Department of Neurology, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing, 100034, China.
Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, Tibet, China.
BMC Neurol. 2020 Oct 21;20(1):380. doi: 10.1186/s12883-020-01957-0.
Numerous studies on acute ischemic stroke (AIS) have been conducted at low-altitude regions, and the related findings have been used to guide clinical management. However, corresponding studies at high altitude are few. This study aimed to analyse the clinical characteristics of AIS patients at high-altitude regions through a hospital-based comparative study between Tibet and Beijing.
This study included the diagnoses of AIS patients from People's Hospital of Tibet Autonomous Region (PHOTAR) and Peking University First Hospital (PUFH) between 1 January 2014 and 31 December 2017, where data including patient demographics, treatment time, onset season, risk factors, infarction location, laboratory data, image examination results, treatments, and AIS subtype were collected and compared. Continuous and categorical variables were analysed with a two-sample t-test or Wilcoxon rank sum test and chi-square test, respectively. Significant risk factors were examined with binary logistic regression analysis.
In total, 236 and 1021 inpatients from PHOTAR and PUFH were included, respectively. The PHOTAR patients were younger than the PUFH patients (P < 0.001). Young adult stroke, erythrocytosis, and hyperhomocysteinemia were more frequent in PHOTAR patients (all P < 0.001). Other vascular risk factors, including hypertension, diabetes mellitus, hyperlipidaemia, smoking and alcohol consumption history, were less prevalent in PHOTAR patients than in PUFH patients. The rate of intravenous thrombolysis and the rate of within intravenous thrombolysis window time were also lower in PHOTAR patients (both P < 0.001). The PHOTAR group also tended to have anterior circulation infarction. Erythrocytosis and hyperhomocysteinemia were independent risk factors in PHOTAR, and young adults accounted for a larger proportion of stroke cases.
In Tibet, AIS patients were relatively younger, and anterior circulation infarctions were more common. Erythrocytosis and hyperhomocysteinemia may contribute to these differences. Here, young adult stroke also accounted for a higher proportion, and this may be associated with erythrocytosis. Our findings present the first hospital-based comparative study in Tibet and may contribute to policies for stroke prevention in this region.
已有大量研究针对低海拔地区的急性缺血性脑卒中（AIS）展开，相关研究结果也被用于指导临床管理。然而，高海拔地区相关研究较少。本研究旨在通过对西藏自治区人民医院（PHOTAR）和北京大学第一医院（PUFH）的病例进行医院对照研究，分析高原地区 AIS 患者的临床特征。
本研究纳入了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间 PHOTAR 和 PUFH 的 AIS 患者的诊断资料，包括患者的人口统计学特征、治疗时间、发病季节、危险因素、梗死部位、实验室数据、影像学检查结果、治疗方法和 AIS 亚型等。采用两样本 t 检验或 Wilcoxon 秩和检验比较连续变量，采用卡方检验比较分类变量。采用二分类 Logistic 回归分析有统计学意义的危险因素。
本研究共纳入了 236 例 PHOTAR 患者和 1021 例 PUFH 患者。PHOTAR 患者比 PUFH 患者年轻（P<0.001）。青年脑卒中、红细胞增多症和高同型半胱氨酸血症在 PHOTAR 患者中更为常见（均 P<0.001）。高血压、糖尿病、高脂血症、吸烟和饮酒史等其他血管危险因素在 PHOTAR 患者中的发生率低于 PUFH 患者。PHOTAR 患者静脉溶栓率和静脉溶栓时间窗内的溶栓率也较低（均 P<0.001）。PHOTAR 患者也更倾向于发生前循环梗死。红细胞增多症和高同型半胱氨酸血症是 PHOTAR 的独立危险因素，青年脑卒中患者所占比例也较大。
在西藏，AIS 患者相对较年轻，前循环梗死更为常见。红细胞增多症和高同型半胱氨酸血症可能是导致这些差异的原因。此外，青年脑卒中的比例也较高，这可能与红细胞增多症有关。本研究为西藏地区的首个基于医院的对照研究，可为该地区的脑卒中预防政策提供参考。
