青年脑出血患者的临床特点及发病危险因素分析(3)
对青年患者而言,有效预防比发病后有效治疗更为重要,更能有效减轻卒中的疾病负担[12]。但急性脑卒中的有效预防进展缓慢,其中一个重要原因在于对于脑卒中的高危因素未完全掌握[13]。我们的研究结果表明,单因素分析结果显示,青年人群脑出血的发生与糖尿病史、心脏病史、吸烟史、口服抗凝药史相关(P<0.05)。但与缺血性卒中、高脂血症史、肝硬化史、慢性肾脏病史、出血部位、血压等无关(P>0.05)。将上述单因素分析中有意义的指标应用Logstic回归模型进行多因素分析,结果发现心脏病史、吸烟史、口服抗凝药史是影响青年患者发生脑出血的独立性危险因素(P<0.05)。吸烟患者的发病风险远远大于饮酒者,有研究表明吸烟量与脑卒中发生风险之间存在剂量反应关系[14]。这可能与烟草中有毒有害物质、致癌物质对血管壁日积月累的伤害有关[15]。对于有心脏疾患、需长期口服抗凝药的青年人,应积极告知脑卒中相关的危险因素,改善生活习惯,积极预防[16]。
综上所述,青年人群脑出血在临床已不是少见病,高血压合并动脉硬化仍然是最主要病因。心脏病史、吸烟史、口服抗凝药史是影响青年患者发生脑出血的最主要危险因素。对存在相关高危因素的人群,应加强脑出血风险知识的教育,有效预防。
, 百拇医药
参考文献:
[1]Li G,Zhang L,Ming Y,et al.Identification of novel biomarker and therapeutic target candidates for acute intracerebral hemorrhage by quantitative plasma proteomics[J].Clinical Proteomics,2017,14(1):14.
[2]吕春燕.急救护理对急性脑出血患者疗效及预后质量的影响[J].实用临床医药杂志,2016,20(8):127-128.
[3]陈国芳,李夫民,朱军,等.初步探讨急性脑出血死亡的危险因素[J].中华临床医师杂志:电子版,2016(1):46-50.
[4]李萍,赵树明,胡亚男,等.脑出血发病机制研究进展[J].中华老年心脑血管病杂志,2015,17(2):214-215.
, 百拇医药
[5]Tsivgoulis G,Zand R,Katsanos A H,et al.Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden:A Meta-analysis[J].Jama Neurology,2016,73(6):675.
[6]吕昕,王秋茹,宋新涛,等.青年脑出血97例临床分析[J].临床医药实践,2016,25(8):630-632.
[7]Carcel C,Sato S,Zheng D,et al.Prognostic Significance of Hyponatremia in Acute Intracerebral Hemorrhage:Pooled Analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies[J].Critical Care Medicine,2016,44(7):1388.
, http://www.100md.com
[8]林文.青年脑出血108例临床分析[J].实用医院临床杂志, 2016,13(1):50-52.
[9]Rao N M,Levine S R,Gornbein J A,et al.Defining clinically relevant cerebral hemorrhage after thrombolytic therapy for stroke:analysis of the National Institute of Neurological Disorders and Stroke tissue-type plasminogen activator trials[J]. Stroke,2015,46(2):e45.
[10]Yang Q,Zhuang X,Peng F,et al.Relationship of plasma matrix metalloproteinase-9 and hematoma expansion in acute hypertensive cerebral hemorrhage[J].International Journal of Neuroscience,2016,126(3):213.
, http://www.100md.com
[11]Krishnan K,Scutt P,Woodhouse L,et al.Glyceryl Trinitrate for Acute Intracerebral Hemorrhage:Results From the Efficacy of Nitric Oxide in Stroke(ENOS)Trial,a Subgroup Analysis[J]. Stroke,2016,47(1):44.
[12]Chan E,Anderson C S,Wang X,et al.Early Blood Pressure Lowering Does Not Reduce Growth of Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage:Results of the INTERACT Studies[J].Cerebrovascular Diseases Extra,2016,6(3):71-75.
, http://www.100md.com
[13]Murai Y,Ikeda Y,Morita A.Letter by Murai et al Regarding Article,"Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging"[J].Stroke,2016,47(5):e48.
[14]Zeng L,Guo J,Wang J,et al.Clinical re-evaluation of removing blood stasis therapy in treating acute intracerebral hemorrhage safety and efficacy:a protocol for a randomized,controlled, multicenter study(CRRICH Trial)[J].Springerplus,2016,5(1):1466.
