中文摘要：

目的探讨青年缺血性卒中患者早期不良结局的相关因素。方法回顾性连续纳入2006年1月至2016年6月南京军区南京总医院神经内科住院的青年急性缺血性卒中（18-45岁）患者685例,均经头部CT或MRI确诊为首次发病。根据患者出院90 d随访时改良Rankin量表（mRS）,将其分为结局良好（mRS 0-2分）组（554例）和结局不良（mRS 3-6分）组（131例）。入院当天完善临床资料的收集,包括脑血管病危险因素（口服避孕药等）、入院时美国国立卫生研究院卒中量表（NIHSS）评分、住院后前3 d平均收缩压（以〉140 mmHg进行分析）及实验室检查等。卒中亚型采用急性卒中低分子肝素试验（TOAST）分型标准。采用单因素分析组间临床资料的差异,并对早期不良结局的危险因素进行多因素Logistic回归分析。结果与结局良好组比较,结局不良组住院后前3 d平均收缩压〉140 mmHg者的比率[37.4%（49/131）比21.7%（120/554）,χ^2=14.131]、入院时NIHSS评分[10.0（7.0,14.0）分比1.5（0,3.0）分,Z=-15.300]、白细胞计数[7.5（6.0,9.0）×10^-9/L比6.8（5.7,8.2）×10^-9/L,Z=-3.157]、空腹血糖[4.9（4.6,6.0）mmol/L比4.8（4.4,5.3）mmol/L,Z=-2.726]、纤维蛋白原水平[2.8（2.3,3.4）g/L比2.6（2.3,3.2）g/L,Z=-2.018]较高,血尿酸[291（220,346）mmol/L比315（261,374）mmol/L,Z=-3.443]和血浆白蛋白水平[43.1（40.0,45.9）g/L比44.8（42.4,47.4）g/L,Z=-4.708]降低,组间差异均有统计学意义（均P〈0.05）。TOAST分型比较,结局不良组心源性栓塞患者比例高于结局良好组,组间差异有统计学意义[6.9%（9/131）比2.5%（14/554）,χ^2=4.893,P〈0.05]。其余临床资料的组间差异均无统计学意义（均P〉0.05）。多因素Logistic回归分析结果显示,入院时NIHSS评分较高（OR=1.474,95%CI：1.378-1.576,P〈0.01）、入院后前3 d平均收缩压〉140 mmHg（OR=2.134,95%CI：1.210-3.764,P=0.009）、心源性栓塞（OR=4.902,95%CI：1.07

英文摘要：

Objective To investigate the related factors of early adverse outcomes in young patients with ischemic stroke.Methods From January 2006 to June 2016,685 young patients （18-45 years old） with acute ischemic stroke admitted to the Department of Neurology,Nanjing General Hospital of Nanjing Military Command were enrolled retrospectively.They were diagnosed as the first onset with head CT or MRI.According to the modified Rankin scale （mRS） at 90 d,the patients were divided into a favorable outcome （mRS 0-2） group （n=554） and a poor outcome （mRS 3-6） group （n=131）.The collection of clinical data were completed on the day of admission,including the risk factors for cerebrovascular disease （oral contraceptives,etc）,the National Institutes of Health stroke scale （NIHSS） score on admission,the mean systolic blood pressure （〉140 mmHg was analyzed） and laboratory examination.The stroke subtypes were classified with the trial of org 10172 in acute stroke treatment （TOAST） classification criteria.Univariate analysis was used to analyze the difference of clinical data between groups,and multivariate logistic regression analysis was used to analyze the risk factors for early poor outcomes.Results Compared with the favorable outcome group,the patients with the ratio of mean systolic pressure 〉140 mmHg in the first 3 d after hospitalization （37.4% [49/131] vs.21.7% [120/554],χ^2=14.131）,NIHSS score on admission （10.0 [7.0,14.0] vs.1.5 [0,3.0],Z=-15.300）,white blood cell count （7.5 [6.0,9.0] ×10^-9/L vs.6.8 [5.7,8.2]×10^-9/L,Z=-3.157）,fasting glucose （4.9 [4.6,6.0] mmol/L vs.4.8 [4.4,5.3] mmol/L,Z=-2.726）,higher fibrinogen level （2.8 [2.3,3.4] g/L vs.2.6 [2.3,3.2] g/L,Z=-2.018,blood uric acid level （291[220,346] mmol/L vs.315 [261,374] mmol/L,Z=-3.443）,and plasma albumin level （43.1[40.0,45.9] g/L vs.44.8 [42.4,47.4] g/L,Z=-4.708） were decreased in the poor outcome group.There were significant differences between the two groups （all P〈0.05）.TOAST classi