Clinical Features And Influencing Factors Of Recurrent Ischemic Stroke In Young And Middle-aged Patients

Objective:To retrospectively analyze the clinical data of young and middle-aged patients with ischemic stroke admitted to the Department of Neurology,Affiliated Hospital of Youjiang Medical College for Nationalities,to summarize the clinical characteristics of young and middle-aged patients with ischemic stroke,and explore the possible risk factors affecting their recurrence.Methods:A total of 464 young and middle-aged patients with ischemic stroke who met the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018 in the Department of Neurology,Affiliated Hospital of Youjiang Medical College for Nationalities from January 1,2020 to December 31,2021 were collected.The general data,laboratory data and imaging data of the patients were recorded as required.According to the diagnostic criteria of recurrent ischemic stroke,the two groups were divided into the initial group and the recurrent group.The age,gender,ethnicity,education level,history of hypertension,diabetes,coronary heart disease,smoking,drinking,body mass index,homocysteine,glycosylated hemoglobin,and blood lipid were compared between the two groups.Total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol and lipoprotein(a),creatinine,uric acid,cystatin C,neutrophil/high density lipoprotein cholesterol,monocyte/lymphocyte high density lipoprotein cholesterol,NIHSS score,TOAST classification,infarct size,degree of intracranial and extracranial large vessel stenosis,carotid plaque Differences between blocks.SPSS26.0 software was used to analyze the influencing factors of recurrence of ischemic stroke in young and middle-aged people by non-conditional Logistic regression model.Results:(1)A total of 464 young and middle-aged patients with ischemic stroke were enrolled,including 350 cases in the initial group and 114 cases in the recurrent group.(2)Young and middle-aged recurrent ischemic stroke is more common in 50-59 years old age group,male,and more hypertensive disease in the past.The clinical symptoms are mild,with multiple and lacunar infarction more common,mainly small vessel occlusion type,large artery atherosclerosis type,often occur carotid plaque and different degrees of intracranial and extracranial large vessel stenosis.(3)Among young and middle-aged patients with ischemic cerebral infarction,age,hypertension,course of hypertension,drinking history,carotid plaque,cystatin C,low-density lipoprotein cholesterol,lipoprotein(a),fibrinogen,monocyte count/high-density lipoprotein cholesterol in the recurrent group were higher than those in the initial group,and the differences were statistically significant(P<0.05);The level of HDL cholesterol in the recurrent group was lower than that in the primary group,and the difference was statistically significant(P<0.05);In the recurrence group,gender,ethnicity,education level,history of diabetes,history of coronary heart disease,smoking history,body mass index,systolic blood pressure,diastolic blood pressure,homocysteine,uric acid,creatinine,total cholesterol,triglyceride,neutrophil/high-density lipoprotein cholesterol,TOAST classification,NIHSS score,intracranial and extracranial large artery stenosis,infarct size and initial onset were compared Group comparison,the difference was not statistically significant(P>0.05).(4)In young and middle-aged patients with recurrent ischemic stroke,hba1c level was positively correlated with NIHSS score(r_s=0.208,P=0.026).Uric acid was negatively correlated with NIHSS score(r_s=-0.292,P=0.002).(5)Multivariate Logistic regression analysis showed that hypertension(OR 2.466,95%CI 1.058-5.746,P=0.037),carotid plaque(OR 2.538,95%CI 1.524-4.228,P<0.001),fibrinogen(OR 1.666,95%CI 1.272-2.184,P<0.001),LDL-C(OR 1.272,95%CI 1.017-1.589,P=0.035)were risk factors for recurrence of ischemic stroke in young and middle-aged patients(all P<0.05),HDL-C(OR 0.239,95%CI 0.090-0.588,P=0.002)was a protective factor for recurrence(P<0.05).Conclusions:(1)In young and middle-aged patients with ischemic stroke,hypertension,carotid atherosclerotic plaque,elevated serum low density lipoprotein cholesterol level and elevated fibrinogen level all increase the risk of recurrence.Attention should be paid to the control of risk factors to reduce recurrence.(2)The level of peripheral blood glycosylated hemoglobin reflects the severity of recurrent ischemic stroke in young and middle-aged patients.In clinical practice,attention should be paid to monitoring the blood glucose of patients and preventing them early.