不同年龄组缺血性卒中患者危险因素分析
|
摘要
目的:缺血性脑卒中是目前我国主要的死亡和致残原因,严重威胁人民的生命和健康,给社会和家庭带来沉重的负担。缺血性卒中作为中老年人的常见病之一,其发病年龄有逐年年轻化的趋势,由此导致青年缺血性卒中的发病率不断上升,在增加缺血性卒中的复发率和致残率的同时,严重影响青壮年人群的生活质量。因此,探讨青年缺血性卒中患者的危险因素及病因学特征成为卒中防治的关键,也成为全球性研究的热点,对卒中早期防治有重要意义。国外研究报道[1],青年缺血性卒中的主要病因依次为吸烟(50.5%)、高脂血症(31.2%)、高血压病(22.6%)、酗酒(16.1%)等,明显不同于老年患者常见的发病原因。相关研究国内报道较少。基于此,本研究依据Trial of Org 10 172 in acute stroke treatment (TOAST)分型法[2],探讨不同年龄段缺血性脑卒中患者的病因,了解青年组缺血性卒中患者的病因学特征,研究其发病机制,指导不同年龄组缺血性卒中患者的防治。
方法:收集2002年1月至2007年6月期间在我科住院的缺血性脑卒中患者为研究对象,常规登记患者年龄、性别、血压、血糖、血脂、吸烟史、酗酒史、既往史、家族史等人口构成情况及相关临床资料。以年龄区域分组,年龄界于18至45岁之间(包括18岁和45岁)的患者为青年组,年龄大于45岁的患者列为中老年组。
根据TOAST分型方法[2]将缺血性卒中分为以下五个亚型:
1、大动脉粥样硬化性卒中(large-artery atherosclerosis, LAA):这一类型卒中患者均经TCD和/或MRA、颈动脉多普勒超声扫描明确颅内外动脉粥样硬化性狭窄或闭塞的诊断,且责任血管的狭窄程度50%以上。
2、小动脉卒中(腔隙性脑梗死small - artery occlusion lacunars, SAA):具备以下三项标准之一者即可确诊:(1)具有典型的腔隙性梗死综合征表现,且影像学检查可见与临床表现相符的、最大直径< 1.5 cm的责任病灶;(2)具有典型的腔隙性梗死综合征表现,但影像学检查未发现相应的责任病灶;(3)具有非典型的腔隙性脑梗死综合征表现,但影像学检查发现与临床表现相符的、最大径< 1.5 cm的责任病灶。
3、心源性脑栓塞(cardioembolism, CE):这一类别包括各种具有心源性栓子来源的疾病引发的脑栓塞。
4、其他原因引发的缺血性卒中(stroke of other demon- strated etiology, SOE):这一类别指由其他病因引发的脑梗死,该病因明确为高凝状态、血液系统疾病或吸食毒品等。
5、原因不明的缺血性卒中(stroke of other undemon- strated etiology, SUE):这一类别包括不能归于以上类别的缺血性脑卒中。
依据TCD和MRA对颅内外血管狭窄的诊断标准[3-6]判断颈部及颅内血管病变的部位、程度及侧支循环状态。
应用Logistic回归分析各种卒中危险因素对TOAST分类中不同亚型的影响。显著性差异水准为0.05。
结果:102例青年缺血性卒中患者中,男性78例(76.47%),女性24例(23.53%),男性所占比例显著高于女性,平均年龄为40.00±5.10岁。根据TOAST病因分型,大动脉粥样硬化性卒中45例(44.12%),小动脉卒中31例(30.39%),心源性脑栓塞7例(6.86%),其他原因引发的缺血性卒中6例(5.88%),原因不明的缺血性卒中13例(12.75%)。各危险因素构成比依次为高血压病(69.61%)、吸烟史(58.82%)、高脂血症(43.14%)、酗酒史(39.22%)、脑血管病家族史(24.51%)、糖尿病(20.59%)。
1062例中老年缺血性卒中患者中,男性645例(60.73%),女性417例(39.27%),男性所占比例明显高于女性,平均年龄为64.64±10.28岁。根据TOAST病因分型,大动脉粥样硬化性卒中787例(74.11%),小动脉卒中218例(20.53%),心源性脑栓塞29例(2.73%),其他原因引发的缺血性卒中4例(0.38%),原因不明的缺血性卒中24例(2.26%)。各危险因素构成比依次为高血压病(78.51%)、吸烟史(50.66%)、高脂血症(35.40%)、糖尿病(31.07%)、酗酒史(21.75%)、脑血管病家族史(16.57%)。
经Logistic回归分析显示,糖尿病、吸烟史与青年大动脉粥样硬化性卒中(LAA)密切相关(OR值分别为4.182,3.044; P值分别=0.020,=0.014);高血压病与青年小动脉性卒中(SAA)密切相关的危险因素为高血压病(OR值为6.444,P=0.004)。糖尿病、酗酒史、吸烟史、高血压病与中老年大动脉粥样硬化性卒中(LAA)密切相关,(OR值分别为17.872,7.738,2.739,2.191;P值均<0.0001)。高血压病、高脂血症与中老年小动脉性卒中(SAA)密切相关(OR值分别为:2.541,1.582;P值分别=0.0002,=0.014)。
结论:
1、青年缺血性卒中患者TOAST病因学分型各型所占比例从多到少依次为:大动脉粥样硬化性卒中、小动脉卒中、原因不明的缺血性卒中、心源性脑栓塞、其他原因引发的缺血性卒中。最常见危险因素为高血压病、吸烟、高脂血症、酗酒。
2、中老年缺血性卒中患者TOAST病因学分型各型所占比例从多到少依次为大动脉粥样硬化性卒中、小动脉卒中、心源性脑栓塞、原因不明的缺血性卒中、其他原因引发的缺血性卒中。最常见的危险因素是高血压病、吸烟、高脂血症、糖尿病。
3、TOAST病因学分型各亚型构成比在青年组与中老年组缺血性卒中患者间存在显著差异。两组结果分别进行Logistic回归分析,结果均显示糖尿病和吸烟与大动脉粥样硬化性卒中的密切相关,高血压病与小动脉性卒中的密切相关。对青年缺血性卒中患者进行诊断时,要重视导致早期动脉硬化的危险因素,此外,无传统脑血管病危险因素的患者,要考虑其他导致青年卒中的特殊病因。
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.
