Zhongguo cuzhong zazhi (Sep 2022)
青年烟雾病患者的卒中类型及危险因素分析 The Types and Risk Factors of Stroke in Young Patients with Moyamoya Disease
Abstract
目的 探索青年烟雾病患者的卒中类型及临床特征，分析青年烟雾病患者发生卒中的危险因素。 方法 回顾性纳入2020年1月-2021年12月解放军总医院第五医学中心收治的青年（18～45岁）卒中型烟雾病患者，将患者分为出血性卒中组和缺血性卒中组进行亚型分析，对比不同卒中类型患者的临床及影像学特征。并以同期未发生卒中的烟雾病患者作为对照组，应用多因素logistic回归分析青年烟雾病患者发生出血性或缺血性卒中的危险因素。 结果 共入组108例卒中型烟雾病患者，其中出血性卒中22例（20.4%），缺血性卒中86例（79.6%）。出血性卒中组中脑室出血12例（54.5%），脑实质出血7例（31.8%），蛛网膜下腔出血3例（13.6%）。缺血性卒中组中大动脉梗死型21例（24.4%），血流动力学梗死36例（41.9%），穿支动脉梗死29例（33.7%）。出血性卒中组与缺血性卒中组性别和合并动脉瘤者比例的差异有统计学意义。无卒中对照组共104例，多因素logistic回归分析结果显示，合并动脉瘤（OR 10.569，95%CI 1.524～73.274，P=0.017）为青年烟雾病患者发生出血性卒中的独立危险因素；增龄（OR 1.058，95%CI 1.004～1.115，P=0.034）、合并糖尿病（OR 4.005，95%CI 1.766～9.080，P=0.001）、高铃木分期（OR 1.363，95%CI 1.037～1.793，P=0.027）为青年烟雾病患者发生缺血性卒中的独立危险因素。 结论 青年烟雾病患者的卒中类型以缺血性卒中为主。血流动力学梗死和脑室出血分别是缺血性卒中和出血性卒中的主要类型。增龄、高铃木分期、合并糖尿病和颅内动脉瘤是引起青年烟雾病患者卒中的独立危险因素。 Abstract: Objective To explore the stroke types and clinical characteristics of in young patients with moyamoya disease, and to analyze the risk factors of stroke in young patients with moyamoya disease (MMD). Methods The clinical and imaging data of MMD with stroke patient (age 18 to 45 years old) between January 2020 and December 2021 who were admitted to the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. The MMD patients with stroke were divided into hemorrhagic stroke and ischemic stroke groups, imaging and clinical features of patients with different stroke types were compared. The MMD patients without stroke during the same period were selected as the control group, and multivariate logistic regression analysis was used to analyze the risk factors of hemorrhagic stroke and ischemic stroke in young MMD patients. Results A total of 108 patients with stroke were enrolled, including 22 cases (20.4%) of hemorrhagic stroke and 86 cases (79.6%) of ischemic stroke. A total of 104 subjects in control group were included. In hemorrhagic stroke group, there were 12 cases (54.5%) intraventricular hemorrhage, 7 cases (31.8%)of parenchymal hemorrhage, 3 cases (13.6%) of subarachnoid hemorrhage. In ischemic stroke group, there were 21 cases (24.4%) of larger artery infarction type, 36 cases (41.9%) of hemodynamic infarction type, and 29 cases (33.7%) of perforating artery infarction type. There were statistical differences in gender and the percentage of aneurysms between hemorrhage stroke group and ischemic stroke group. Multivariate logistic regression analysis showed that aneurysm was a risk factor for hemorrhagic stroke in young MMD patients (OR 10.569, 95%CI 1.524-73.274, P=0.017); age increasing (OR 1.058, 95%CI 1.004-1.115, P=0.034), Suzuki stage (OR 1.363, 95%CI 1.037-1.793, P=0.027) and diabetes mellitus (OR 4.005, 95%CI 1.766-9.080, P=0.001) were independent risk factors for ischemic stroke in young MMD patients. Conclusions The main type of stroke in young MMD patients is ischemic stroke. For MMD patients with stoke, hemodynamic infarction type was the main type of ischemic stroke, and ventricular hemorrhage was the main type of hemorrhagic stroke. Age, Suzuki stage, diabetes mellitus and intracranial aneurysm were independent risk factors for stroke in young MMD patients.
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