Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T
Department of Neurology, University Hospital, Umeå, Sweden.
Stroke. 1997 Sep;28(9):1702-9. doi: 10.1161/01.str.28.9.1702.
The aim of this study was to conduct a population-based epidemiological survey among young adults aged 18 to 44 years in Northern Sweden and furthermore to gain further insight into the etiology of ischemic stroke in this age group.
Two studies were done. In the first part, epidemiological data were collected to calculate incidence and mortality from 1991 through 1994. This was based on the World Health Organization Northern Sweden MONICA register of acute stroke events. Eighty-eight first-ever ischemic stroke patients were identified during that period. In the second part, 107 consecutive patients aged 18 to 44 years with ischemic stroke referred to a university hospital were studied prospectively during a 5-year period and were extensively evaluated according to a standardized protocol. On the basis of modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, the patients were classified into eight subtypes of ischemic stroke.
The average population-based annual incidence rate for ischemic stroke (cases per 100,000 per year) was 11.3 (95% confidence interval, 6.7 to 16.1). The case-fatality rate was 5.7%. According to the modified TOAST criteria, a probable cause of ischemic stroke was identified in 36% and remained unexplained in 21% of cases. Spontaneous cervical arterial dissection was the leading probable etiology (13%). Patent foramen ovale or atrial septal aneurysm was a possible cause of stroke in 28% of cases. The percentages of ischemic stroke attributed to IgG anticardiolipin antibodies (4.7%), atherothrombotic vasculopathy (3.7%), oral contraceptive use (7%), and migraine (1%) were lower than reported in recent clinical series.
The incidence rate for ischemic stroke was higher than previously reported from most countries in Western Europe. The higher incidence was not explained by a higher prevalence of premature atherosclerotic vasculopathy. Without the additional diagnostic information derived from advanced cardiac imaging, the proportion of indeterminate cases would have constituted 37% of the patients.
本研究旨在对瑞典北部18至44岁的年轻人进行一项基于人群的流行病学调查，并进一步深入了解该年龄组缺血性卒中的病因。
进行了两项研究。在第一部分中，收集了1991年至1994年的流行病学数据以计算发病率和死亡率。这基于世界卫生组织瑞典北部急性卒中事件莫尼卡登记册。在此期间确定了88例首次发生的缺血性卒中患者。在第二部分中，对一所大学医院收治的107例年龄在18至44岁之间的连续缺血性卒中患者进行了为期5年的前瞻性研究，并根据标准化方案进行了广泛评估。根据改良的急性卒中治疗中ORG 10172试验（TOAST）标准，将患者分为缺血性卒中的八个亚型。
基于人群的缺血性卒中平均年发病率（每年每10万人中的病例数）为11.3（95%置信区间，6.7至16.1）。病死率为5.7%。根据改良的TOAST标准，36%的病例确定了缺血性卒中的可能病因，21%的病例病因不明。自发性颈内动脉夹层是主要的可能病因（13%）。卵圆孔未闭或房间隔瘤在28%的病例中是卒中的可能原因。归因于IgG抗心磷脂抗体（4.7%）、动脉粥样硬化血栓形成性血管病（3.7%）、口服避孕药使用（7%）和偏头痛（1%）的缺血性卒中百分比低于近期临床系列报道。
缺血性卒中的发病率高于西欧大多数国家先前报道的水平。较高的发病率并非由早发性动脉粥样硬化性血管病的较高患病率所解释。如果没有从先进心脏成像获得的额外诊断信息，不确定病例的比例将占患者的37%。