方法:收集2002年1月至2007年6月期间在我科住院的缺血性脑卒中患者为研究对象,常规登记患者年龄、性别、血压、血糖、血脂、吸烟史、酗酒史、既往史、家族史等人口构成情况及相关临床资料。以年龄区域分组,年龄界于18至45岁之间(包括18岁和45岁)的患者为青年组,年龄大于45岁的患者列为中老年组。
根据TOAST分型方法[2]将缺血性卒中分为以下五个亚型:
1、大动脉粥样硬化性卒中(large-artery atherosclerosis, LAA):这一类型卒中患者均经TCD和/或MRA、颈动脉多普勒超声扫描明确颅内外动脉粥样硬化性狭窄或闭塞的诊断,且责任血管的狭窄程度50%以上。
2、小动脉卒中(腔隙性脑梗死small - artery occlusion lacunars, SAA):具备以下三项标准之一者即可确诊:(1)具有典型的腔隙性梗死综合征表现,且影像学检查可见与临床表现相符的、最大直径< 1.5 cm的责任病灶;(2)具有典型的腔隙性梗死综合征表现,但影像学检查未发现相应的责任病灶;(3)具有非典型的腔隙性脑梗死综合征表现,但影像学检查发现与临床表现相符的、最大径< 1.5 cm的责任病灶。
3、心源性脑栓塞(cardioembolism, CE):这一类别包括各种具有心源性栓子来源的疾病引发的脑栓塞。
4、其他原因引发的缺血性卒中(stroke of other demon- strated etiology, SOE):这一类别指由其他病因引发的脑梗死,该病因明确为高凝状态、血液系统疾病或吸食毒品等。
5、原因不明的缺血性卒中(stroke of other undemon- strated etiology, SUE):这一类别包括不能归于以上类别的缺血性脑卒中。
依据TCD和MRA对颅内外血管狭窄的诊断标准[3-6]判断颈部及颅内血管病变的部位、程度及侧支循环状态。
应用Logistic回归分析各种卒中危险因素对TOAST分类中不同亚型的影响。显著性差异水准为0.05。
结果:102例青年缺血性卒中患者中,男性78例(76.47%),女性24例(23.53%),男性所占比例显著高于女性,平均年龄为40.00±5.10岁。根据TOAST病因分型,大动脉粥样硬化性卒中45例(44.12%),小动脉卒中31例(30.39%),心源性脑栓塞7例(6.86%),其他原因引发的缺血性卒中6例(5.88%),原因不明的缺血性卒中13例(12.75%)。各危险因素构成比依次为高血压病(69.61%)、吸烟史(58.82%)、高脂血症(43.14%)、酗酒史(39.22%)、脑血管病家族史(24.51%)、糖尿病(20.59%)。
1062例中老年缺血性卒中患者中,男性645例(60.73%),女性417例(39.27%),男性所占比例明显高于女性,平均年龄为64.64±10.28岁。根据TOAST病因分型,大动脉粥样硬化性卒中787例(74.11%),小动脉卒中218例(20.53%),心源性脑栓塞29例(2.73%),其他原因引发的缺血性卒中4例(0.38%),原因不明的缺血性卒中24例(2.26%)。各危险因素构成比依次为高血压病(78.51%)、吸烟史(50.66%)、高脂血症(35.40%)、糖尿病(31.07%)、酗酒史(21.75%)、脑血管病家族史(16.57%)。
经Logistic回归分析显示,糖尿病、吸烟史与青年大动脉粥样硬化性卒中(LAA)密切相关(OR值分别为4.182,3.044; P值分别=0.020,=0.014);高血压病与青年小动脉性卒中(SAA)密切相关的危险因素为高血压病(OR值为6.444,P=0.004)。糖尿病、酗酒史、吸烟史、高血压病与中老年大动脉粥样硬化性卒中(LAA)密切相关,(OR值分别为17.872,7.738,2.739,2.191;P值均<0.0001)。高血压病、高脂血症与中老年小动脉性卒中(SAA)密切相关(OR值分别为:2.541,1.582;P值分别=0.0002,=0.014)。
结论:
1、青年缺血性卒中患者TOAST病因学分型各型所占比例从多到少依次为:大动脉粥样硬化性卒中、小动脉卒中、原因不明的缺血性卒中、心源性脑栓塞、其他原因引发的缺血性卒中。最常见危险因素为高血压病、吸烟、高脂血症、酗酒。
2、中老年缺血性卒中患者TOAST病因学分型各型所占比例从多到少依次为大动脉粥样硬化性卒中、小动脉卒中、心源性脑栓塞、原因不明的缺血性卒中、其他原因引发的缺血性卒中。最常见的危险因素是高血压病、吸烟、高脂血症、糖尿病。
3、TOAST病因学分型各亚型构成比在青年组与中老年组缺血性卒中患者间存在显著差异。两组结果分别进行Logistic回归分析,结果均显示糖尿病和吸烟与大动脉粥样硬化性卒中的密切相关,高血压病与小动脉性卒中的密切相关。对青年缺血性卒中患者进行诊断时,要重视导致早期动脉硬化的危险因素,此外,无传统脑血管病危险因素的患者,要考虑其他导致青年卒中的特殊病因。
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.
