Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Clin Neurol Neurosurg. 2021 May;204:106595. doi: 10.1016/j.clineuro.2021.106595. Epub 2021 Mar 6.
Young-onset stroke has a greater social impact than does stroke in older persons, indicating the importance of its prevention. Although there have been studies comparing stroke risk factors in young versus older individuals, no definition of young-onset ischemic stroke has been established. Large extracranial and intracranial atheroma, small vessel disease and atrial fibrillation have a major role in cases of stroke in the elderly, while these disorders are much less frequent in young adults. The purpose of this study was to determine the optimal cut-off point for defining young-onset ischemic stroke according to its cause.
We identified 203 patients aged 65 years or less who had been admitted to our hospital between 2010 and 2017 with ischemic stroke, and we divided them into two groups according to the causes of the stroke. We allocated patients with strokes caused by small vessel occlusion, large artery atherosclerosis, atrial fibrillation, or aortic atheroma to Group A and those with strokes of other causes to Group B which included dissection, Trousseau syndrome and cerebral sinus thrombosis. We then used receiver operating characteristics curve analysis by the above groups and by sex to determine the cut-off age for defining young-onset.
Group A comprised 131 patients (58 ± 7 years, 92 men, 39 women) and Group B 72 (45 ± 15 years, 47 men, 25 women). Receiver operating characteristics curve analysis to differentiate Group B from Group A in all participants indicated a cut-off value of 53 years of age (area under curve: 0.78 [0.71-0.85], P < 0.001), which we therefore considered should define young-onset ischemic stroke. After dividing all patients by their sex, ROC analyses identified a cut-off for age of between 53 and 54 years for men (AUC: 0.75, 95% CI: 0.65-0.85, P < 0.001). In comparison, ≤ 48 years was the cut-off for young ischemic stroke in women (AUC: 0.83, 95% CI: 0.71-0.94, P < 0.001).
The age of 53 years may be the optimal cut-off point for young-onset ischemic stroke. Of note, the cut-off point between young- and non-young-onset stroke was 48 years for women, whereas it was 53 years for men. It is therefore important to carefully examine and treat female patients with this sex difference in mind.
青年卒中比老年卒中具有更大的社会影响，这表明预防青年卒中的重要性。虽然已经有研究比较了青年人和老年人的卒中危险因素，但尚未确定青年卒中的定义。大动脉粥样硬化、小血管疾病和心房颤动在老年人卒中中起主要作用，而这些疾病在青年人群中则少见得多。本研究旨在根据病因确定定义青年卒中的最佳截断点。
我们纳入了 2010 年至 2017 年期间因缺血性卒中入住我院的 203 名年龄在 65 岁及以下的患者，并根据卒中的病因将他们分为两组。我们将由小血管闭塞、大动脉粥样硬化、心房颤动或主动脉粥样硬化引起的卒中患者分为 A 组，将由其他原因引起的卒中患者分为 B 组，包括夹层、Trousseau 综合征和脑静脉窦血栓形成。然后，我们通过上述两组和性别进行受试者工作特征曲线分析，以确定定义青年卒中的截断年龄。
A 组包括 131 例患者（58±7 岁，92 例男性，39 例女性），B 组包括 72 例患者（45±15 岁，47 例男性，25 例女性）。对所有参与者进行的区分 B 组和 A 组的受试者工作特征曲线分析显示，截断年龄为 53 岁（曲线下面积：0.78[0.71-0.85]，P<0.001），我们认为这应定义为青年卒中。在根据性别将所有患者分组后，ROC 分析确定男性的年龄截断值为 53-54 岁（AUC：0.75，95%CI：0.65-0.85，P<0.001）。相比之下，女性的青年缺血性卒中截断值为≤48 岁（AUC：0.83，95%CI：0.71-0.94，P<0.001）。
53 岁可能是青年缺血性卒中的最佳截断点。值得注意的是，女性青年和非青年卒中的截断点为 48 岁，而男性为 53 岁。因此，考虑到这种性别差异，仔细检查和治疗女性患者非常重要。
