Zhongguo cuzhong zazhi (Dec 2024)
残余代谢危险因素与青年卒中 Residual Metabolic Risk Factors and Stroke in Young Adults
Abstract
青年卒中一般指在18～50岁年龄段内发生的卒中，其发病率上升给我国带来了日益增加的社会经济负担。在探讨青年卒中的代谢危险因素时，除了传统的高血压、糖代谢异常、脂代谢异常和肥胖外，残余代谢危险因素亦不容忽视。本文重点关注了炎症、高同型半胱氨酸血症、高尿酸血症和肠道微生物群代谢产物这4种残余代谢危险因素对青年卒中的影响。炎症在青年卒中中的作用显著，与心源性脑栓塞这一重要病因的发生发展密切相关。高同型半胱氨酸血症通过影响血管内皮和凝血功能促进血栓形成，是有望预测卒中风险及预后的重要指标，其在青年卒中患者中的检出率较高。高尿酸血症通过氧化应激和炎症反应与多种血管危险因素和代谢综合征相关联，增加了青年卒中的风险。肠道微生物群通过肠-脑轴与青年卒中相互影响，其代谢产物如三甲胺N-氧化物和短链脂肪酸与卒中风险和预后相关。本文强调了深入研究残余代谢危险因素对青年卒中影响的重要性，并指出了未来研究的方向，包括按年龄分层的大规模前瞻性研究设计等。通过早期识别与控制这些代谢危险因素，可以为青年卒中的预防、治疗和预后判断提供参考依据，降低青年卒中的社会经济负担。 Abstract: The stroke in young adults is generally defined as a stroke occurring in the age range of 18 to 50 years. The increasing incidence rate of this condition has resulted in a significant socio-economic burden in China. In addition to the traditional metabolic risk factors for stroke in young adults, such as hypertension, abnormal glucose metabolism, abnormal lipid metabolism, and obesity, residual metabolic risk factors should not be overlooked. This article focuses on the influence of four residual metabolic risk factors on stroke in young adults: inflammation, hyperhomocysteinemia, hyperuricemia, and gut microbiota metabolites. Inflammation plays a significant role in young adult stroke and is closely related to the occurrence and development of cardiogenic cerebral embolism, an important cause in this age group. Hyperhomocysteinemia promotes thrombosis by affecting vascular endothelium and coagulation function, which is a promising indicator for predicting stroke risk and prognosis. The detection rate of hyperhomocysteinemia is high in young stroke patients. Hyperuricemia is associated with a number of vascular risk factors and metabolic syndrome through oxidative stress and inflammatory responses, increasing the risk of stroke in young adults. The gut microbiota interacts with stroke in young adults through the gut-brain axis, and its metabolites such as trimethylamine N-oxide and short-chain fatty acids are associated with stroke risk and prognosis. This article emphasizes the importance of further research into the effects of these residual metabolic risk factors on stroke in young adults and suggests directions for future research, including large-scale prospective studies designed by age stratification. Early identification and management of these metabolic risk factors can provide a reference for the prevention, treatment, and prognosis of stroke in young adults, thereby reducing the socio-economic burden of young adult stroke.
Keywords