引文
1 Otero Palleiro MM, Barbagelata López C.Etiologic subtypes of ischemic stroke in young adults aged 18 to 45 years: a study of a series of 93 patients. Revista clinica espahola, 2007 Apr; 207(4):158-165
2 Adams H, Bendixen B. Classification subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Of Org 10 172 in acute stroke treatment. Stroke, 1993, 24:35-41
3 黄一宁,高山,王莉鹃等. 闭塞性脑血管病经颅多普勒超声和脑血管造影的比较. 中华神经科杂志,1997,30:98-101
4 Gao S, Lam WW, Chan YL, et al. Optimal values of flow velocity on transcranial Doppler in grading middle cerebral artery stenosis in comparison with magnetic resonance angiography. J Neuroimaging, 2002, 12(3): 213-218
5 Gao S, Chan YL, Lam WWM, et al. The optimal values of flow velocity on trascranial Doppler in grading middle cerebral artery stenosis in comparison with magneticresonance angiography. Neuroimag, 2001, 12: 1-6
6 Norh American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991, 325-453
7 中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29: 379-380
8 Madden K,Adams H. Accuracy of initial stroke subtype diagnosis in the TOAST study. Neurology, 1995, 45 ( 11) :1975-1979
9 周衡,王拥军,王素香等. 急性缺血性脑卒中的TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
10 中国高血压防治指南修订委员会.2004年中国高血压防治指南(实用本).高血压杂志,2004,12:483-486
11 Tsong-Hai Lee,Wen-Chuin Hsu, Chi-Jen Chen, et al. Etiologic Study of Young Ischemic Stroke in Taiwan. Stroke, 2002; 33:1950-1955
12 Jousilahti P, Rastenyte D, Tuomilehto J, et al. Parental history of cardiovascular disease and risk of stroke. A prospective follow-up of 14371 middle-aged men and women in Finland. Stroke, 1997, 28(7):1361-1366
13 Kappelle LJ, Adams HP Jr, Heffner ML, et al. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke, 1994, 25(7):1360-1365
14 毕齐、张茁、张微微等. 2359 例青年脑卒中患者危险因素研究. 中华流行病学杂志,2003,24(2):106-108
15 王薇、赵冬、孙佳艺等. 中国 11 省市队列人群危险因素与不同类型心血管病发病危险的比较. 中华心血管病杂志,2006,12(34):1133-1137
16 Kwon SU, Kim JS, Lee JH, et al. Ischemic stroke in Korean young adults. Acta Neurol Scand. 2000; 101: 19-24
17 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke, 1997, 28: 1702-1709
18 Zétola VH, Nóvak EM, Camargo CH, et al. Stroke in young adults: analysis of 164 patients. Arq Neuropsiquiatr. 2001 Sep; 59(3-B):740-745
19 Love BB, Biller J, JonesM P, et al. Cigarette smoking. A risk factor for cerebral infaretion in young adults. A rch Neurol, 1990, 47: 693-698
20 Whisnant JP, Wiebers DO, O’Fallon WM, et al. A population based model of risk factors for ischemic stroke. Neurology, 1996, 47: 1420
21 Pires SL, Gagliardi RJ, Gorzoni ML. Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients. Arquivos de neuro-psiquiatria, 2004 Sep ; 62(3B): 844-851
22 陈彤、尹岭、李小鹰等. 老年人群脑卒中现患率及危险因素调查. 中华老年心脑血管病杂志. 2003,6(5):168-170
23 刘迎梅,丁学兵,巩延丽等. 不同年龄组脑梗死病人危险因素及临床特点分析. 中西医结合心脑血管病杂志,2005,3(3):272-273
24 刘运海、杨期东、刘尊敬等. 队列人群脑血管病危险因素干预效果评价. 中华流行病学杂志,2003,24(2):102-105
25 赵翠、刘俊艳、吴婧. 不同类型卒中与代谢综合征的相关性研究. 中国脑血管病杂志,2008,5(3):97-101
26 Mehndiratta MM, Agarwal P, Sen K, et al. Stroke in young adults: a study from a university hospital in north India. Med Sci Monit. 2004 Sep; 10(9): 535-541
27 Rasura M, Spalloni A, Ferrari M, et al. A case series of young stroke in Rome. Eur J Neurol, 2006, Feb; 13(2):146-152
28 Szapáry L, Sz?ts M, Pál E, et al. Ischemic stroke in young adults. Orv Hetil, 2001, Mar, 25; 142(12):607-610
29 Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992; 10: 113-124
30 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue Neurol (Paris), 1999, Sep; 155(8):575-582
31 Siqueira Neto JI, Santos AC, Fabio SR, et al. Cerebral infarction in patients aged 15 to 40 years. Stroke. 1996; 27: 2016-2019
32 Chan MT, Nadareishvili ZG, Norris JW. Diagnostic strategies in young patients with ischemic stroke in Canada. Can J Neurol Sci. 2000; 27: 120-124
33 Williams LS, Garg BP, Cohen M, et al. Subtypes of ischemicstroke in children and young adults. Neurology. 1997; 49: 1541-1545
34 Qureshi AI, Safdar K, Patel M, et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke, 1995, 26: 1995-1998
35 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand. 1994; 89: 323-328
36 Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol. 2007; 57(2): 96-102
37 Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epide- miology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001, Dec 1; 32(12):2735-2740
38 Petty GW, Brown RD J r, Whisnant J P , et al. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke, 1999, 30: 2513-2516
39 Yip PK. Subtypes of Ischemic Stroke: A Hospital-Based Stroke Registry in Taiwan (SCAN - IV). Stroke, 1997, 28 (12) : 2507-2512
40 刘俊艳,刘嘉林,魏娟红. 缺血性卒中患者颅内外血管狭窄率研究. 脑与神经疾病杂志,2005,13:20-21
41 Huang YN, Gao S, Li SW, et al. Vascular lesions in Chinese patients with transient ischemic attacks. Neurology, 1997, 48: 524-525
42 Wong KS, Huang YN, Gao S, et al. Intracranial stenosis in Chinese with acute stroke. Neurology. 1998, 50:812-813
43 Wong KS, Li H, Chan YL, et al. Use of transcranial Doppler to predict outcome in patients with intracranial large-artery occlusive disease. Stroke, 2000, 31: 2641-2647
44 李春雨,崔小波,饶英生等. 北京市 1997-2004 年三次居民吸烟情况分析比较. 中华流行病学杂志,2007,28(5):453-456
45 Lee LJ, Kidwell CS , Alger J , et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke , 2000 , 31: 1081-1089
46 刘俊艳,高山,黄家星.经颅多谱勒超声评估大脑中动脉狭窄程度的最佳速度值.中华神经科杂志,2003,36(6):458-460
47 Leung DY, Black IW, Cranney GB, et al. Selection of patients for transesophageal echocardiography after stroke and systemic embolic events: role of transthoracic echocardiography. Stroke. 1995; 26: 1820-1824
