Risk Factors, Etiologic And Genetic Study Of148Cases Of Youth Cerebral Infarction In Anyang Area

Background:Cerebral infarction (CI) in young people increased gradually, and the disease incidence showed a younger trend in recent years. Young adults were the main labor force in the human society, once suffering from CI, they may result in long-term neurological dysfunction, and it would be a great burden to family and society. Patients with CI in different regions may have different distribution characteristics of risk factors and etiology, so it was improtant to study the characteristics of the risk factors and etiology of CI for taking effective measures of prevention and control for CI. However, there were no large-scale clinical trials for young patients with CI in Anyang region so far.Objective:To investigate the etiology and risk factors of youth cerebral infarction in Anyang area, and to provide evidence for clinical prevention and healthcare decision-making of ischemic stroke in the region.Method:148cases of inpatients (aged from18to45years) with first-ever acute CI, who were admitted to the Department of Neurology, the People’s Hospital of Anyang City, from December2011to August2013were selected in the study, they were separated into two groups:youth group I (aged from18to35years) and youth group Ⅱ (aged from36to45years).232cases of inpatients (older than45years) with first-ever acute CI in the same period were collected as control group. The etiologic patterns were classified using TOAST (Trial of Org10172in Acute Stroke Treatment) classification, the risk factors and distribution of stroke subtypes were compared and analyzed statistically between groups stratified by age.Results:1. In youth group I, the top three risk factors were hyperhomocysteinemia (HHcy)(66.7%), hyperlipemia (40.7%) and hypertension (33.3%). In youth group Ⅱ, the three most frequent risk factors were hyperlipemia (59.5%), HHcy (56.2%) and hypertension (47.1%). In the control group, the three most common risk factors were hyperlipemia (72.4%), HHcy (55.2%) and hypertension (48.7%).2. The frequencies of hypertension and diabetes in control group were observed to be lower than that in other two groups (p<0.05), and which was lower in youth group Ⅰ than in youth group Ⅱ (p<0.05). The exposure of heavy smoking was of no statistically differences between youth group Ⅱ and control group (p>0.05), significantly lower in youth group Ⅰ than that in other group (p<0.05).3. Stroke etiology can be determined in63.0%of patients in youth group Ⅰ, and the constituent ratio of large artery atherosclerosis (LAA), which was the most frequent subtype in stroke of determined etiology, was25.9%.73.5%of stroke etiology can be determined in youth group Ⅱ, mostly with LAA, the constituent ratio of which was50.4%. The proportion of LAA was of no statistically differences between youth group Ⅱ and control group (p>0.05), significantly higher than that in youth group Ⅰ (p<0.05), and the proportion of SUE was of no statistically differences between youth group Ⅰ and Ⅱ (p>0.05), significantly higher than that in control group (p<0.05).Conclusion:The main characteristics of youth CI in Anyang area are as follows:1. Among patients aged18to35years, the top three risk factors are HHcy, hyperlipidemia and hypertension. Among patients aged36to45years, the top three risk factors are hypertension, HHcy and hyperlipidemia.2. The incidence of HHcy in Anyang region is much higher than that previously reported in other region.3. Frequencies of hypertension, diabetes and cigarette smoking increase along with aging, rapidly after age of36years.4. The most common etiology of youth CI was LAA. Background:The onset of cerebral infarction involved in both environmental and genetic factors, effects of polymorphisms in the related genes had become a new research hotspot. Compared to older people, the etiology of youth cerebral infarction was more complicated, but the report was fewer. The first part of this topic research showed that hyperhomocysteinemia and hyperlipidemia were common in Anyang region, so this part selective analysised the methylenetetrahydrofolate reductase (MTHFR) and lipoprotein lipase (LPL) gene polymorphisms.Objective:To study the association of MTHFR and LPL gene polymorphisms with atherosclerotic thrombotic cerebral infarction (ATCI), and to examine the impact of polymorphisms in the levels of serum homocysteine (Hcy) and blood fats among the youth population in Anyang area.Method:A case-control study was performed on80young adults who were admitted to the People’s Hospital of Anyang City, from March2012to August2013,50cases of inpatients with ATCI (aged from18to45years) were enrolled into the case group and30cases of matched healthy people as the control group. High-throughput sequencing was used for the genotyping of MTHFR G1793A and LPL Ser447Ter, and the serum folate (Fol), vitamin B12(VitB12), Hcy and blood fats concentrations were assayed by automatic analyzers. Comparison was performed between case group and control group in the levels of serum biochemical indices, frequency of genotypes and alleles, the differences in the levels of serum biochemical indices among different genotypes were compared by chi-square test. Results:1.There were significantly higher levels of serum Hcy in the case group than that in the control group (p<0.05), and no differences in serum Fol and vitamin B12levels were found between the two groups (p>0.05).2. There were no heterogeneity in the SNP haplotypes and allele frequencies of the LPL gene at position rs328between two groups (p>0.05), and no significant differences were observed in AA genotype and A allele distributions of MTHFR gene at position1793between two groups (p>0.05).3. Significantly higher serum Hcy levels were observed in MTHFR1793AA homozygote carriers than non-carriers in the case group and control group (p<0.05).4. It was also found that carriers of the LPL mutation have a lower serum TG concentration and a higher serum HDL-C level than non-carriers in both groups (p<0.05).Conclusion:1. The polymorphism of MTHFR gene G1793A is correlated with the levels of Hcy, and the homozygous mutation of MTHFR gene may be result in an increase in the serum Hcy concentration.2. The genovariation of LPL Ser447Ter may be associated with the elevated serum HDL-C and the reduced serum TG levels.3.The mutation frequency of MTHFR gene G1793A in Anyang area is much higher than that previously reported in other region.4. Elevated serum Hcy levels are closely associated with ATCI in young adults, but the polymorphism of MTHFR gene G1793A and LPL gene Ser447Ter may be not correlated with the susceptibility of ATCI in young adults.