You R X, McNeil J J, O'Malley H M, Davis S M, Thrift A G, Donnan G A
Department of Neurology, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Vic., Australia.
Stroke. 1997 Oct;28(10):1913-8. doi: 10.1161/01.str.28.10.1913.
Stroke in the young is particularly tragic because of the potential for a lifetime of disablement. More than 10% of patients with stroke due to cerebral infarction are aged 55 years or younger. While a number of studies have addressed the issue of stroke mechanism in the young, quantitation of risk factors has rarely been undertaken. Given the importance of risk factor assessment in primary prevention, we aimed to assess this using case-control methodology in a hospital-based series and community-based control subjects.
A total of 201 consecutive patients with first-onset stroke due to cerebral infarction aged 15 to 55 years (mean, 45.5 years) were accrued from four teaching hospitals during 1985 to 1992 and compared with their age- and sex-matched neighborhood controls. Information concerning potential risk factor exposure status was collected by structured questionnaire at interview. Stroke risks were estimated by calculating the odds ratios with multivariate logistic regression.
Significantly increased risk of stroke was found among those with diabetes (odds ratio, 11.6 [95% confidence intervals, 1.2 to 115.2]), hypertension (6.8 [3.3 to 13.9]), heart disease (2.7 [1.1 to 6.4]), current cigarette smoking (2.5 [1.3, 5.0]), and long-term heavy alcohol consumption (> or = 60 g/d) (15.3 [1.0 to 232.0]). However, heavy alcohol ingestion (> or = 60 g) within 24 hours preceding stroke onset was not a risk factor (0.9 [0.3 to 3.4]).
Diabetes, hypertension, heart disease, current smoking, and long-term heavy alcohol consumption are major risk factors for stroke in young adults. Given that the majority of these factors are either correctable or modifiable, prevention strategies may have the potential to reduce the impact of stroke in this age group.
青年卒中尤其悲惨，因为患者有可能终身残疾。超过10%的脑梗死性卒中患者年龄在55岁及以下。虽然有多项研究探讨了青年卒中的发病机制问题，但很少对危险因素进行量化。鉴于危险因素评估在一级预防中的重要性，我们旨在采用病例对照方法，对一组以医院为基础的病例和以社区为基础的对照对象进行评估。
1985年至1992年期间，从四家教学医院收集了201例年龄在15至55岁（平均45.5岁）的首次发生脑梗死性卒中的连续患者，并与年龄和性别匹配的社区对照对象进行比较。通过结构化问卷在访谈时收集有关潜在危险因素暴露状况的信息。通过多变量逻辑回归计算比值比来估计卒中风险。
发现糖尿病患者（比值比，11.6[95%置信区间，1.2至115.2]）、高血压患者（6.8[3.3至13.9]）、心脏病患者（2.7[1.1至6.4]）、当前吸烟者（2.5[1.3，5.0]）和长期大量饮酒者（≥60克/天）（15.3[1.0至232.0]）发生卒中的风险显著增加。然而，卒中发作前24小时内大量饮酒（≥60克）不是危险因素（0.9[0.3至3.4]）。
糖尿病、高血压、心脏病、当前吸烟和长期大量饮酒是青年成人卒中的主要危险因素。鉴于这些因素中的大多数是可纠正或可改变的，预防策略可能有潜力降低该年龄组卒中的影响。