48 Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients. Lancet. 1988; 2: 11-12
49 Job FP, Ringelstein EB, Grafen Y, et al. Comparison of transcranial contrast Doppler sonography and transe- sophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Am J Cardiol.1994; 74: 381-384
50 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997; 28: 1702-1709
51 Bots ML, Launer LJ, Lindemans J, et al . Homocysteine and short-term risk of myocardial infarction and stroke in the elderly : the Rotterdam Study. Arch Intern Med, 1999, 159: 38-44
52 Kristensen B, Malm J, Nilsson TK, et al. Hyperhomo- cysteinemia and hypofibrinolysis in young adults with ischemic stroke. Stroke, 1999, 30: 974-980
53 Tan NC, Venketasubramanian N, Saw SM, et al. Hyper- homocyst-(e)inemia and risk of ischemic stroke among young Asian adults. Stroke, 2002, 33: 1956-1962
54 Brey RL, Stallworth CL, McGlasson DL, et al. Antipho- spholipid antibodies and stroke in young women. Stroke, 2002, 33: 2396-2401
55 Rasura M, Spalloni A, Ferrari M,et al. A case series of young stroke in Rome. European journal neurology, 2006, Feb; 13(2):146-152
56 Donaghy M, Chang CL, N Poulter. Duration, frequency, recency, and type of migraine and the risk of ischemic stroke in women of childbearing age. Journal of Neurology, Neurosurg and Psychiatry, 2002, 73:747-750
57 Schwartz SM, Petitti DB, Siscovick DS, et al. Stroke and use of low-dose oral contraceptives in young women: a pooledanalysis of two US studies. Stroke, 1998, 29: 2277-2284
58 Cole JW, Pinto AM, Hebel JR, et al. Acquired Immuno- deficiency Syndrome and the Risk of Stroke. Stroke, 2004, 35: 51-56
59 Connor MD, Lammie GA, Bell JE, et al. Cerebral infarction in adult AIDS patients: observation from the Edinburgh HIV Autopsy Cohort. Stroke, 2000, 31: 2117-2126
60 Lehto S, Niskanen L, Ronnemaa T, et al. Serum uric acid is a strong predictor of stroke in patients with non-insulin- dependent diabetes mellitus. Stroke, 1998, 29: 635-639
61 汪波,高山,刘俊艳,等. 无症状人群脑血管狭窄的调查。中华流行病学杂志,1998,19:344-347
62 Song YM, Kwon SU, Sung J, et al. Different risk factor profiles between subtypes of ischemic stroke. A case-control study in Korean men. Eur J Epidemiol. 2005; 20(7):605-612
1 Tsong-Hai Lee,Wen-Chuin Hsu, Chi-Jen Chen, et al. Etiologic Study of Young Ischemic Stroke in Taiwan. Stroke, 2002; 33: 1950-1955
2 王德生,徐心,李树祥等. 中青年脑梗死患者的临床与病理. 中华神经科杂志,1998,31 (2) : 98-101
3 Zétola VH, Nóvak EM, Camargo CH. Stroke in young adults: analysis of 164 patients. Arquivos de neuro-psiquiatria, 2001 Sep; 59(3-B): 740-745
4 罗国君,迟路湘,王云甫等. 青年缺血性脑卒中患者脑血管病变的特点. 卒中与神经疾病,2006,13(3):163-165
5 毕齐、张茁、张微微等. 2359 例青年脑卒中患者危险因素研究. 中华流行病学杂志,2003,24(2):106-108
6 Szapary L, SzotsM, Pal E, et al. Ischemic stroke in young adults.Orv Hetil, 2001, 142: 607-610
7 Ruiz - sandoval J I, Cantu C, Barinagarrementeria F.Intracerbral hemorrhage in young people:analysis of risk factors, location, causes, and prognosis, Stroke, 1999, 30: 537-541
8 Ghandehari K, Moud ZI. Incidence and etiology of ischemic stroke in Persian young adults. Acta neurologica scandinavica, 2006, Feb; 113(2):121-124
9 Rasura M, Spalloni A, Ferrari M,et al. A case series of young stroke in Rome. European journal neurology, 2006, Feb; 13(2):146-152
10 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue neurologique (Paris), 1999, Sep; 155(8):575-582
11 Bots ML, Launer LJ, Lindemans J, et al. Homocysteine and short-term risk of myocardial infarction and stroke in the elderly: the Rotterdam Study. Arch Intern Med, 1999, 159:38-44
12 Kristensen B, Malm J, Nilsson T, et al. Hyperhomocy- steinemia and hypofibrinolysis in young adults with ischemic stroke. Stroke, 1999, 30: 974-980
13 Tan NC, Venketasubramanian N, Saw SM, et al. Hyperho- mocyst-(e)inemia and risk of ischemic stroke among young Asian adults. Stroke, 2002, 33: 1956-1962
14 Santonja JM, Vicent V, Pareja A, et al. Cerebrovascular disease in young adults. A study of its course in 167 patients. Rev Neurol, 1998, 26 : 787-789
15 Vermeulen EG, Rauwerda JA , van den Berg M, et al . Homocysteine-lowering treatment with folic acid plus vitamin B6 lowers urinary albumin excretion but not plasma markers of endothelial function or C-reactive protein : further analysis of secondary end2points of a randomized clinical trial . Eur J Clin Invest, 2003, 33: 209-215
16 Van Guldener C, Stehouwer CD. Hyperhomocysteinemia, vascular pathology , and endothelial dysfunction. Semin Thromb Hemost, 2000, 26 : 281-289
17 Stamler JS , Osborne JA , Jaraki O , et al . Adverse vascular effects of homocysteine are modulated by endothelium-derived relaxing factor and related oxides of nitrogen. J Clin Invest, 1993, 91: 308-318
18 Hovind P, Tarnow L, Rossing P, et al. Progression of diabeticnephropathy: role of plasma homocysteine and plasminogen activator inhibitor-1. Am J Kidney Dis , 2001 , 38 : 1376-1380
19 Van Dijk RA , Rauwerda JA , Steyn M, et al. Long-term homocysteine lowering treatment with folic acid plus pyridoxine is associated with decreased blood pressure but not with improved brachial artery endothelium-dependent vasodilation or carotid artery stiffness : a 2 - year , randomized , placebo - controlled trial . Arterioscler Thromb Vasc Biol, 2001, 21 : 2072-2079
20 Vermeulen EG, Niessen HW, Bogels M, et al. Decreased smooth muscle cell/extracellular matrix ratio of media of femoral artery in patients with atherosclerosis and hyperhomocysteinemia. Arterioscler Thromb Vasc Biol, 2001, 21: 573-577
