Yan Yujia, Zhang Xiqiang, Ren Hecheng, An Xingwei, Fan Wanpeng, Liang Jingbo, Huang Ying
Department of Neurosurgery, Tianjin University Huanhu Hospital, Tianjin, China.
Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.
Front Neurol. 2022 Apr 13;13:859616. doi: 10.3389/fneur.2022.859616. eCollection 2022.
Acute ischemic stroke has a high incidence in the plateau of China. It has unique characteristics compared to the plains, and the specific relationship with altitude has not yet been appreciated. This study aimed to investigate the specificity of the plateau's anterior circulation acute ischemic stroke in China.
To retrospectively collect clinical data of patients with first-episode acute ischemic stroke in the anterior circulation in Tianjin and Xining city. The differences in clinical presentation, laboratory, and imaging examinations were compared.
Patients at high altitudes showed a significant trend toward lower age (61.0 ± 10.2 vs. 64.8 ± 8.1, = 0.010) and had a history of dyslipidemia, higher levels of inflammatory markers, erythrocytosis, and alcohol abuse. The main manifestations were higher diastolic blood pressure (85.5 ± 14.0 mmHg vs. 76.8 ± 11.6 mmHg, < 0.001), triglycerides [2.0 (1.8) mmol/L vs. 1.3 (0.9) mmol/L, < 0.001], CRP [4.7 (4.4) mg/L vs. 2.1 (1.9) mg/L, < 0.001], homocysteine levels [14.5 (11.7) μmol/L vs. 11.2 (5.2) μmol/L, < 0.001]; larger infarct volume [3.5 (4.8) cm vs. 9.0 (6.9) cm, < 0.001] and worse prognosis. Patients at high altitudes had higher atherosclerotic indexes in cIMT and plaque than those in plains.
The natural habituation and genetic adaptation of people to the particular geo-climatic environment of the plateau have resulted in significant differences in disease characteristics. Patients with the anterior circulation acute ischemic stroke in the plateau show more unfavorable clinical manifestations and prognosis. This study provides a preliminary interpretation of the effects of altitude and suggests developing preventive and therapeutic protocol measures that are more appropriate for the plateau of China.
急性缺血性卒中在中国高原地区发病率较高。与平原地区相比，其具有独特特征，且与海拔的具体关系尚未明确。本研究旨在探讨中国高原地区前循环急性缺血性卒中的特异性。
回顾性收集天津市和西宁市首发前循环急性缺血性卒中患者的临床资料。比较临床表现、实验室及影像学检查的差异。
高原地区患者年龄有显著降低趋势（61.0±10.2岁对64.8±8.1岁，P=0.010），且有血脂异常、炎症标志物水平较高、红细胞增多症及酗酒史。主要表现为舒张压较高（85.5±14.0 mmHg对76.8±11.6 mmHg，P<0.001）、甘油三酯[2.0(1.8)mmol/L对1.3(0.9)mmol/L，P<0.001]、CRP[4.7(4.4)mg/L对2.1(1.9)mg/L，P<0.001]、同型半胱氨酸水平[14.5(11.7)μmol/L对11.2(5.2)μmol/L，P<0.001]；梗死体积较大[3.5(4.8)cm对9.0(6.9)cm，P<0.001]且预后较差。高原地区患者颈总动脉内膜中层厚度（cIMT）和斑块的动脉粥样硬化指数高于平原地区患者。
人们对高原特殊地理气候环境的自然适应和遗传适应导致了疾病特征的显著差异。高原地区前循环急性缺血性卒中患者临床表现和预后更差。本研究对海拔影响进行了初步阐释，并建议制定更适合中国高原地区的预防和治疗方案措施。
