中老年腦梗塞與年輕人腦梗塞之流行病學與臨床表現之比較

Comparison of Epidemiology and Clinical Manifestations in Senile Stroke with Young Stroke

洪啟偉(Chi-Wei Hung) ； 邱偉嘉(Wei-Chia Chiu) ； 陳岑佩(Chin-Pei Chen) ； 蘇世斌(Shih-Bin Su) ； 王嘉聲(Chia-Sheng Wang)

《台灣家庭醫學雜誌》 22卷4期 (2012/12) Pp. 198-210

https://doi.org/10.7023/TJFM.201212.0198

摘要

Background: Stroke has become one of the three major causes of death in Taiwan in recent years. The rate of young stroke was 6.8% in northern Taiwan in 2000, and 5% to 15% in foreign countries. Recently, the prevalence of young stroke has increased dramatically according to the American Stroke Association. The incidence and etiology of young stroke were different in different ethnic groups and different years. We conducted this study to identify the risk factors for cerebral infarction in a young population in hope of providing a preventive strategy.Methods: In this retrospective study, we collected cases of stroke patients from January 1, 2009 to December 31, 2010 in the Chi-Mei hospital stroke registry. In total, 2,175 patients were included in our study, 4.18% of whom were between 18 and 45 years old. We collected data from the registry and medical records including type and location of stroke, history of hypertension, diabetes, cardiovascular disease, previous stroke, uremia, smoking/ alcohol consumption, time of onset and prognosis. Laboratory data including chest X-ray, electrocardiogram, blood pressure, blood glucose, lipid profiles, brain CT or MRI reports, and intracranial artery ultrasound or echocardiography were collected for the diagnosis and classification of stoke. According to the TOAST criteria, cerebral infarction was classified in five categories: (1) small-vessel occlusion, (2) large-artery atherosclerosis, (3) cardioembolism, (4) stroke of other determined etiology, and (5) stroke of undetermined etiology. We used the National Institute of Health Stroke Scale, Barthel Index and Modified Ranking Scale to determine the prognosis.Results: Overall, most strokes occurred between 6AM and 12PM. Females had a higher proportion of hypertension and diabetes and males had a higher proportion of smoking, alcohol consumption and a family history of ischemic stroke. Young ischemic stroke patients had less hypertension, diabetes, or a history of heart disease or ischemic stroke (p＜0.05); however, they did have more family histories of ischemic stroke (p＜0.05), smoking and alcohol consumption (p＜0.001). In terms of the type of ischemic stroke, there was less small-vessel occlusion and large-artery atherosclerosis in young ischemic stroke patients and more stroke of other determined etiology and stroke of undetermined etiology.Conclusions: We found that the prevalence of young ischemic stroke was relatively small; however, there were significant differences between young ischemic stroke patients and older ones. Further research in this population is necessary to identify more clearly the risk factors involved.

並列摘要

Background: Stroke has become one of the three major causes of death in Taiwan in recent years. The rate of young stroke was 6.8% in northern Taiwan in 2000, and 5% to 15% in foreign countries. Recently, the prevalence of young stroke has increased dramatically according to the American Stroke Association. The incidence and etiology of young stroke were different in different ethnic groups and different years. We conducted this study to identify the risk factors for cerebral infarction in a young population in hope of providing a preventive strategy.Methods: In this retrospective study, we collected cases of stroke patients from January 1, 2009 to December 31, 2010 in the Chi-Mei hospital stroke registry. In total, 2,175 patients were included in our study, 4.18% of whom were between 18 and 45 years old. We collected data from the registry and medical records including type and location of stroke, history of hypertension, diabetes, cardiovascular disease, previous stroke, uremia, smoking/ alcohol consumption, time of onset and prognosis. Laboratory data including chest X-ray, electrocardiogram, blood pressure, blood glucose, lipid profiles, brain CT or MRI reports, and intracranial artery ultrasound or echocardiography were collected for the diagnosis and classification of stoke. According to the TOAST criteria, cerebral infarction was classified in five categories: (1) small-vessel occlusion, (2) large-artery atherosclerosis, (3) cardioembolism, (4) stroke of other determined etiology, and (5) stroke of undetermined etiology. We used the National Institute of Health Stroke Scale, Barthel Index and Modified Ranking Scale to determine the prognosis.Results: Overall, most strokes occurred between 6AM and 12PM. Females had a higher proportion of hypertension and diabetes and males had a higher proportion of smoking, alcohol consumption and a family history of ischemic stroke. Young ischemic stroke patients had less hypertension, diabetes, or a history of heart disease or ischemic stroke (p＜0.05); however, they did have more family histories of ischemic stroke (p＜0.05), smoking and alcohol consumption (p＜0.001). In terms of the type of ischemic stroke, there was less small-vessel occlusion and large-artery atherosclerosis in young ischemic stroke patients and more stroke of other determined etiology and stroke of undetermined etiology.Conclusions: We found that the prevalence of young ischemic stroke was relatively small; however, there were significant differences between young ischemic stroke patients and older ones. Further research in this population is necessary to identify more clearly the risk factors involved.

並列關鍵字

cerebral infarction ； young stroke ； risk factor ； preventive medicine

參考文獻

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