21 Dickerhoff R, Pongratz E, Scheel-Waker HG. Cerebral infarct and hemorrhage in patients with sickle cell disease. Klin Padiatr, 1994,206: 381-384
22 Kristensen B, Malm J, Nilsson TK, et al. Increased fibrinogen levels and acquired hypofibrinolysis in young adults with ischemic stroke. Stroke, 1998, 29: 2261-2267
23 Woo J, L au E, L am CW, et al. Hypertension, lipop-rotein(a) and apolipoproteinA-I as risk factors for stroke in the Chinese.Stroke, 1991, 22: 203
24 Shintani S, Kikuchi S, Hamaguchi H, et al. High serum lipoprotein(a) levels are an independent risk factor for cerebral infarction. Stroke, 1993, 24: 965
25 Bladassarre D, Tremoli E, Franceschini G, et al. Plasma lipoprotein(a) is an independent factor associated with carotid wall thickening in severely but not moderately hyper-cholesterolemic patients. Stroke, 1996, 27: 1044
26 Brey RL, Stallworth CL, McGlasson DL, et al. Antipho- spholipid antibodies and stroke in young women. Stroke, 2002, 33: 2396-2401
27 Donaghy M, Chang CL, N Poulter. Duration, frequency, recency, and type of migraine and the risk of ischemic stroke in women of childbearing age. Journal of Neurology, Neurosurg and Psychiatry, 2002, 73: 747-750
28 Schwartz SM, Petitti DB, Siscovick DS, et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke, 1998, 29: 2277-2284
29 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue neurologique (Paris), 1999, Sep; 155(8):575-582
30 Musolino R, La Spina P, Granata A, et al. Ischemic stroke in young people: a prospective and long-term follow-up study. Cerebrovasclar diseases, 2003; 15(1-2):121-128
31 周衡,王拥军,王素香等. 急性缺血性脑卒中的 TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
32 Otero Palleiro MM, Barbagelata López C. Etiologic subtypes of ischemic stroke in young adults aged 18 to 45 years: a study of a series of 93 patients. Revista Clinical Espahola, 2007, Apr; 207(4):158-165
33 Mehndiratta MM, Agarwal P, Sen K, et al. Stroke in young adults: a study from a university hospital in north India. Med Sci Monit. 2004 Sep; 10(9): 535-541
34 Kwon SU, Kim JS, Lee JH, et al. Ischemic stroke in Korean young adults. Acta Neurol Scand. 2000; 101: 19-24
35 Szapáry L, Sz?ts M, Pál E, et al. Ischemic stroke in young adults. Orv Hetil, 2001, Mar, 25; 142(12):607-610
36 Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992; 10: 113-124
37 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke, 1997, 28:1702-1709
38 Siqueira Neto JI, Santos AC, Fabio SR, et al. Cerebral infarction in patients aged 15 to 40 years. Stroke. 1996; 27: 2016-2019
39 Chan MT, Nadareishvili ZG, Norris JW. Diagnostic strategies in young patients with ischemic stroke in Canada. Can J Neurol Sci. 2000; 27: 120-124
40 Williams LS, Garg BP, Cohen M, et al. Subtypes of ischemic stroke in children and young adults. Neurology. 1997; 49: 1541-1545
41 Qureshi AI, Safdar K, Patel M, et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke, 1995, 26: 1995-1998
42 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand. 1994; 89: 323-328
43 Szabo K, Kern R, Gass A, et al. Acute stroke patterns in patients with internal carotid artery disease: a diffusion- weighted magnetic resonance imaging study. Stroke, 2001, 32(6): 1323-1329
44 胡大一,王宏宇.高血压病流行的全球趋势及对策.中国实用内科杂志,2002,22:195-196
45 Pires SL, Gagliardi RJ, Gorzoni ML. Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients. Arquivos de neuro-psiquiatria, 2004, Sep;62(3B): 844-851
46 Arboix A, Morcillo C, Garcia-Eroles L, et al. Different vascular risk factor profiles in ischemic stroke subtypes: a study from the“Sagrat Cor Hospital of Barcelona Stroke Registry”. Acta Neurol Scand, 2000, 102 (4): 264
47 Mohr JY. Some clinical aspects of acute stroke. Stroke, 1997, 28:1835-1839
48 周衡,王拥军,王素香等. 急性缺血性脑卒中的TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
49 Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol. 2007; 57(2): 96-102
50 Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epide- miology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001, Dec 1; 32(12):2735-2740
51 Petty GW, Brown RD J r, Whisnant J P , et al. Ischemic stroke subtypes: a population2based study of incidence and risk factors.Stroke , 1999, 30: 2513-2516
52 Saposnik G,Caplan L. Differences in Stroke Subtypes Among Natives and Caucasians in Boston and Buenos Aires .Stroke , 2000 , 31 (10): 2385-2389
53 Yip PK. Subtypes of Ischemic Stroke: A Hospital-Based Stroke Registry in Taiwan (SCAN - IV). Stroke, 1997, 28 (12) : 2507-2512
54 吴晓球. 老年人腔隙性脑梗死临床特点分析(附 154 病例报告). 中国医师杂志,2004,6(3):375
55 Murat SM, Erturk O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurol Sci, 2002, 22 :449-454
56 Tanizaki Y, Kiyoharay, Kato I, et al. Incidence and risk factors for subtypes of cerebral infarction in a general population: the Hisayama Study. Stroke, 2000, 31: 2616-2632
57 余玲玲、陈治卿、陈健等. 老年人脑腔隙梗死与胰岛素抵抗关系的临床研究. 中国老年保健医学杂志,2003,1(3):12-15
58 林金秀、陈达光、谢良地.高血压病患者胰岛素抵抗与其他代谢异常的关系.中华心血管病杂志,2000,28(3):170-172
59 Arboix A, GE Lluis, Massons JB, et al. Atrial fibrillation and stroke: clinical presentation of cardioembolic versus athero- thrombotic infarction.Int J of Cardiol, 2000, 73: 33-42
60 胡大一、孙艺红、周自强等. 中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究. 中华内科杂志,2003,42(3):157-161
61 A dam E, Probsfield JL, Mclollum CH, et al. High levels of cytomegalovirusanribody in patients requiring vascular surgery for atherosclerosis. Lancet, 1987, 2: 291
62 Petrue BL , M elniek JL , A dam E, et al. Nucleic acid sequences of cytomegalovirus in cells cultured from humanarterial tissue. J Infect D is, 1987, 155: 158
