamoya disease, other vascular causes, arterial dissection, and cerebral venous thrombosis; hematologic diseases: antiphospholipid syndrome and protein S deficiency) were more prevalent in young adults than in non-young adults, and these trends decreased with age. Certain embolic sources and uncommon causes may be etiologically important causes of ischemic stroke in young adults. However, the contribution of conventional vascular risk factors and lifestyle-related risk factors is not negligible with advancing age, even in young adults.