无明确血管风险因素的急性缺血性脑卒中：患者特征、脑卒中机制和长期预后。

Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long-term outcome.

机构信息

Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.

出版信息

Eur J Neurol. 2021 Apr;28(4):1275-1283. doi: 10.1111/ene.14667. Epub 2020 Dec 7.

DOI:10.1111/ene.14667

PMID:33284528

Abstract

BACKGROUND AND PURPOSE

Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long-term outcome.

METHODS

All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003-2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models.

RESULTS

Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08-0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26-9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44-6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients <55 years old, PFO (OR 2.76; 95% CI 1.50-5.08) and contraceptive use in females (OR 2.75; 95% CI 1.40-5.41) were more frequent, whereas sleep apnea syndrome (OR 0.09; 95% CI 0.01-0.63) was less. In patients ≥55 years, female sex (OR 2.84; 95% CI 1.43-5.65) and active cancer (OR 3.27; 95% CI 1.34-7.94) were more prevalent. At 12 months, patients without EVRFs had worse adjusted functional outcome (Rankin shift OR 0.63; 95% CI 0.42-0.95) and higher rate of recurrence and death (adjusted hazard ratio 2.11; 95% CI 1.19-3.74).

CONCLUSIONS

In a consecutive cohort of AIS patients, only 2% showed no EVRFs. PFO and contraceptive use exhibited a strong association with the absence of EVRFs in younger patients and female sex and active cancer in elderly patients. Our findings highlight the importance of searching for previously unknown risk factors and/or unusual stroke mechanisms in patients without EVRFs.

摘要

背景与目的

部分急性缺血性脑卒中（AIS）患者不具有已确立的血管危险因素（EVRFs）。本研究旨在评估这些患者的临床特征、卒中亚型病因分类和长期预后。

方法

回顾性分析了 2003 年至 2018 年期间洛桑急性卒中登记处（Acute Stroke Registry of Lausanne）所有连续的 AIS 患者，对以下 EVRFs 进行了完整评估：高血压、糖尿病、大的心源性栓塞源、血脂异常、吸烟、肥胖、酗酒、既往卒中和短暂性脑缺血发作、抑郁和精神障碍。使用适当的统计模型比较无 EVRFs 的患者与具有 1 种或多种 EVRFs 的患者。

结果

在 4889 例纳入的患者中，有 103 例（2.1%）无 EVRFs。多因素回归分析显示，无 EVRFs 的患者显著更年轻（比值比[OR]0.13；95%置信区间[CI]0.08-0.20），且多为多部位卒中（OR 3.38；95% CI 1.26-9.05）。这些卒中更常与卵圆孔未闭（PFO）相关（OR 3.02；95% CI 1.44-6.32），而与动脉粥样硬化、心源性栓塞或小血管疾病的关系较少。在＜55 岁的患者中，PFO（OR 2.76；95% CI 1.50-5.08）和女性使用避孕药（OR 2.75；95% CI 1.40-5.41）更为常见，而睡眠呼吸暂停综合征（OR 0.09；95% CI 0.01-0.63）则较少。在≥55 岁的患者中，女性（OR 2.84；95% CI 1.43-5.65）和活动性癌症（OR 3.27；95% CI 1.34-7.94）更为常见。在 12 个月时，无 EVRFs 的患者调整后的功能结局较差（Rankin 转移 OR 0.63；95% CI 0.42-0.95），且复发和死亡的发生率较高（调整后的危险比 2.11；95% CI 1.19-3.74）。