2 Adams H, Bendixen B. Classification subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Of Org 10 172 in acute stroke treatment. Stroke, 1993, 24:35-41
3 黄一宁,高山,王莉鹃等. 闭塞性脑血管病经颅多普勒超声和脑血管造影的比较. 中华神经科杂志,1997,30:98-101
4 Gao S, Lam WW, Chan YL, et al. Optimal values of flow velocity on transcranial Doppler in grading middle cerebral artery stenosis in comparison with magnetic resonance angiography. J Neuroimaging, 2002, 12(3): 213-218
5 Gao S, Chan YL, Lam WWM, et al. The optimal values of flow velocity on trascranial Doppler in grading middle cerebral artery stenosis in comparison with magneticresonance angiography. Neuroimag, 2001, 12: 1-6
6 Norh American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991, 325-453
7 中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29: 379-380
8 Madden K,Adams H. Accuracy of initial stroke subtype diagnosis in the TOAST study. Neurology, 1995, 45 ( 11) :1975-1979
9 周衡,王拥军,王素香等. 急性缺血性脑卒中的TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
10 中国高血压防治指南修订委员会.2004年中国高血压防治指南(实用本).高血压杂志,2004,12:483-486
11 Tsong-Hai Lee,Wen-Chuin Hsu, Chi-Jen Chen, et al. Etiologic Study of Young Ischemic Stroke in Taiwan. Stroke, 2002; 33:1950-1955
12 Jousilahti P, Rastenyte D, Tuomilehto J, et al. Parental history of cardiovascular disease and risk of stroke. A prospective follow-up of 14371 middle-aged men and women in Finland. Stroke, 1997, 28(7):1361-1366
13 Kappelle LJ, Adams HP Jr, Heffner ML, et al. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke, 1994, 25(7):1360-1365
14 毕齐、张茁、张微微等. 2359 例青年脑卒中患者危险因素研究. 中华流行病学杂志,2003,24(2):106-108
15 王薇、赵冬、孙佳艺等. 中国 11 省市队列人群危险因素与不同类型心血管病发病危险的比较. 中华心血管病杂志,2006,12(34):1133-1137
16 Kwon SU, Kim JS, Lee JH, et al. Ischemic stroke in Korean young adults. Acta Neurol Scand. 2000; 101: 19-24
17 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke, 1997, 28: 1702-1709
18 Zétola VH, Nóvak EM, Camargo CH, et al. Stroke in young adults: analysis of 164 patients. Arq Neuropsiquiatr. 2001 Sep; 59(3-B):740-745
19 Love BB, Biller J, JonesM P, et al. Cigarette smoking. A risk factor for cerebral infaretion in young adults. A rch Neurol, 1990, 47: 693-698
20 Whisnant JP, Wiebers DO, O’Fallon WM, et al. A population based model of risk factors for ischemic stroke. Neurology, 1996, 47: 1420
21 Pires SL, Gagliardi RJ, Gorzoni ML. Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients. Arquivos de neuro-psiquiatria, 2004 Sep ; 62(3B): 844-851
22 陈彤、尹岭、李小鹰等. 老年人群脑卒中现患率及危险因素调查. 中华老年心脑血管病杂志. 2003,6(5):168-170
23 刘迎梅,丁学兵,巩延丽等. 不同年龄组脑梗死病人危险因素及临床特点分析. 中西医结合心脑血管病杂志,2005,3(3):272-273
24 刘运海、杨期东、刘尊敬等. 队列人群脑血管病危险因素干预效果评价. 中华流行病学杂志,2003,24(2):102-105
25 赵翠、刘俊艳、吴婧. 不同类型卒中与代谢综合征的相关性研究. 中国脑血管病杂志,2008,5(3):97-101
26 Mehndiratta MM, Agarwal P, Sen K, et al. Stroke in young adults: a study from a university hospital in north India. Med Sci Monit. 2004 Sep; 10(9): 535-541
27 Rasura M, Spalloni A, Ferrari M, et al. A case series of young stroke in Rome. Eur J Neurol, 2006, Feb; 13(2):146-152
28 Szapáry L, Sz?ts M, Pál E, et al. Ischemic stroke in young adults. Orv Hetil, 2001, Mar, 25; 142(12):607-610
29 Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992; 10: 113-124
30 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue Neurol (Paris), 1999, Sep; 155(8):575-582
31 Siqueira Neto JI, Santos AC, Fabio SR, et al. Cerebral infarction in patients aged 15 to 40 years. Stroke. 1996; 27: 2016-2019
32 Chan MT, Nadareishvili ZG, Norris JW. Diagnostic strategies in young patients with ischemic stroke in Canada. Can J Neurol Sci. 2000; 27: 120-124
33 Williams LS, Garg BP, Cohen M, et al. Subtypes of ischemicstroke in children and young adults. Neurology. 1997; 49: 1541-1545
34 Qureshi AI, Safdar K, Patel M, et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke, 1995, 26: 1995-1998
35 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand. 1994; 89: 323-328
36 Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol. 2007; 57(2): 96-102
37 Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epide- miology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001, Dec 1; 32(12):2735-2740
38 Petty GW, Brown RD J r, Whisnant J P , et al. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke, 1999, 30: 2513-2516
39 Yip PK. Subtypes of Ischemic Stroke: A Hospital-Based Stroke Registry in Taiwan (SCAN - IV). Stroke, 1997, 28 (12) : 2507-2512
40 刘俊艳,刘嘉林,魏娟红. 缺血性卒中患者颅内外血管狭窄率研究. 脑与神经疾病杂志,2005,13:20-21
41 Huang YN, Gao S, Li SW, et al. Vascular lesions in Chinese patients with transient ischemic attacks. Neurology, 1997, 48: 524-525
42 Wong KS, Huang YN, Gao S, et al. Intracranial stenosis in Chinese with acute stroke. Neurology. 1998, 50:812-813
43 Wong KS, Li H, Chan YL, et al. Use of transcranial Doppler to predict outcome in patients with intracranial large-artery occlusive disease. Stroke, 2000, 31: 2641-2647
44 李春雨,崔小波,饶英生等. 北京市 1997-2004 年三次居民吸烟情况分析比较. 中华流行病学杂志,2007,28(5):453-456
45 Lee LJ, Kidwell CS , Alger J , et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke , 2000 , 31: 1081-1089
46 刘俊艳,高山,黄家星.经颅多谱勒超声评估大脑中动脉狭窄程度的最佳速度值.中华神经科杂志,2003,36(6):458-460
47 Leung DY, Black IW, Cranney GB, et al. Selection of patients for transesophageal echocardiography after stroke and systemic embolic events: role of transthoracic echocardiography. Stroke. 1995; 26: 1820-1824
48 Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients. Lancet. 1988; 2: 11-12
