Günther G, Junker R, Sträter R, Schobess R, Kurnik K, Heller C, Kosch A, Nowak-Göttl U
Department of Paediatrics, University of Magdeburg, Magdeburg, Germany.
Stroke. 2000 Oct;31(10):2437-41. doi: 10.1161/01.str.31.10.2437.
The present multicenter case-control study was prospectively designed to assess the extent to which single and combined clotting factor abnormalities influence the onset of symptomatic ischemic stroke in full-term neonates.
Lipoprotein (Lp)(a); the factor V (FV) G1691A mutation; the prothrombin (PT) G20210A variant; the methylenetetrahydrofolate reductase (MTHFR) T677T genotype; antithrombin; protein C; protein S; and anticardiolipin antibodies (ACAs) were investigated in 91 consecutively recruited neonatal stroke patients and 182 age- and sex-matched healthy controls.
Sixty-two of 91 stroke patients (68.1%) had at least 1 prothrombotic risk factor compared with 44 control subjects (24.2%) (odds ratio [OR]/95% confidence interval [CI], 6.70/3.84 to 11.67). An increased Lp(a) level (>30 mg/dL) was found in 20 patients and 10 controls (OR/95% CI, 4.84/2. 16 to 10.86); FV G1691A was present in 17 patients and 10 controls (OR/95% CI, 3.95/1.72 to 9.0); the PT G20210A variant was detected in 4 patients and 4 controls (OR/95% CI, 2.04/0.49 to 8.3); the MTHFR TT677 genotype was found in 15 patients and 20 controls (OR/95% CI, 1.59/0.77 to 3.29); and protein C type I deficiency was found in 6 neonates. Neither antithrombin deficiency nor protein S deficiency was found in the neonatal patients studied. Acquired IgG ACAs were found in 3 cases. Additional triggering factors, ie, asphyxia, septicemia, maternal diabetes, and perinatally acquired renal venous thrombosis, were reported in 54.0% of patients.
Besides acquired triggering factors, the data presented here suggest that genetic prothrombotic risk factors play a role in symptomatic neonatal stroke.
本多中心病例对照研究进行前瞻性设计，旨在评估单一和合并凝血因子异常对足月儿症状性缺血性卒中发病的影响程度。
对91例连续招募的新生儿卒中患者和182例年龄及性别匹配的健康对照者，检测脂蛋白（Lp）（a）、凝血因子V（FV）G1691A突变、凝血酶原（PT）G20210A变异、亚甲基四氢叶酸还原酶（MTHFR）T677T基因型、抗凝血酶、蛋白C、蛋白S及抗心磷脂抗体（ACA）。
91例卒中患者中有62例（68.1%）至少有1种血栓形成危险因素，而对照组为44例（24.2%）（比值比[OR]/95%可信区间[CI]，6.70/3.84至11.67）。20例患者和10例对照者Lp（a）水平升高（>30mg/dL）（OR/95%CI，4.84/2.16至10.86）；17例患者和10例对照者存在FV G1691A（OR/95%CI，3.95/1.72至9.0）；4例患者和4例对照者检测到PT G20210A变异（OR/95%CI，2.04/0.49至8.3）；15例患者和20例对照者发现MTHFR TT677基因型（OR/95%CI，1.59/0.77至-3.29）；6例新生儿发现蛋白C I型缺乏。在所研究的新生儿患者中未发现抗凝血酶缺乏和蛋白S缺乏。3例患者发现获得性IgG ACA。54.0%的患者报告有其他触发因素，即窒息、败血症、母亲糖尿病和围生期获得性肾静脉血栓形成。
除获得性触发因素外，本文数据提示遗传性血栓形成危险因素在症状性新生儿卒中中起作用。