, 百拇医药
[15]Pan W,Yan Q,Qin M,et al.Detection of cerebral hemorrhage in rabbits by time-difference magnetic inductive phase shift spectroscopy[J].Plos One,2015,10(5):e0128127.
[16]Liu H,Wang Y,Xiao Y,et al.Hydrogen Sulfide Attenuates Tissue Plasminogen Activator-Induced Cerebral Hemorrhage Following Experimental Stroke[J].Translational Stroke Research,2016,7(3):209-219.
收稿日期:2017-9-11;修回日期:2017-10-11
編辑/李桦, 百拇医药(孙志 邢效如 揣兰香 赵新春 郝亚楠)
综上所述,青年人群脑出血在临床已不是少见病,高血压合并动脉硬化仍然是最主要病因。心脏病史、吸烟史、口服抗凝药史是影响青年患者发生脑出血的最主要危险因素。对存在相关高危因素的人群,应加强脑出血风险知识的教育,有效预防。
, 百拇医药
参考文献:
[1]Li G,Zhang L,Ming Y,et al.Identification of novel biomarker and therapeutic target candidates for acute intracerebral hemorrhage by quantitative plasma proteomics[J].Clinical Proteomics,2017,14(1):14.
[2]吕春燕.急救护理对急性脑出血患者疗效及预后质量的影响[J].实用临床医药杂志,2016,20(8):127-128.
[3]陈国芳,李夫民,朱军,等.初步探讨急性脑出血死亡的危险因素[J].中华临床医师杂志:电子版,2016(1):46-50.
[4]李萍,赵树明,胡亚男,等.脑出血发病机制研究进展[J].中华老年心脑血管病杂志,2015,17(2):214-215.
, 百拇医药
[5]Tsivgoulis G,Zand R,Katsanos A H,et al.Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden:A Meta-analysis[J].Jama Neurology,2016,73(6):675.
[6]吕昕,王秋茹,宋新涛,等.青年脑出血97例临床分析[J].临床医药实践,2016,25(8):630-632.
[7]Carcel C,Sato S,Zheng D,et al.Prognostic Significance of Hyponatremia in Acute Intracerebral Hemorrhage:Pooled Analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies[J].Critical Care Medicine,2016,44(7):1388.
, http://www.100md.com
[8]林文.青年脑出血108例临床分析[J].实用医院临床杂志, 2016,13(1):50-52.
[9]Rao N M,Levine S R,Gornbein J A,et al.Defining clinically relevant cerebral hemorrhage after thrombolytic therapy for stroke:analysis of the National Institute of Neurological Disorders and Stroke tissue-type plasminogen activator trials[J]. Stroke,2015,46(2):e45.
[10]Yang Q,Zhuang X,Peng F,et al.Relationship of plasma matrix metalloproteinase-9 and hematoma expansion in acute hypertensive cerebral hemorrhage[J].International Journal of Neuroscience,2016,126(3):213.
, http://www.100md.com
[11]Krishnan K,Scutt P,Woodhouse L,et al.Glyceryl Trinitrate for Acute Intracerebral Hemorrhage:Results From the Efficacy of Nitric Oxide in Stroke(ENOS)Trial,a Subgroup Analysis[J]. Stroke,2016,47(1):44.
[12]Chan E,Anderson C S,Wang X,et al.Early Blood Pressure Lowering Does Not Reduce Growth of Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage:Results of the INTERACT Studies[J].Cerebrovascular Diseases Extra,2016,6(3):71-75.
, http://www.100md.com
[13]Murai Y,Ikeda Y,Morita A.Letter by Murai et al Regarding Article,"Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging"[J].Stroke,2016,47(5):e48.
[14]Zeng L,Guo J,Wang J,et al.Clinical re-evaluation of removing blood stasis therapy in treating acute intracerebral hemorrhage safety and efficacy:a protocol for a randomized,controlled, multicenter study(CRRICH Trial)[J].Springerplus,2016,5(1):1466.
, 百拇医药
[15]Pan W,Yan Q,Qin M,et al.Detection of cerebral hemorrhage in rabbits by time-difference magnetic inductive phase shift spectroscopy[J].Plos One,2015,10(5):e0128127.
[16]Liu H,Wang Y,Xiao Y,et al.Hydrogen Sulfide Attenuates Tissue Plasminogen Activator-Induced Cerebral Hemorrhage Following Experimental Stroke[J].Translational Stroke Research,2016,7(3):209-219.
收稿日期:2017-9-11;修回日期:2017-10-11
編辑/李桦, 百拇医药(孙志 邢效如 揣兰香 赵新春 郝亚楠)