摘要
目的探讨不同出血部位和不同年龄阶段高血压性脑出血(HICH)发病危险因素之间的差异。方法连续收录2018年3月5日至2019年3月5日就诊于天津市环湖医院的HICH患者2212例,采用χ^(2)检验、t检验和F检验的方法比较不同出血部位以及不同年龄阶段(青年与中老年阶段)HICH危险因素的差异,采用Logistic回归分析筛选与青年HICH相关的变量。结果(1)本研究收集的HICH患者中男性(68.21%)多于女性,基底节出血最为常见(53.98%),青年患者占11.71%(259/2212)。不同出血部位HICH前三位的危险因素均为高血压病史>7年(81.28%)、男性(68.21%)和高脂血症(56.01%)。青年HICH好发部位为基底节(66.02%)和脑叶(17.76%)。(2)基底节出血和脑干出血中男性比例(70.85%、71.48%;χ^(2)=18.645,P=0.002)和吸烟率(38.61%、44.77%;χ^(2)=13.740,P=0.017)较其他部位HICH高;小脑出血和多部位脑出血中高血压病史>7年(87.83%、87.50%;χ^(2)=14.872,P=0.011)和糖尿病(33.91%、37.50%;χ^(2)=23.630,P<0.001)患病比例较其他部位HICH高。(3)与中老年HICH患者相比,青年HICH患者中男性比例更高(81.08%vs66.51%,χ^(2)=22.384,P<0.001)、高脂血症患病率更高(68.73%vs54.33%,χ^(2)=9.946,P=0.002),吸烟、酗酒、肥胖率更高(46.72%vs36.46%,χ^(2)=10.256,P=0.001;25.87%vs17.56%,χ^(2)=10.448,P=0.001;13.90%vs7.89%,χ^(2)=10.535,P=0.001)。而与青年HICH患者相比,中老年HICH患者中女性比例更高(33.49%vs18.92%,χ^(2)=22.384,P<0.001)、糖尿病患病率更高(27.50%vs16.60%,χ^(2)=14.028,P<0.001)。二元Logistic回归结果显示入院舒张压(OR=1.308,P<0.001)、高脂血症(OR=2.800,P=0.001)、吸烟(OR=2.332,P=0.008)、肥胖(OR=2.227,P=0.044)与青年HICH呈正相关。结论HICH最常见的危险因素是高血压病史>7年、男性和高脂血症。男性比例、吸烟率、高血压病史>7年和糖尿病患病率在不同部位HICH之间存在差异,男性比例和吸烟率在脑干和基底节出血中更常见;高血压病史>7年和糖尿病在小脑和多部位脑出血中更常见。不同年龄阶段之间HICH危险因素存在差异,舒张压增高、高脂血症、吸烟和肥胖是青年HICH的独立危险因素。
ObjectiveTo explore the differences in risk factors of hypertensive intracerebral hemorrhage(HICH)in different bleeding sites and different age stages.Methods2212 HICH patients were consecutive included in Tianjin Huanhu Hospital from March 5,2018 to March 5,2019.χ^(2)test,ttest,Ftest were used to compare the differences of risk factors for HICH in different bleeding sites and different age stages(young and middle-aged);Logistic regression was used to analyze the correlation between risk factors and young patients with HICH.Results(1)Among the HICH patients collected in this study,there were more males(68.21%).The most common site was basal ganglia(53.98%),and young patients accounted for 11.71%(259/2212).The top three risk factors for HICH at all bleeding sites were hypertension history>7 years(81.28%),being male(68.21%),and hyperlipidemia(56.01%).HICH in young people most commonly occurs in the basal ganglia(66.02%)and cerebral lobes(17.76%).(2)The proportion of men(70.85%,71.48%;χ^(2)=18.645,P=0.002)and smoking rate(38.61%,44.77%;χ^(2)=13.740,P=0.017)in basal ganglia hemorrhage and brainstem hemorrhage were higher than those in other bleeding sites;the incidence of hypertension>7 years(87.83%,87.50%;χ^(2)=14.872,P=0.011)and diabetes(33.91%,37.50%;χ^(2)=23.630,P<0.001)in cerebellar hemorrhage and multiple-site intracerebral hemorrhage was higher than HICH at other bleeding sites.(3)The proportion of men(81.08%vs66.51%,χ^(2)=22.384,P<0.001),hyperlipidemia(68.73%vs54.33%,χ^(2)=9.946,P=0.002),smoking(46.72%vs36.46%,χ^(2)=10.256,P=0.001),alcohol abuse(25.87%vs17.56%,χ^(2)=10.448,P=0.001),and obesity rate(13.90%vs7.89%,χ^(2)=10.535,P=0.001)in young patients with HICH was higher than those of middle-aged and elderly patients with HICH.The proportion of women(33.49%vs 18.92%,χ^(2)=22.384,P<0.001)and the prevalence of diabetes(27.50%vs16.60%,χ^(2)=14.028,P<0.001)in the elderly patients with HICH was higher.Binary logistic regression showed that there was a positive correlation between diastolic blood pressure at admission(OR=1.308,P<0.001),hyperlipidemia(OR=2.800,P=0.001),smoking(OR=2.332,P=0.008),obesity(OR=2.227,P=0.044),and young patients with HICH.ConclusionThe most common risk factors for HICH were hypertension,history>7 years,male,and hyperlipidemia.HICH-relevant variables such as male ratio,smoking rate,hypertension history>7 years,and diabetes varied in different bleeding sites.Male and smoking were more common in brain stem and basal ganglia hemorrhage.A history of hypertension for more than 7 years,as well as diabetes,were more common in the cerebellum,as is multiple-site cerebral hemorrhage.There were differences in the risk factors of HICH among young patients.Elevated diastolic blood pressure,hyperlipidemia,smoking,and obesity were independent factors for HICH in young people.
作者
赵希宇
凌菱
张超
卢珊
相蕾
岳伟
Zhao Xiyu;Ling Ling;Zhang Chao;Lu Shan;Xiang Lei;Yue Wei(Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300000,China;Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300000,China;Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases,Tianjin Neurosurgical Institute,Tianjin Huanhu Hospital,Tianjin 300350,China)
出处
《中华脑血管病杂志（电子版）》
2022年第3期165-171,共7页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
基金
天津市医学重点学科(专科)建设项目资助
关键词
高血压性脑出血
出血部位
青年
危险因素
Hypertensive intracerebral hemorrhage
Bleeding site
Youth
Risk factors
作者简介
通信作者:岳伟,Email:hhyuewei2008@163.com
