青年不明来源栓塞性卒中的发病率及特征
Frequency and features of embolic stroke of undetermined source in young adults.
作者信息
Perera Kanjana S, Swaminathan Balakumar, Veltkamp Roland, Arauz Antonio, Ameriso Sebastian, Marti-Fabregas Joan, Arnold Marcel, Hankey Graeme J, Lutsep Helmi, Hart Robert G
机构信息
1Department of Medicine (Neurology), Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
2Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.
出版信息
Eur Stroke J. 2018 Jun;3(2):110-116. doi: 10.1177/2396987318755585. Epub 2018 Jan 24.
INTRODUCTION
The sources of emboli in those with embolic stroke of undetermined source may differ in old and young. We assessed the frequency, features and potential embolic sources of younger vs. older embolic stroke of undetermined source patients in the embolic stroke of undetermined source Global Registry.
PATIENTS AND METHODS
Cross-sectional study of consecutive patients over age 18 years, with recent ischaemic strokes at 19 centres conducted in 2013-2014. Characteristics of embolic stroke of undetermined source patients who aged ≤50 years were analysed and compared with embolic stroke of undetermined source patients who aged >50 years.
RESULTS
Among 2144 patients with ischaemic stroke, 323 (15.1%, 95% confidence interval: 13.6-16.7%) were ≤50 years old and, 1821 >50 years. 24% ( = 78) of young vs. 15% ( = 273) of older patients met embolic stroke of undetermined source criteria. The mean age of young embolic stroke of undetermined source patients was 40 years (standard deviation +/-9), 33% were women and the most prevalent vascular risk factor was hypertension (38%). Conventional vascular risk factors were less frequent in younger embolic stroke of undetermined source patients. Fewer young embolic stroke of undetermined source patients (63%) had potential minor risk embolic sources identified vs. older embolic stroke of undetermined source patients (77%) ( = 0.02). Stroke severity on admission was similar in younger vs. older patients (National Institute of Health Stroke Scale (NIHSS) 3 vs. 4, = 0.06).
DISCUSSION
Young embolic stroke of undetermined source patients comprise an important subset of ischaemic stroke patients around the world. Severity of stroke on admission and 30-day mortality rates are similar among young and older patients. However, there are important differences between younger vs. older embolic stroke of undetermined source patients with respect to risk factors, and potential embolic sources that could affect response to anticoagulants vs. antiplatelet therapies.
CONCLUSION
This study provides a benchmark for the global frequency and characteristics of young embolic stroke of undetermined source patients and shows consistent high frequency of embolic stroke of undetermined source in young adults.
引言
不明来源栓塞性卒中患者的栓子来源在年轻人和老年人中可能有所不同。我们在不明来源栓塞性卒中全球注册研究中评估了年龄较小与年龄较大的不明来源栓塞性卒中患者的频率、特征及潜在栓子来源。
患者与方法
对2013 - 2014年在19个中心连续纳入的18岁以上近期发生缺血性卒中的患者进行横断面研究。分析年龄≤50岁的不明来源栓塞性卒中患者的特征，并与年龄>50岁的不明来源栓塞性卒中患者进行比较。
结果
在2144例缺血性卒中患者中，323例（15.1%，95%置信区间：13.6 - 16.7%）年龄≤50岁，1821例年龄>50岁。年龄较小的患者中有24%（n = 78）符合不明来源栓塞性卒中标准，而年龄较大的患者中这一比例为15%（n = 273）。年龄较小的不明来源栓塞性卒中患者的平均年龄为40岁（标准差±9），33%为女性，最常见的血管危险因素是高血压（38%）。在年龄较小的不明来源栓塞性卒中患者中，传统血管危险因素的发生率较低。与年龄较大的不明来源栓塞性卒中患者（77%）相比，年龄较小的不明来源栓塞性卒中患者中识别出潜在微小风险栓子来源的较少（63%）（P = 0.02）。年龄较小与年龄较大的患者入院时的卒中严重程度相似（美国国立卫生研究院卒中量表（NIHSS）评分分别为3分和4分，P = 0.06）。
讨论
不明来源栓塞性卒中的年轻患者是全球缺血性卒中患者中的一个重要亚组。年轻患者和老年患者入院时的卒中严重程度及30天死亡率相似。然而，年龄较小与年龄较大的不明来源栓塞性卒中患者在危险因素以及可能影响抗凝与抗血小板治疗反应的潜在栓子来源方面存在重要差异。
结论
本研究为不明来源栓塞性卒中年轻患者的全球发病率及特征提供了一个基准，并显示出年轻成年人中不明来源栓塞性卒中的发病率持续较高。
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