49 Job FP, Ringelstein EB, Grafen Y, et al. Comparison of transcranial contrast Doppler sonography and transe- sophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Am J Cardiol.1994; 74: 381-384
50 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997; 28: 1702-1709
51 Bots ML, Launer LJ, Lindemans J, et al . Homocysteine and short-term risk of myocardial infarction and stroke in the elderly : the Rotterdam Study. Arch Intern Med, 1999, 159: 38-44
52 Kristensen B, Malm J, Nilsson TK, et al. Hyperhomo- cysteinemia and hypofibrinolysis in young adults with ischemic stroke. Stroke, 1999, 30: 974-980
53 Tan NC, Venketasubramanian N, Saw SM, et al. Hyper- homocyst-(e)inemia and risk of ischemic stroke among young Asian adults. Stroke, 2002, 33: 1956-1962
54 Brey RL, Stallworth CL, McGlasson DL, et al. Antipho- spholipid antibodies and stroke in young women. Stroke, 2002, 33: 2396-2401
55 Rasura M, Spalloni A, Ferrari M,et al. A case series of young stroke in Rome. European journal neurology, 2006, Feb; 13(2):146-152
56 Donaghy M, Chang CL, N Poulter. Duration, frequency, recency, and type of migraine and the risk of ischemic stroke in women of childbearing age. Journal of Neurology, Neurosurg and Psychiatry, 2002, 73:747-750
57 Schwartz SM, Petitti DB, Siscovick DS, et al. Stroke and use of low-dose oral contraceptives in young women: a pooledanalysis of two US studies. Stroke, 1998, 29: 2277-2284
58 Cole JW, Pinto AM, Hebel JR, et al. Acquired Immuno- deficiency Syndrome and the Risk of Stroke. Stroke, 2004, 35: 51-56
59 Connor MD, Lammie GA, Bell JE, et al. Cerebral infarction in adult AIDS patients: observation from the Edinburgh HIV Autopsy Cohort. Stroke, 2000, 31: 2117-2126
60 Lehto S, Niskanen L, Ronnemaa T, et al. Serum uric acid is a strong predictor of stroke in patients with non-insulin- dependent diabetes mellitus. Stroke, 1998, 29: 635-639
61 汪波,高山,刘俊艳,等. 无症状人群脑血管狭窄的调查。中华流行病学杂志,1998,19:344-347
62 Song YM, Kwon SU, Sung J, et al. Different risk factor profiles between subtypes of ischemic stroke. A case-control study in Korean men. Eur J Epidemiol. 2005; 20(7):605-612
1 Tsong-Hai Lee,Wen-Chuin Hsu, Chi-Jen Chen, et al. Etiologic Study of Young Ischemic Stroke in Taiwan. Stroke, 2002; 33: 1950-1955
2 王德生,徐心,李树祥等. 中青年脑梗死患者的临床与病理. 中华神经科杂志,1998,31 (2) : 98-101
3 Zétola VH, Nóvak EM, Camargo CH. Stroke in young adults: analysis of 164 patients. Arquivos de neuro-psiquiatria, 2001 Sep; 59(3-B): 740-745
4 罗国君,迟路湘,王云甫等. 青年缺血性脑卒中患者脑血管病变的特点. 卒中与神经疾病,2006,13(3):163-165
5 毕齐、张茁、张微微等. 2359 例青年脑卒中患者危险因素研究. 中华流行病学杂志,2003,24(2):106-108
6 Szapary L, SzotsM, Pal E, et al. Ischemic stroke in young adults.Orv Hetil, 2001, 142: 607-610
7 Ruiz - sandoval J I, Cantu C, Barinagarrementeria F.Intracerbral hemorrhage in young people:analysis of risk factors, location, causes, and prognosis, Stroke, 1999, 30: 537-541
8 Ghandehari K, Moud ZI. Incidence and etiology of ischemic stroke in Persian young adults. Acta neurologica scandinavica, 2006, Feb; 113(2):121-124
9 Rasura M, Spalloni A, Ferrari M,et al. A case series of young stroke in Rome. European journal neurology, 2006, Feb; 13(2):146-152
10 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue neurologique (Paris), 1999, Sep; 155(8):575-582
11 Bots ML, Launer LJ, Lindemans J, et al. Homocysteine and short-term risk of myocardial infarction and stroke in the elderly: the Rotterdam Study. Arch Intern Med, 1999, 159:38-44
12 Kristensen B, Malm J, Nilsson T, et al. Hyperhomocy- steinemia and hypofibrinolysis in young adults with ischemic stroke. Stroke, 1999, 30: 974-980
13 Tan NC, Venketasubramanian N, Saw SM, et al. Hyperho- mocyst-(e)inemia and risk of ischemic stroke among young Asian adults. Stroke, 2002, 33: 1956-1962
14 Santonja JM, Vicent V, Pareja A, et al. Cerebrovascular disease in young adults. A study of its course in 167 patients. Rev Neurol, 1998, 26 : 787-789
15 Vermeulen EG, Rauwerda JA , van den Berg M, et al . Homocysteine-lowering treatment with folic acid plus vitamin B6 lowers urinary albumin excretion but not plasma markers of endothelial function or C-reactive protein : further analysis of secondary end2points of a randomized clinical trial . Eur J Clin Invest, 2003, 33: 209-215
16 Van Guldener C, Stehouwer CD. Hyperhomocysteinemia, vascular pathology , and endothelial dysfunction. Semin Thromb Hemost, 2000, 26 : 281-289
17 Stamler JS , Osborne JA , Jaraki O , et al . Adverse vascular effects of homocysteine are modulated by endothelium-derived relaxing factor and related oxides of nitrogen. J Clin Invest, 1993, 91: 308-318
18 Hovind P, Tarnow L, Rossing P, et al. Progression of diabeticnephropathy: role of plasma homocysteine and plasminogen activator inhibitor-1. Am J Kidney Dis , 2001 , 38 : 1376-1380
19 Van Dijk RA , Rauwerda JA , Steyn M, et al. Long-term homocysteine lowering treatment with folic acid plus pyridoxine is associated with decreased blood pressure but not with improved brachial artery endothelium-dependent vasodilation or carotid artery stiffness : a 2 - year , randomized , placebo - controlled trial . Arterioscler Thromb Vasc Biol, 2001, 21 : 2072-2079
20 Vermeulen EG, Niessen HW, Bogels M, et al. Decreased smooth muscle cell/extracellular matrix ratio of media of femoral artery in patients with atherosclerosis and hyperhomocysteinemia. Arterioscler Thromb Vasc Biol, 2001, 21: 573-577
21 Dickerhoff R, Pongratz E, Scheel-Waker HG. Cerebral infarct and hemorrhage in patients with sickle cell disease. Klin Padiatr, 1994,206: 381-384
