Neurology：男性更常见狭窄性颈动脉斑块

　　欧洲学者的一项研究表明。相当一部分青年卒中患者伴有动脉粥样硬化颈动脉狭窄和闭塞。论文于2013年3月6日在线发表于《神经病学》（Neurology）。

　　此项研究共纳入2187例卒中或短暂脑缺血发作（TIA）患者，其中男性为1319例，年龄为18至44岁者为744例。1612例（73.7%）患者接受附加颅内动脉超声检查。依据性别和年龄组（青年18～44岁；中年44～55岁）对患者进行分层。

　　结果显示，在缺血性卒中患者中，颈动脉狭窄和闭塞的总体发病率为8.9%（青年组4.9%；中年组11.0%），其中81%为症状性。男性出现非狭窄性颈动脉斑块较女性更为常见（15.8%对7.7%，P < 0.001），并且中年组患者较青年组更为常见（17.9%对4.9%，P < 0.001）。幕上颅内动脉狭窄和闭塞总计为11.8%。在中年组患者中幕上狭窄发生率更高（13.0%对7.8%，P < 0.001），闭塞发生率则等同于青年组。

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Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients
OBJECTIVE
Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study.
METHODS
From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years).
RESULTS
In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant).
CONCLUSIONS
We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.