22 Kristensen B, Malm J, Nilsson TK, et al. Increased fibrinogen levels and acquired hypofibrinolysis in young adults with ischemic stroke. Stroke, 1998, 29: 2261-2267
23 Woo J, L au E, L am CW, et al. Hypertension, lipop-rotein(a) and apolipoproteinA-I as risk factors for stroke in the Chinese.Stroke, 1991, 22: 203
24 Shintani S, Kikuchi S, Hamaguchi H, et al. High serum lipoprotein(a) levels are an independent risk factor for cerebral infarction. Stroke, 1993, 24: 965
25 Bladassarre D, Tremoli E, Franceschini G, et al. Plasma lipoprotein(a) is an independent factor associated with carotid wall thickening in severely but not moderately hyper-cholesterolemic patients. Stroke, 1996, 27: 1044
26 Brey RL, Stallworth CL, McGlasson DL, et al. Antipho- spholipid antibodies and stroke in young women. Stroke, 2002, 33: 2396-2401
27 Donaghy M, Chang CL, N Poulter. Duration, frequency, recency, and type of migraine and the risk of ischemic stroke in women of childbearing age. Journal of Neurology, Neurosurg and Psychiatry, 2002, 73: 747-750
28 Schwartz SM, Petitti DB, Siscovick DS, et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke, 1998, 29: 2277-2284
29 Ducrocq X, Lacour JC, Debouverie M, et al. Cerebral ischemic accidents in young subjects. A prospective study of 296 patients aged 16 to 45 years. Revue neurologique (Paris), 1999, Sep; 155(8):575-582
30 Musolino R, La Spina P, Granata A, et al. Ischemic stroke in young people: a prospective and long-term follow-up study. Cerebrovasclar diseases, 2003; 15(1-2):121-128
31 周衡,王拥军,王素香等. 急性缺血性脑卒中的 TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
32 Otero Palleiro MM, Barbagelata López C. Etiologic subtypes of ischemic stroke in young adults aged 18 to 45 years: a study of a series of 93 patients. Revista Clinical Espahola, 2007, Apr; 207(4):158-165
33 Mehndiratta MM, Agarwal P, Sen K, et al. Stroke in young adults: a study from a university hospital in north India. Med Sci Monit. 2004 Sep; 10(9): 535-541
34 Kwon SU, Kim JS, Lee JH, et al. Ischemic stroke in Korean young adults. Acta Neurol Scand. 2000; 101: 19-24
35 Szapáry L, Sz?ts M, Pál E, et al. Ischemic stroke in young adults. Orv Hetil, 2001, Mar, 25; 142(12):607-610
36 Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992; 10: 113-124
37 Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke, 1997, 28:1702-1709
38 Siqueira Neto JI, Santos AC, Fabio SR, et al. Cerebral infarction in patients aged 15 to 40 years. Stroke. 1996; 27: 2016-2019
39 Chan MT, Nadareishvili ZG, Norris JW. Diagnostic strategies in young patients with ischemic stroke in Canada. Can J Neurol Sci. 2000; 27: 120-124
40 Williams LS, Garg BP, Cohen M, et al. Subtypes of ischemic stroke in children and young adults. Neurology. 1997; 49: 1541-1545
41 Qureshi AI, Safdar K, Patel M, et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke, 1995, 26: 1995-1998
42 Awada A. Stroke in Saudi Arabian young adults: a study of 120 cases. Acta Neurol Scand. 1994; 89: 323-328
43 Szabo K, Kern R, Gass A, et al. Acute stroke patterns in patients with internal carotid artery disease: a diffusion- weighted magnetic resonance imaging study. Stroke, 2001, 32(6): 1323-1329
44 胡大一,王宏宇.高血压病流行的全球趋势及对策.中国实用内科杂志,2002,22:195-196
45 Pires SL, Gagliardi RJ, Gorzoni ML. Study of the main risk factors frequencies for ischemic cerebrovascular disease in elderly patients. Arquivos de neuro-psiquiatria, 2004, Sep;62(3B): 844-851
46 Arboix A, Morcillo C, Garcia-Eroles L, et al. Different vascular risk factor profiles in ischemic stroke subtypes: a study from the“Sagrat Cor Hospital of Barcelona Stroke Registry”. Acta Neurol Scand, 2000, 102 (4): 264
47 Mohr JY. Some clinical aspects of acute stroke. Stroke, 1997, 28:1835-1839
48 周衡,王拥军,王素香等. 急性缺血性脑卒中的TOAST 亚型分析. 中华内科杂志,2004,43(7):495-498
49 Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism. Eur Neurol. 2007; 57(2): 96-102
50 Kolominsky-Rabas PL, Weber M, Gefeller O, et al. Epide- miology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001, Dec 1; 32(12):2735-2740
51 Petty GW, Brown RD J r, Whisnant J P , et al. Ischemic stroke subtypes: a population2based study of incidence and risk factors.Stroke , 1999, 30: 2513-2516
52 Saposnik G,Caplan L. Differences in Stroke Subtypes Among Natives and Caucasians in Boston and Buenos Aires .Stroke , 2000 , 31 (10): 2385-2389
53 Yip PK. Subtypes of Ischemic Stroke: A Hospital-Based Stroke Registry in Taiwan (SCAN - IV). Stroke, 1997, 28 (12) : 2507-2512
54 吴晓球. 老年人腔隙性脑梗死临床特点分析(附 154 病例报告). 中国医师杂志,2004,6(3):375
55 Murat SM, Erturk O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurol Sci, 2002, 22 :449-454
56 Tanizaki Y, Kiyoharay, Kato I, et al. Incidence and risk factors for subtypes of cerebral infarction in a general population: the Hisayama Study. Stroke, 2000, 31: 2616-2632
57 余玲玲、陈治卿、陈健等. 老年人脑腔隙梗死与胰岛素抵抗关系的临床研究. 中国老年保健医学杂志,2003,1(3):12-15
58 林金秀、陈达光、谢良地.高血压病患者胰岛素抵抗与其他代谢异常的关系.中华心血管病杂志,2000,28(3):170-172
59 Arboix A, GE Lluis, Massons JB, et al. Atrial fibrillation and stroke: clinical presentation of cardioembolic versus athero- thrombotic infarction.Int J of Cardiol, 2000, 73: 33-42
60 胡大一、孙艺红、周自强等. 中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究. 中华内科杂志,2003,42(3):157-161
61 A dam E, Probsfield JL, Mclollum CH, et al. High levels of cytomegalovirusanribody in patients requiring vascular surgery for atherosclerosis. Lancet, 1987, 2: 291
62 Petrue BL , M elniek JL , A dam E, et al. Nucleic acid sequences of cytomegalovirus in cells cultured from humanarterial tissue. J Infect D is, 1987, 155: 158